Shortening of the cervix at 16 weeks of pregnancy. Short cervix: minor pathology or death sentence

For every pregnant woman, the greatest danger is associated with premature birth or miscarriage.

Undoubtedly, such a problem is very difficult to survive, both from a psychological and physiological point of view.

The essence of the pathology and possible consequences

According to gynecologists, a short cervix becomes a serious stumbling block on the path to pregnancy. In some cases, the pregnancy can be maintained, but the woman cannot give birth on her own.

From a physiological point of view, the isthmus and cervix represent the first section of the birth canal.

The shape of the cervix resembles a truncated cone or cylinder, which is formed by muscles (30%) and connective tissue (70%). It is the muscular part of the cervix that is located near the uterus and is a muscle ring or sphincter. The main function of this ring is to prevent the uterus from dilating before childbirth.

During labor, the muscle ring opens, which becomes a signal for the beginning of the last stage of labor.

Cervix without pathologies has a length of 40 mm. During pregnancy, this indicator decreases somewhat, the internal os expands - this is how the body prepares for childbirth.

Due to various circumstances, the process of shortening the cervix can begin in the first half of pregnancy. In this case, doctors diagnose isthmic-cervical insufficiency(ICN).

As a result of premature reduction of the cervix, the muscle ring softens, which can lead to the opening of the first section of the birth canal and result in premature birth. A diagnosis of isthmic-cervical insufficiency made in the first and second trimesters significantly increases the risk of miscarriage.

It is important to note that the cervix, the length of which does not meet the norm, is not capable of performing one of the main tasks - protecting the fetus from infections. Thus, the child is defenseless against microorganisms.

Causes of isthmic-cervical insufficiency and diagnosis

The pathology is both congenital and acquired.

Congenital pathology, as a rule, is associated with the physiological characteristics of the structure of the body or genetic heredity.

Such a pathology can be discovered by a gynecologist during an examination, during which a specialist will assess the size of the cervix and its condition. An ultrasound examination of the pelvic organs can also be used.

Ultrasound is performed using two methods:

1. transabdominal– through the abdominal cavity;
2. transvaginal– through the vagina using a special sensor.

The diagnosis of “isthmic-cervical insufficiency” can be made if the diameter of the internal os is less than 1 cm and the length of the cervix is ​​less than 2 cm.

In this situation, pregnancy will not be easy and will be under the constant supervision of a specialist. The expectant mother needs to regularly monitor her own well-being, eliminate any physical activity and, if possible, remain as quiet as possible for nine months.

However, the pathology may be acquired. In this case, the process of shortening the cervix may begin before pregnancy. What can provoke pathology?

You can name other factors that result in shortening of the cervix. All of them are associated with its injury or expansion.

Any mechanical impact on the cervix can cause its deformation and the appearance of scars on its walls. The consequences are quite serious: the cervix loses its elasticity and becomes shorter.

In addition, experts identify another reason for the shortening of the cervix, which is easily explained from a physiological point of view.

From approximately the tenth week of pregnancy, the child begins to independently synthesize the androgen hormone, necessary for successful labor. If the amount of androgen in the body of the expectant mother exceeds the permissible norm, a natural process of preparation for childbirth occurs: the cervix shortens, the internal os opens and the risk of premature birth increases.

How to avoid the occurrence of pathology?

When a pathology is detected, the doctor must prescribe a series of studies to understand the cause of its development.

First of all, it is important to donate blood for hormones. If the cause of the shortening of the cervix is ​​a hormonal imbalance, then it is quite possible that the danger can be eliminated with the help of hormonal therapy.

If studies have shown an insignificant degree of changes in the cervix, the doctor can use a conservative method of therapy: intravenous drip administration of Magnesia or Ginipral, which eliminates the tone of the uterus.

A woman with this diagnosis needs complete rest and bed rest, and a bandage is a must. If, while following these recommendations, the pathology progresses, a special device is installed on the cervix - an obstetric pessary, which supports the uterus in its natural position and reduces the pressure of the fetus on the cervix.

In critical situations, when the length of the neck less than 20 mm, and the internal os has opened more than 10 mm, cervical correction is performed surgical method– cervical cerclage is applied. The procedure is possible for up to 27 weeks, under ultrasound control, in a hospital, using anesthesia.

The cervical cerclage is removed during contractions, when the water breaks or when labor bleeding begins. If childbirth does not take place before 38 weeks, the sutures are removed as planned.

It is important to understand that a shortened cervix is ​​not a death sentence for motherhood. The problem can and must be dealt with and follow all the doctor’s recommendations.

A pregnant woman in our time should calmly perceive news about pathologies and abnormalities of bearing a child. Firstly, modern medicine has enormous capabilities and treatment methods, and secondly, excessive nervousness can only harm the condition of the woman and the fetus. So, let's talk about shortening the cervix during pregnancy. Why it occurs, what it threatens and what doctors usually do in such a situation.

Cervix and pregnancy

When doctors talk about pregnancy, with the diagnosis confirmed by research results, this may be a symptom of isthmic-cervical insufficiency (ICI). This, in turn, is the cause of self-abortions and premature births. The diagnosis of “isthmic-cervical insufficiency” means that the cervix and isthmus cannot cope with the ever-increasing pressure load of the fetus and. This phenomenon leads to premature dilatation of the cervix. Let us remember that the cervix and isthmus are part of a woman’s birth canal. Sometimes the neck is naturally short. And often shortening of a woman’s cervix occurs as a result of various types of intrauterine interventions associated with its dilation. This could be abortion, previous childbirth with trauma to the muscle ring of the cervix. Scars appear at the site of the injury, the ability of the muscles to stretch and contract is impaired, and the neck shortens.

