Pregnancy and childbirth with IC. How to endure Pregnancy with ICI (personal experience)

My story about how you can endure Pregnancy with ICI or what helped me on this difficult path.

My history

I knew that I was pregnant even before the test showed it. Which I could not resist and did on the first day of the delay at 4 in the morning. I still remember the feeling of unreality, absolute happiness and ecstasy, and then fear.

My first pregnancy is over. And this pregnancy began with a strong pull in the lower abdomen. So much so that I even went to the gynecologist, who confirmed the pregnancy and said that everything is in order and there is no need to be nervous.

I got registered at 12 weeks. Before that, all that tormented me was fatigue, so I had to sleep during the day and also an aversion to certain smells. There was no toxicosis, I did not feel sick.

I signed up for pregnancy yoga and pool. We started going to courses for pregnant women (which helped us a lot). All tests were good. And the doctor even persuaded me to have an ultrasound, which I agreed to only because of the outcome. previous pregnancy.

I told my doctor that I suspected ICI or isthmic-cervical insufficiency. The doctor waved me off and said that everything was fine with me. But the second screening was scheduled for 18 weeks to do more cervicometry- measuring the length of the cervix. At the time, I had no idea how many times I would have to do this procedure.

It was at this screening that we learned that we were expecting a son and that my neck was good and long, 35 mm. I relaxed and even stopped worrying. The doctor said to repeat the cervicometry only at 24 weeks, but I myself went to the ultrasound specialist, explained my fears and she agreed to accept me after her work shift In 2 weeks. And it saved my son's life.

On May holidays we went to my parents in St. Petersburg, where we had a wonderful time. We were in the country, walked in the forest and went to the mall.

Immediately upon arrival, as I agreed with the ultrasound doctor, I went for cervicometry. I knew immediately that something was wrong; The doctor's face changed dramatically and she even asked her colleague to look at the screen. My cervix has shortened to 7mm! From 35!!! And this is for some 2 weeks! And the opening of the neck from above began.

I was loaded directly from there on a gurney into an ambulance and taken to the maternity hospital, where, after 2 days, they urgently sutured my cervix, as the only way support her and not lose the baby.

Then I spent another week in the hospital under the supervision of doctors. The neck has become 1.7 cm.

I was discharged with a decree to lead a normal life. But since I had a lot of free time and had the Internet, I looked around a bunch of American, British and Russian forums dedicated to the problem of ICI (and there were a lot of them!) And I decided that I would comply bed rest at least until 28 weeks. That is, until the time when my baby can already survive, if premature birth suddenly begins.

I was in bed for 7 weeks. I only went to the toilet and 2 times a week to shower. And I also went in the back seat of the car lying to the doctor for an appointment and for cervicometry (using ultrasound, they tracked the length of the cervix and it was such a great joy for me to hear that it had not decreased and that the stitches were holding). We went to cervicometry every 2 weeks until 32 weeks, then the doctor said that there was no point in monitoring further.

All this time I thought I was going crazy. Lying all day long and doing nothing is already deadly, and at the same time being afraid of any feeling inside, perceiving it as something bad with the baby, is 1000 times worse.

As a result, I got up for the first time on my husband's DR. My back ached and my legs didn't work. And so it continues almost until childbirth. Saved me only manual therapy and massage.

I gave birth at 35 weeks and 3 days, that is 8 month old baby. My water broke at home and the stitches were removed at the hospital. I already wrote about how we gave birth with my husband in.

What is an ICN?

If to speak plain language, that is inability of the cervix to perform its function, namely to play the role of a kind of barrier between the vagina and the amniotic sac.

Normally, the cervix is long, longer than 3 cm, and begins to contract before childbirth. If the cervix during pregnancy is shorter than 3 cm, then this big risk premature birth. This happened with my first pregnancy, my cervix shortened and I went into preterm labor at 18 weeks. So I lost my baby and realized that I have CCI.

Usually, ICI is set if there has already been a failed pregnancy that ended due to an incapable cervix.

No one could explain to me how I got such happiness, there were no gynecological operations, abortions either.

How can I endure pregnancy with ICI

Firstly, everyone who reads this post and who has ICI - know that you can endure pregnancy with ICI! I am living proof of that.

Secondly, it will most likely be difficult. But it's definitely worth it. Below I will describe what I did and what I followed. And what I think helped me now to hold my son in my arms.

Additives

Pregnancy is a special delicate state of the body that requires additional nourishment. Therefore, throughout the pregnancy I took:

Probiotics specially formulated for pregnant women; I increased the dosage to 2 capsules a day.

Vitamin C

I found a study stating that taking this vitamin can reduce the risk of preterm labor. In addition, it helps maintain immunity and prevents the development of infection, which is very useful when you have stitches in your cervix. I drank natural vitamin C 1 capsule 2 times a day with meals.

Garlic

- it's powerful natural antibiotic not destroying our precious intestinal microflora and preventing the development of infections. Eating raw garlic is not always convenient and desirable, so I took it as a supplement, 1 capsule 2 times a day with meals.

Cranberry Extract

Or rather special active substances, which it contains are famous for the fact that they can treat and prevent infections urinary system. During pregnancy, and especially stitches, this is very important. I took cranberry extract once a day with meals.

Medications

Vaginorm-S

This drug was advised to me by a friend, who, in turn, strongly recommended “for stitches” to her by an eminent obstetrician-gynecologist professor. This ascorbic acid, which normalizes the pH of the vagina and is used when bacterial vaginosis. I decided that it was better than Hexicon, which my doctor prescribed for me.

I used Vaginorm 2 times a week right after my stitches and before delivery. Seams are foreign material and fertile ground for possible infection therefore it is very important to try to maintain normal vaginal pH and microflora.

Duphaston

I am an ardent opponent of hormone therapy, but I agree that sometimes it becomes vital. Dufaston is a drug of the female hormone progesterone. I found a study that says that taking progesterone "keeps the cervix normal" and prevents it from shortening.

I took it from the moment I got to the hospital (I was given injections), then switched to the tablet form and began to “peel off” very slowly and gradually, starting at 34 weeks, as the doctor told me).

Nifedipine

This drug is commonly used to lower blood pressure.

In the States, he is already very for a long time used for uterine tonus / contractions. In Russia, Ginepral was previously used for this reason, but many were shaking from it in the truest sense of the word, so some gynecologists now prescribe Nifedipine.

I drank it from 24 to 32 weeks. Now I doubt if this should have been done. Because having studied the topic of uterine tone, I realized that this is generally the wrong term. The mother is muscular organ, which should contract and relax. In addition, there are so-called training contractions or Braxton-Hicks contractions, which do not affect the length of the cervix in any way.

But then I was in a panic, I was very afraid of losing my son, and therefore I began to take them.

These pills should not be taken during the first trimester as they interfere with organogenesis and can lead to malformations.

Water

I drank a lot of water. About 3 liters a day. Firstly, during pregnancy, you need to drink so that the baby has enough amniotic fluid. Secondly, enough water can prevent infection in the vagina, which can again lead to preterm labor. And stitches are good breeding grounds for infection.

Bed rest

It was another thing I didn't do as the doctor told me. But I have read a lot of American forums dedicated specifically to the problem of ICI. And there, some of the doctors prescribed bed rest, some did not. But a lot positive feedback from those who adhered to it. And I decided that I would do it too.

It was the hardest part of my pregnancy. Lie for a month and a half. Get up only to use the toilet and shower 2 times a week. And see the doctor every 2 weeks.

I thought I was going crazy, but now I don't even remember it, because it was not in vain. I read a lot, worked on the blog (I prepared posts in advance for the time of childbirth and recovery), talked with friends, ordered little things for my son. My mother and sister took turns moving to us, helping at home. We wouldn't have made it without them.

positive attitude

It was very difficult for me to tune in to a good outcome.