Why does the cervix shorten during pregnancy?

Shortening of the cervix during pregnancy can be caused by hormonal imbalances. As a rule, this occurs between 11 and 27 weeks of pregnancy, and most often from the 16th week. At this time, the child develops adrenal activity. They secrete androgens - hormones that provoke the development of shortening of the cervix. Under their influence, the cervix softens, shortens and opens. The pregnant woman herself may not be aware that she is developing ICI. After all, the tone of the uterus may be normal.

Typically, ICI is diagnosed by a doctor during an examination of a woman in a gynecological chair. The diagnosis is confirmed using vaginal ultrasound. When the length of the cervix is ​​less than 2 cm, and the diameter of the internal os is more than 1 cm, then signs of ICI can be stated.

If the cervix shortens during pregnancy, this is a reason for close monitoring by a gynecologist. When this problem is caused by excess androgens, treatment with the drug dexamethasone is usually prescribed. Also used for treatment are drugs that relax the smooth muscles of the uterus, sedatives, and vitamins. Usually, after several weeks of such therapy, the condition of the cervix stabilizes. Otherwise, surgical correction is performed. This means that stitches are placed in the neck. As a rule, this procedure is done before 28 weeks of pregnancy. Another option for correcting the problem is an obstetric pessary, that is, a special device that holds the uterus in the correct position and reduces the pressure of fetal fluid on the cervix. This treatment option is acceptable after 28 weeks of pregnancy.

Why is a short cervix dangerous during childbirth?

If shortening of the cervix occurs immediately before childbirth, then this is considered a normal preparatory process. At the same time, a short cervix during childbirth can become a factor in the onset. They, in turn, are fraught with ruptures of the cervix and vagina.

Medical statistics suggest that shortening of the cervix during pregnancy may be the norm for women who are not having their first birth.

In order to avoid the negative impact of cervical shortening on childbirth, a pregnant woman must constantly and strictly follow the doctor’s prescriptions, undergo medical examinations on time and visit the gynecologist within the specified time frame.

Especially for Elena TOLOCHIK

No woman wants her pregnancy to be overshadowed by the occurrence of any complications, especially the threat of termination of pregnancy or premature birth. But, unfortunately, this happens, and many different reasons can contribute to this. One of these reasons may be a short cervix.

Why is a short cervix dangerous?

- This is the lower, narrowed, rounded part of the uterus that connects to the vagina. Normally, its length is about one third of the total length of the uterus, approximately 3 to 4 cm. But in some cases it can be short, reaching only 2 or even less centimeters.

A short cervix can cause the development of so-called isthmic-cervical insufficiency (ICI). This condition is characterized by the physiological inability of the cervix to hold the constantly growing fetus in the cavity. Under pressure from the baby, the cervix begins to shorten and open even more, which can lead to miscarriage or premature birth.

Information A deformed and shortened cervix not only cannot hold the baby in the cavity, but is also unable to protect him from infections. And during childbirth, it can cause rapid progress, and as a result, cause ruptures of the perineum and vagina.

Causes

1. , a short cervix may be a congenital, genetically determined feature of the anatomical structure of the genital organs;
2. , it can be shortened against the background of hormonal changes occurring in the body during pregnancy (this becomes especially noticeable in the second trimester of pregnancy);
3. , deformation and shortening of the cervix are facilitated by previously performed abortions, curettage of the uterine cavity and childbirth.

Examination and diagnosis

An obstetrician-gynecologist may suspect that the cervix is ​​shortened already during the first vaginal examination of a woman. But usually such a diagnosis is made after a transvaginal ultrasound examination or during a second planned ultrasound examination at 18-22 weeks of pregnancy.

What to do if the cervix turns out to be short during pregnancy?

Additionally If you knew about this problem from the very beginning, that is, you have a congenital feature or this has already happened in previous pregnancies, then the most correct solution would be constant monitoring by a specialist, maintaining peace and caring attitude towards yourself.

It is recommended to ensure that the uterus is not in good shape during pregnancy, as this provokes ripening of the cervix, its shortening and opening. It is best to limit physical activity and resort to wearing a bandage.

If shortening of the cervix is ​​detected during pregnancy, that is, the cause is hormonal disorders, then depending on the gestational age and whether there is an opening, the woman is offered corrective treatment for this condition.

Actually, there are two treatment methods: - sutures (applied up to 27 weeks) and - use of an obstetric pessary (when there is no significant shortening, but there is a threat of developing ICI).

One of the most common mistakes women make is fear of these procedures, unwillingness to play it safe and mistrust of the doctor. If you have any doubts and want to visit another specialist, then it is better to do so. But remember that treatment for a shortened cervix is ​​not just reinsurance - it is a necessity that will eliminate the threat of premature birth and help you carry and give birth to a healthy baby on time.

Short cervix during pregnancy

Causes, prevention and treatment of short cervix during pregnancy

A short cervix during pregnancy is a fairly common pathology. It is dangerous because it can cause miscarriage or premature birth, since the cervix is ​​not able to hold the baby inside the uterus, it opens under his weight. But if a woman regularly visits a gynecologist and undergoes ultrasound examinations, the doctor will definitely notice this cervical pathology and take measures to prolong pregnancy.

Why the cervix opens prematurely and diagnosis of pathology

This pathology is medically called isthmic-cervical insufficiency (ICI). Its signs: premature shortening, softening and dilatation of the cervix. These signs are most often diagnosed at 15-20 weeks, when rapid weight gain in the fetus begins and the cervix experiences heavy loads during pregnancy. A doctor can notice abnormalities during a gynecological examination, as well as during an ultrasound. The expectant mother herself may notice heavy watery or bloody discharge. But in most cases there are no symptoms.

There are many reasons for this pathology. These include various injuries resulting from cervical ruptures during childbirth, during medical abortion, during conization, application of obstetric forceps, etc. The situation is aggravated by multiple pregnancies, polyhydramnios, and a large fetus.

ICI can also be congenital and caused by hormonal disorders, due to which the length of the cervix during pregnancy begins to decrease long before the date of birth.

All women with cervical injuries, as well as with a poor medical history (miscarriages in the second trimester of pregnancy) are under especially careful medical supervision.

Methods of prevention and treatment

Early prevention includes reliable contraception, which will help avoid abortions. In second place is a regular, at least once a year, visit to the gynecologist. Preventive medical examinations will help to identify cervical pathology in time and treat it conservatively. And finally, planning a pregnancy. This is especially true for those women who have had pregnancies in the past with an unfavorable outcome, and the loss of pregnancy occurred at a longer period.

If a short cervix is ​​detected during pregnancy, treatment is prescribed depending on whether there is dilation, as well as directly on the gestational age. Let us remind you that a short one is less than 2.5-3 cm. Actually, there are 2 treatment methods: suturing and an obstetric ring pessary. Sutures are placed before 27 weeks, and the sooner, the more effective the measure will be. Stitches will help even if the cervix is ​​slightly open. Meanwhile, as a conservative method - a ring, it is put on rather for prophylactic purposes, when there is no significant shortening, but the doctor suspects ICI in the patient.

Sutures are removed if the amniotic fluid has broken, labor or bleeding has begun. If everything is in order, then the stitches are routinely removed at 38 weeks. If a caesarean section is planned, in most cases the stitches will not be removed at all.

Know that isthmic-cervical insufficiency is not a death sentence if you take timely measures to prevent further dilatation of the cervix and follow the doctor’s recommendations.

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Shortening of the cervix during pregnancy

A pregnant woman in our time should calmly perceive news about pathologies and abnormalities of bearing a child. Firstly, modern medicine has enormous capabilities and treatment methods, and secondly, excessive nervousness can only harm the condition of the woman and the fetus. So, let's talk about shortening the cervix during pregnancy. Why it occurs, what it threatens and what doctors usually do in such a situation.

Cervix and pregnancy

When doctors talk about a short cervix during pregnancy, with the diagnosis confirmed by research results, this may be a symptom of isthmic-cervical insufficiency (ICI). This, in turn, is the cause of self-abortions and premature births. The diagnosis of “isthmic-cervical insufficiency” means that the cervix and isthmus cannot cope with the constantly increasing load of fetal pressure and amniotic fluid. This phenomenon leads to premature dilatation of the cervix. Let us remember that the cervix and isthmus are part of a woman’s birth canal. Sometimes the neck is naturally short. And often shortening of a woman’s cervix occurs as a result of various types of intrauterine interventions associated with its dilation. This could be abortion, curettage, previous childbirth with trauma to the muscle ring of the cervix. Scars appear at the site of the injury, the ability of the muscles to stretch and contract is impaired, and the neck shortens.

Read also Dilatation of the cervix

Why does the cervix shorten during pregnancy?

Shortening of the cervix during pregnancy can be caused by hormonal imbalances. As a rule, this occurs between 11 and 27 weeks of pregnancy, and most often from the 16th week. At this time, the child develops adrenal activity. They secrete androgens - hormones that provoke the development of shortening of the cervix. Under their influence, the cervix softens, shortens and opens. The pregnant woman herself may not be aware that she is developing ICI. After all, the tone of the uterus may be normal.

Typically, ICI is diagnosed by a doctor during an examination of a woman in a gynecological chair. The diagnosis is confirmed using vaginal ultrasound. When the length of the cervix is ​​less than 2 cm, and the diameter of the internal os is more than 1 cm, then signs of ICI can be stated.

If the cervix shortens during pregnancy, this is a reason for close monitoring by a gynecologist. When this problem is caused by excess androgens, treatment with the drug dexamethasone is usually prescribed. Also used for treatment are drugs that relax the smooth muscles of the uterus, sedatives, and vitamins. Usually, after several weeks of such therapy, the condition of the cervix stabilizes. Otherwise, surgical correction is performed. This means that stitches are placed in the neck. As a rule, this procedure is done before 28 weeks of pregnancy. Another option for correcting the problem is an obstetric pessary, that is, a special device that holds the uterus in the correct position and reduces the pressure of fetal fluid on the cervix. This treatment option is acceptable after 28 weeks of pregnancy.

Why is a short cervix dangerous during childbirth?

If shortening of the cervix occurs immediately before childbirth, then this is considered a normal preparatory process. At the same time, a short cervix during childbirth can become a factor in the onset of rapid labor. They, in turn, are fraught with ruptures of the cervix and vagina.

Medical statistics suggest that shortening of the cervix during pregnancy may be the norm for women who are not having their first birth.

In order to avoid the negative impact of cervical shortening on childbirth, a pregnant woman must constantly and strictly follow the doctor’s prescriptions, undergo medical examinations on time and visit the gynecologist within the specified time frame.

Especially for beremennost.net Elena TOLOCHIK

Short cervix: causes of pathology and its elimination

The greatest danger facing a woman during pregnancy is the threat of miscarriage or premature birth. From both the physiological and psychological sides, this problem for a woman becomes one of the most significant.

That is why any pregnancy should be under the strict supervision of a doctor, who is able to suspect the threat of miscarriage or premature birth, and, if necessary, take measures to preserve the pregnancy. One of the common causes of miscarriage or rapid premature birth is a short cervix.

If this pathology is present, a woman may be unable to bear a fetus and give birth to a child without medical intervention.

Short neck. Physiological side of the issue

The isthmus and cervix are the first section of the birth canal. The neck has the shape of a truncated cone or cylinder, 70% consists of connective tissue, and 30% muscle. The muscles of the cervix are located closer to the body of the uterus and form the so-called sphincter - a muscle ring that keeps the cervix closed, and during childbirth it opens, which becomes the beginning of the last phase of labor. The normal cervix with all its sections is approximately 40 mm long.

Towards the end of pregnancy, as the body prepares for childbirth, the cervix shortens, its internal os widens and childbirth occurs. For various reasons, this process may begin earlier. In this case, ICI occurs - isthmic-cervical insufficiency. This condition is characterized by premature shortening of the cervix and softening of the sphincter, which can result in opening of the first section of the birth canal and premature birth.

If the cervix shortens to 20-30 mm in the first or second trimesters of pregnancy, this is a signal of the presence of ICI, a condition in which the risk of miscarriage increases many times over.

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Short cervix: causes of pathology

Isthmic-cervical insufficiency can be congenital or acquired. In the first case, the pathological condition is associated with individual characteristics of the body structure, as well as genetic predisposition.

The congenital form can be detected during a gynecological examination or ultrasound of the woman’s pelvic organs before her first pregnancy. If it is present, pregnancy can be complicated, therefore, while carrying a child, a woman needs to closely monitor her well-being, eliminate the maximum possible amount of physical activity and ensure rest, and also regularly visit a doctor.

However, even in the absence of congenital pathology, the cervix can shorten even before pregnancy. The reason for this may be previous births complicated by ruptures, spontaneous and medical abortions, surgical interventions in the uterine cavity, diagnostic curettage, conization and many other factors, one way or another related to the dilation or injury of the cervix.

As a result, scars may form on its muscle walls, the neck becomes deformed, becomes incapable of normal stretching and shortens. There is also a completely physiological reason for the shortening of the cervix during pregnancy. At 10-21 weeks of obstetrics, the fetus begins to produce its own hormones, in particular androgens, which are necessary for normal labor.

If by that time androgens are contained in excess in the mother’s body, gradual premature preparation for childbirth occurs: the cervix shortens and the internal os opens, which leads to the risk of premature birth.

How to maintain pregnancy with a short cervix?

A shortening of the cervix may be suspected by a doctor during a gynecological examination and confirmed by an ultrasound specialist during an intravaginal examination. When a pathology is detected, a series of studies are prescribed to determine the cause of its development, one of the mandatory ones being a blood test for hormone levels.

If the cervix shortens due to excess hormones, the condition can often be stabilized by prescribing hormonal therapy. A pregnant woman with a shortened cervix is ​​given rest and bed rest, wearing a prenatal bandage. In some cases, the patient is offered to continue the pregnancy in the hospital.

Progressive shortening of the cervix despite bed rest and lack of physical activity requires taking measures to maintain pregnancy. In this case, it may be recommended to install an obstetric pessary on the cervix - a special polymer device like a ring that supports the uterus in a physiologically normal position, reduces fetal pressure on the cervix and prevents further shortening and dilation of the cervix.

If the condition is critical, that is, the length of the cervix is ​​less than 20 mm and there is an opening of the pharynx of more than 10 mm, the doctor may recommend surgical correction of the cervix - applying a cervical cerclage. The procedure involves placing stitches in specific areas of the cervix. Sutures are placed no later than 27 weeks of pregnancy in a hospital setting using anesthesia and under ultrasound control.

Cervical cerclage is removed at the beginning of labor: during contractions, water breaking, or labor bleeding beginning. If labor does not begin before 38 weeks, the sutures are removed as planned, and for a planned caesarean section they may not be removed at all. A shortened cervix is ​​not a death sentence for a pregnant woman. In most cases, the situation is fixable, thanks to which a woman can safely carry and give birth to a child without any special consequences for her body.

The main thing is to detect the pathology in time and take action, as well as lead a calm lifestyle, rest more often, reduce physical activity and wear a prenatal bandage, which reduces the pressure of the amniotic sac on the internal os of the cervix.

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Diagnosis and treatment of a short cervix

Today, with such a fast pace of life, many women simply do not have time for their health.

And if it comes to an asymptomatic disease, then representatives of the weaker half of humanity learn about it only when the trouble makes itself felt. A short cervix also falls into this category of pathologies.

This disease is not “exotic”, as it occurs quite often. However, the danger is that in the normal state of a woman, the disease does not manifest itself in any way. And only during pregnancy it suddenly turns out that the patient has a short cervix.

A little anatomy

In a woman’s body, the organ in which the embryo is formed from the fertilized egg and then the fetus develops is the uterus. It has two parts: the body, where the unborn child is located, and the cervix, which subsequently, during labor, performs the function of the birth canal. The shape of the neck resembles a truncated cone or cylinder, 3.5 - 4 cm long. Conventionally, it is divided into 2 parts:

• vaginal (clearly visible during a gynecological examination);
• retrovaginal (not visible on examination).

The part of the cervix adjacent to the body of the uterus is called the internal os. The part that passes into the vagina is the external os.

In composition, 1/3 of the cervix consists of muscle tissue. Moreover, the main part of the muscles is “concentrated” in the area of ​​the internal os, and forms a powerful muscle ring (sphincter) there, which allows the fetus to be retained in the uterine cavity throughout pregnancy.

Why is a shortened cervix dangerous?

A short cervix (less than 2.5 cm) is one of the reasons for the development of ICI (isthmic-cervical insufficiency) in a woman. With this pathological condition that occurs during pregnancy, the cervix is ​​not able to hold the unborn child in the uterine cavity. The constantly growing fetus, together with amniotic fluid, puts pressure on the cervix. As a result of this, it becomes even shorter and opens, leading to premature or accelerated labor (with ruptures of the vagina and even the uterus), and in the early stages – to miscarriage.

In addition, a shortened cervix is ​​not able to fully protect the fetus from the effects of infectious agents, since it does not perform a barrier function, becoming permeable to various microorganisms.

Symptoms

Symptoms of FCI most often begin to appear during pregnancy between 15 and 27 weeks. And this is no coincidence. It is from this period that the fetus intensively increases in size and, gaining weight, begins to put more pressure on the muscular sphincter of the internal os of the cervix.

The doctor detects changes in the size of the cervix during the next gynecological examination. In this case, the woman usually does not make any complaints. Only in some cases, a short cervix is ​​manifested by bloody discharge or profuse watery discharge from the vagina, pain in the lower abdomen. If these symptoms are present, in order to finally confirm the diagnosis, the doctor sends the patient for an ultrasound examination.

Causes

Why is such a pathology suddenly discovered during pregnancy?

In some women, for example, a short cervix can be detected during the second pregnancy, even if its length during the first pregnancy was within the normal range.

The main reasons leading to shortening of the cervix during pregnancy include:

1. Congenital anomalies of the structure of the uterus. Rarely encountered and usually inherited
2. Mechanical injuries to the cervix with subsequent deformation resulting from operations (for example, when applying medical forceps, during conization), abortions, diagnostic curettages. In this case, the muscular sphincter loses its elasticity, i.e. ability to stretch.
3. Hormonal imbalances during pregnancy. They begin at 11-12 weeks of pregnancy, when the fetus’s adrenal glands begin to actively function. They secrete hormones, including androgens, under the influence of which (with an increased level of a woman’s “own” androgens), the cervix becomes soft and shortens. This helps to open it up. In this case, the woman is not even aware of the threatening danger, since there is no increase in the tone of the uterus (and, accordingly, certain symptoms).
4. Damage to the cervix during previous births. In this case, the risk of injury increases in the presence of so-called aggravating factors, which include:

• multiple pregnancy,
• polyhydramnios.

Diagnostics

In order for a short cervix to be detected in the early stages of pregnancy, a woman needs to visit a gynecologist as soon as she learns about her “interesting” position. The first thing the doctor will do is examine the patient in a gynecological chair. During this study, a specialist can visually assess the condition of the cervix and its size.

The woman is also obliged to inform the doctor that she has a history of pregnancy that ended in miscarriage. In this case, the patient will be under special control, in which monitoring of the condition of the cervix is ​​mandatory every week (or once every two weeks) (from 12-16 weeks of pregnancy).

Ultrasound is another research method that is widely used in diagnosing cervical pathologies. This can be done in two ways:

• transabdominal (through the stomach);
• transvaginal (using a vaginal sensor through the vagina).

By ultrasound, isthmic-cervical insufficiency is determined when the diameter of the internal pharynx is > 1 cm and the length of the cervix< 2 см.

Prevention

After diagnostic measures, the doctor prescribes the necessary treatment aimed at maintaining the pregnancy. However, a short cervix is ​​a problem, the unpleasant consequences of which can be avoided by carrying out early prevention of the disease, which includes the following measures:

• Timely visit to the gynecologist. It is during the examination that the doctor can see the problem and begin the necessary treatment in time.
• Using reliable methods of contraception to avoid unwanted pregnancy and its consequences - abortion.
• Pregnancy planning. This is especially important for those women who have a history of problematic pregnancies.

Treatment

If a woman knows about the structural features of her cervix (there were similar problems in previous pregnancies or there are congenital anomalies of the structure), then she needs to be constantly observed by a gynecologist, not to be nervous, and to rest more. In addition, care should be taken to ensure that the tone of the uterus does not increase, as in this case there is a risk of miscarriage. It is recommended to limit any physical activity as much as possible and wear a bandage.

For minor changes in the cervix, the doctor resorts to conservative therapy. The woman is prescribed medications that relieve the tone of the uterus and help return the cervix to a physiological state. For these purposes, intravenous drip administration of Magnesia, Ginipral (can also be used in tablets) is indicated.

If the cause of a short neck is an excess of androgens, glucocorticoid drugs (for example, dexamethasone) are prescribed to correct the condition. After the course of treatment, the condition of the cervix is ​​assessed. If there is no improvement, as well as if the shortened neck has arisen as a result of exposure to a traumatic factor, surgical correction is performed - cervical cerclage. In this procedure, which takes place under anesthesia (epidural or intravenous), stitches are placed on the cervix. This helps keep the fetus in the uterine cavity.

Sutures are placed within 17-21 weeks. After the operation, the woman remains in the hospital for 7-20 days. All this time, in order to avoid increasing the tone of the uterus, therapy is carried out with antispasmodic drugs (Papaverine, No-shpa, etc.). In case of infection or when pathogenic microflora is detected, antibacterial drugs are prescribed. After discharge from the hospital, a woman should visit a gynecologist every two weeks, who will monitor the condition of the cervix. Also, 1-2 times a month, the patient takes a bacteriological culture and a smear for flora. Prenatal hospitalization occurs at 37 weeks. At this time, the stitches are removed.

Important!!! If amniotic fluid has leaked or labor has begun, the sutures are removed regardless of the stage of pregnancy. If this is not done, during contractions the stretched threads will injure the cervix.

Traumatic damage to tissue by threads occurs if this operation was performed on an “inflamed neck.”

For a shortened neck, a so-called non-surgical cerclage is performed. The essence of this method is that a special ring is put on the neck - an obstetric pessary. This design can be used in the second half of pregnancy (at 25 weeks), when suturing is contraindicated to avoid infection of the fetus and injury to the amniotic sac. A pessary is a kind of bandage that not only reduces pressure on the cervix, but also reduces the likelihood of infection of the fetus by preserving the cerumen plug.

In order to prevent infectious complications, the installed pessary, as well as the vagina, is treated by a doctor every 15-20 days. The construction is removed during pregnancy at 37-38 weeks.

Every woman dreams of a smooth pregnancy, without complications, and especially without the threat of miscarriage and premature birth. There are certain risks that lead to undesirable consequences - miscarriages and rapid premature birth. One of these threats is a short cervix.

What it is

The cervix is ​​the rounded part of the uterus that connects it to the vagina. In a healthy state, its length varies from 3 to 4 cm, which is approximately a third of the entire length of the uterus. Under the influence of negative factors, this indicator can decrease to two or less centimeters, as a result of which the pregnant woman develops isthmic-cervical insufficiency.

The pathological condition is reflected in the performance of certain functions by the cervix - under the pressure of the increasing size of the fetus, the organ continues to shorten, opens prematurely and provokes miscarriage or premature birth. With this pathological condition of the cervix, infection of the fetus is possible, since the protective function is significantly weakened. During childbirth, there is a high risk of perineal and vaginal ruptures.

Causes

• a short cervix may be a consequence of the anatomical structure of the female body;
• - a consequence of hormonal changes in the body caused by pregnancy. The pathology is especially pronounced in the second trimester;
• deformation of the cervix caused by previous abortions, surgery or multiple births;
• a lack of ;
• stressful situations, fears, worries;
• diseases of the uterus and cervix of an infectious and inflammatory nature, as a result of which the tissues of the organ are deformed and scarring occurs;
• deformation caused by uterine bleeding.

Examination and diagnosis of isthmic-cervical insufficiency
Isthmic-cervical insufficiency can be diagnosed with maximum accuracy in the second half of pregnancy, namely in the period from 14 to 24 weeks.

1. Examination by a gynecologist. At the appointment, the specialist assesses the condition of the cervix, the presence of discharge and its nature, as well as the size of the external pharynx. In a healthy state, the cervix should be tight, have a deviation in the backward direction, the external pharynx should be tightly closed and not allow a finger to pass through.
2. Ultrasound examination using a special sensor. In the first trimester, diagnosis is carried out with a transvaginal probe; in the future, transabdominal examination is used. Based on the diagnostic results, the specialist decides on further treatment methods that will allow you to maintain the pregnancy.

Normal cervical length by week

Also, ultrasound determines the degree of maturity of the cervix, in conclusion, this indicator is assessed in points.

Table of criteria by which cervical maturity is assessed

Each criterion is assessed by a corresponding number of points, which are summed up. The results look like this:

• from 0 to 3 – immature cervix;
• from 4 to 6 – not fully mature cervix, developing isthmic-cervical insufficiency;
• from 7 to 10 – fully matured cervix.

In a healthy state, until the 37th week, the cervix should be in an immature state, and transition to a mature state only before the onset of labor. It is important to consider that the inability of the cervix to transform into a mature state is also regarded as a pathology that requires specialist supervision and correction of the pregnant woman’s condition. It is likely that the woman will be offered delivery by caesarean section.

If ultrasounds indicate borderline examination results and symptoms of premature birth are recorded, the pregnant woman is prescribed a repeat examination - ultrasound diagnostics - to confirm the diagnosis and make appropriate correction.

1. If the cervix is ​​less than 1 cm in length, labor may begin at 32 weeks.
2. With a cervical length of 1 to 1.5 cm, birth occurs at 33 weeks.
3. With a cervical length of 1.5 to 2 cm, the duration of pregnancy is reduced to 34 weeks.
4. If the cervix is ​​between 2 and 2.5 cm long, labor begins at 36 weeks.

What to do with ICN
First of all, it is necessary to evaluate the results of the examinations and determine a further scheme of preventive and therapeutic measures. A short cervix is ​​one of the pathologies that can be avoided with due care and preventive measures. To do this you need:

• visit a gynecologist in a timely manner, because only during an examination can the first signs of pathology be identified and treatment prescribed;
• if the moment for conception is unfavorable, you need to use reliable methods of contraception;
• It is important to plan your pregnancy, this primarily applies to women who have had miscarriages.

Treatment

In many ways, success and the absence of problems during pregnancy with a short cervix depend on the efforts and attention of the woman herself. It is important not to miss visits to the gynecologist, to rest more to eliminate the possibility. It is necessary to wear a bandage and avoid physical activity. These simple preventive measures significantly reduce the risk of premature birth.

If changes in the structure of the cervix are minor, conservative therapy is prescribed. To do this, a course of drugs is prescribed that normalize the physiological state of the uterus and relieve symptoms of tone. Treatment can be carried out with tablets or in the form of droppers.

If the cause of the pathology is hormonal imbalance - an excess of male hormones - drugs are prescribed that normalize the woman’s condition.

If after a course of therapy no improvements are recorded or the pathological condition is caused by a mechanical effect on the cervix, surgical correction or cervical cerclage is prescribed. The procedure is carried out under intravenous or epidural anesthesia; special fixing sutures are placed on the cervix to hold the fetus. The correction is carried out between 17 and 21 weeks. After the procedure, the patient remains in hospital for 2-3 weeks under the supervision of a doctor and is treated with antispasmodic drugs to avoid increased uterine tone. If pathogenic microflora or symptoms of infection are detected, a course of antibacterial drugs is prescribed, which are allowed during pregnancy. After discharge, the patient is required to visit a gynecologist every two weeks to monitor the condition of the cervix. Every month, a bacteriological culture and smear are taken from the pregnant woman to identify pathogenic microflora. At week 37, the woman is hospitalized to prepare for childbirth and the stitches are removed so that they do not damage the cervix during childbirth.

Note: if the amniotic fluid has broken and labor begins, the sutures must be removed immediately, regardless of the stage of pregnancy.

If the diagnosis of “short cervix” is aggravated by concomitant infection or for other reasons surgical intervention is prohibited, non-surgical cerclage is performed. A special uterine ring is placed on the cervix - an obstetric pessary. The procedure can be carried out at least 5 weeks into pregnancy. The pessary functions as a kind of bandage that will help relieve pressure on the weakened cervix, protect the fetus from infection, and also preserve cerumen.

An obstetric pessary requires regular treatment, it is carried out every two to three weeks. At 37-38 weeks, the medical structure is removed.

Childbirth with ICN

A short cervix imposes certain characteristics on the course of labor. Isthmic-cervical insufficiency causes the following processes:

• at the initial stage of labor, a pregnant woman experiences a dilatation of the cervix of 3-4 cm, usually such dilatation is recorded already in the active phase of labor;
• when active, regular contractions begin, the cervix dilates much more actively than in a healthy state - by 1 cm in 1.5-2 hours;

As a result, labor progresses and ends much faster; doctors distinguish two types of childbirth:

• fast - for first-time mothers less than six hours, for multiparous women about four hours;
• rapid - for primiparous women, labor ends in less than four hours, and for multiparous women in 2 hours.

Note: thus, a short cervix is ​​assessed by gynecologists as a serious, pathological condition that requires immediate correction and elimination. Doctors today give preference to a less invasive method of therapy - the introduction of an obstetric pessary.

Sex with a short cervix

Intimate relationships during pregnancy, like ultrasound using sensors, cannot cause miscarriage or premature labor. However, when diagnosing isthmic-cervical insufficiency, it is better for spouses to refrain from intimacy or exercise extreme caution so as not to complicate the course of the pathological process.

It is impossible to deprive a pregnant woman of intimacy, since as the size of the uterus increases, the outflow of blood from the genital organs slows down, and this causes an increase in libido. It is possible to normalize blood flow in the pelvic area, uterus, and also to activate the blood supply to the fetus only with the help of intimate release of the expectant mother. Sexual intercourse interrupted before achieving orgasm has a negative impact on the emotional state of a woman, leading to sleep disturbances, irritability and stagnation of venous blood in the pelvic organs.

• sexual intercourse should be calm;
• the penetration should not be deep, this will eliminate the likelihood of injury to the cervix;
• the sexual partner should not have any infections, otherwise a condom should be used;
• during intimacy, it is necessary to exclude pressure on the mother’s abdominal area; the main criterion for choosing a position is that the woman should be comfortable;
• contractions of the muscular layer of the uterus during orgasm cannot provoke an increase in the tone of the uterus;
• semen contains substances that help soften the cervix, for this reason ejaculation into the vagina is prohibited before the 35th week of pregnancy;
• during anal sex, you need to use a condom or lubricant; it is not advisable to use the same means of protection to continue sexual intercourse and penetration into the vagina, this can cause infection of the fetus, infection of the amniotic membranes and their rupture before the due date.

Note: during pregnancy, women often face the problem of swelling of hemorrhoids, in which case there is a high risk of injury and infection. To avoid unpleasant discomfort, you must avoid anal sex.

During pregnancy, you should not rely on your own feelings, especially when diagnosing a short cervix and isthmic-cervical insufficiency. It is important to inform your gynecologist about any unknown changes in your health status. A timely examination, examination, and prescribed therapy will help to avoid many complications and unpleasant consequences during childbirth.

The cervix or cervical canal is a cylindrical organ that connects the uterine cavity to the vagina. The average length is 3-4 cm. The holes present on the isthmus open when sperm are received or for the release of menstrual blood.

What functions does it perform?

During pregnancy, the cervix performs the following functions:

1. Barrier. The cervical canal prevents pathogens from entering the uterine cavity;
2. Secretion production;
3. Participation in the reproductive system.

Pathologies of the cervix lead to the inability of the normal course of pregnancy. Such diseases include “shortening of the uterine isthmus.”

What does a short cervix mean during pregnancy?

A short cervix is ​​a shortening of the cervical canal due to several reasons. The required length of the CC contributes to the performance of the main functions of the pharynx. And shortening interferes with the gestational process.

The disease has no clinical signs. An obstetrician-gynecologist can identify it during an examination.

The course of pregnancy becomes much more complicated when the diagnosis is confirmed.

A change in the length of the pharynx downward is a threatening condition for the fetus.

Causes of pathology

• Abnormal structures of the pelvic organs, incl. underdevelopment of the isthmus canal;
• Pathological development of the uterus;
• Heredity through the female line (from grandmother to mother, etc.);
• in the endocrine system during pregnancy;
• Hormonal disorders;
• as a result of childbirth, curettage of the walls of the uterine cavity, and other surgical interventions;
• Dysplasia of the epithelial layer;
• During pregnancy this may be;
• Multiple pregnancy or carrying a large child;
• Scars on the uterus;
• Polyhydramnios (the amount of amniotic fluid exceeding the norm).

It is possible to determine the cause through a thorough examination and history taking.

Shortening can be of two types:

1. A slight change in length - instead of the required 4 cm it may be 2.8, but not less than 2.5 cm;
2. Significant shortening of up to 2 cm or less.

A “short” cervical canal can be detected no earlier than 11 weeks of gestation.

Symptoms

In the absence of pregnancy, the woman has no idea about the presence of this pathology. The disease has no clinical manifestations, which is the main danger.

Some women with a short cervix have reported the following symptoms:

• Painful sensations in the lower abdomen (not pulling);
• Minor discharge of a bloody nature;
• Watery mucous discharge.

These symptoms may indicate other pathological conditions, so you should consult a doctor for help.

Short cervix during pregnancy at 20 weeks is a dangerous period in bearing a baby. Having crossed the equator of gestation, the fetus begins to actively move. It has a physical effect on surrounding organs, including which, due to its shortness, is not able to hold the child.

A twenty-week-old baby is not viable in the extrauterine environment. In this case, he will not be able to survive.

Short cervix during pregnancy at 30 weeks– the second dangerous period of gestation. Multiple pregnancies and carrying a large child require special monitoring.

How is a short cervix diagnosed?

A gynecologist is able to identify the disease only after a personal examination in a gynecological chair and in the conclusion of an expert with cervicometry.

Diagnostic procedures to confirm the diagnosis include:

• Examination of the cervical canal using the “finger method”; the patency of the pharynx is also determined;
• Ultrasound diagnostics for detection;

Dangerous consequences of pathology

Shortening of the central circulation threatens with serious complications for both mother and child:

1. Increased risk of premature and;
2. Risk of fetal infection due to deterioration of cervical barrier function;
3. Habitual miscarriage on;
4. and trauma during obstetrics;
5. Hypoxia of the newborn, caused by leakage of amniotic fluid that does not hold due to a weakened pharynx.

Treatment

A short cervix is ​​not an indication for termination of pregnancy. The pathological condition is treatable. There are high-tech methods that help prolong pregnancy with such serious diagnoses.

Several factors influence the method of treatment:

Surgical methods

Stitching of the cervix (cervical canal cerclage).

The operation is performed no earlier than 14 and no later than 25 weeks. The cervix is ​​“sutured” to prevent its expansion;

Conservative treatment

1. - one of the most common methods. A special ring, selected according to an individual size, is placed on the cervical canal.
2. Drug treatment is indicated for mild organ shortening. Medicines are prescribed by the attending physician, who also selects the dosage.

Pharmaceuticals:

• Sedatives and sedatives;
• Hormone therapy (tablets and suppositories);
• Eliminating drugs (drugs, ginipral).

Drug treatment is aimed at maintaining pregnancy. That is, to prevent the risks of developing undesirable consequences.

Preservation of pregnancy with a short cervix

To maintain pregnancy and its normal course, a pregnant woman is recommended to remain in bed. In severe cases of the disease, hospitalization is indicated.

It is necessary to visit a gynecologist according to the established schedule and follow all prescriptions and recommendations.

When carrying a child, pregnant women with a short cervix should not be exposed to stress and anxiety.

If necessary, undergo additional diagnostic methods:

Physical activity and excess worsens the situation. However, completely giving up exercise and going on a diet is not recommended.

Intimacy is not a contraindication for a short os. It should be limited if there are clinical symptoms and the first days after suturing.

Childbirth with identified pathology

If a diagnosis is made, the pregnant woman must go to the hospital before labor begins.

If a pessary was installed, then doctors remove it, as well as stitches. In early gestation, pregnancy is prolonged. If the 38th week has approached, the pregnant woman is allowed to give birth.

Complicated labor or its rapid development should be under the supervision of doctors.

The doctor determines the tactics of treatment and obstetric care.

Prevention

Pathology of the cervix, or rather its shortening, cannot be prevented. But to reduce the severity of the disease during pregnancy or after it, it is important to follow some rules:

There are no medications for this type of pathology. But vitamin therapy will not be a hindrance. For nervousness, magnesium supplements with vitamin B6 are indicated.

Video: k Short cervix during pregnancy