I did not sleep well because every sensation was perceived by me as something terrible and wrong, or as a signal of premature birth. It was very scary, I was constantly worried. But then I realized that it was necessary, on the contrary, to talk with my son and with my body.

I made stickers with positive and in short sentences, which I pasted all over the house and repeated them several times a day. I listened to meditations and beautiful Celtic music. I talked to my baby, said that everything will be fine.

Before they found ICI, I was very active image life. I walked a lot, went to the pool and prenatal yoga. After I had stitches, I had to forget about all this.

I started to do gymnastics lying in bed, stretching my arms, legs and back. The massage also helped a lot. And of course frequent rolling from side to side.

Subsequent pregnancies

During childbirth, the doctor told me that I had a true ICI and that all subsequent pregnancies I would need to apply the so-called preventive sutures at 11-13 weeks of pregnancy.

On the forums, I read that if you suture in advance at an early date, then there is a chance that the neck will not “float” and it will be possible to lead habitual image life without bed rest. That's what I plan to do next time. But in any case, even with sutures, the cervix will have to be monitored every 2 weeks on cervicometry.

According to statistics, emergency suturing allows you to endure pregnancy in about 50% of cases, while preventive suturing in 80-90%.

I used to always say that pregnancy is not a disease and I still think so. But now I consider this as a special delicate state, when a woman changes not only from the outside, but also from the inside, her inner world. And it is important to keep this peace inside.

It was very difficult for me to save this world, my pregnancy was very difficult also because there was not enough information about CCI, especially natural approach to the treatment of this condition. I had to combine the two perfectly different approaches to treatment: conservative and more natural. And I decided that my experience can help all those who, in a panic, are looking for answers to such complex questions, do not know where to turn and where to look for support.

ICI turns out to be a fairly common phenomenon in our time, but this is far from a sentence, it is possible and necessary to bear babies with it. Know that you are not alone, believe in the best and soon you will be holding your baby in your arms too!,

For my husband and I, my pregnancy, to be honest, was unplanned, but at the same time joyful and desirable. At first everything went well. It was interesting to watch my “new” body and the indescribable sensations of what is being born inside new life! Maybe because of the hormones raging inside me, maybe because of my quick-tempered and emotional nature, I was a lot nervous, mostly for no good reason, I ran and worried a lot, did not slow down the pace of work, as pregnancy requires ...

My pregnancy: a difficult start

Detachment occurred at 6-7 weeks gestational sac. It sounds scary, but if you ask for help in time, everything should be in order. I had to lie down for a couple of days, observe bed rest, take droppers. Everything worked out, fortunately! That incident made me think and act more wisely.

It would seem that she has revised her behavior, now everything should be calm. But it was not there. At the first scheduled ultrasound, they warned that the cervix is short and may need to be stitched to further maintain the pregnancy. a month later confirmed the previous diagnosis. For a long time I tormented myself with questions: why, because of what? The gynecologist explained that there is no reason for this as such, physiology ...

We consulted with my husband, re-read the literature on this subject, since we had not even heard of the above mentioned before. Of course, they were worried, after all, an operation under general anesthesia, albeit a small one. But we decided to do it anyway, if necessary.

They put a seam in a maternity hospital that specializes in this process (just the one in which I was registered and was going to give birth). I was also worried about anesthesia. It turned out that in our time they inject such a dose that is needed only for the operation itself (5-7 minutes), then you immediately come to your senses. Doctors say that harm is excluded for the baby. I was also worried about whether I would feel something strange, whether something would interfere with me. Nothing like that, no new discomfort, as it turned out after the operation.

With this seam, it took place until the 37th week inclusive, that is, until the moment when the baby is already fully formed and ready to be born. After removing the suture, she still walked for 6 days (the removal process is simpler - without anesthesia, it does not hurt, only a little discomfort). As a rule, after removal, they give birth almost immediately. But my baby made me wait and finally tune in to childbirth.

Start of labor: good morning!

The first contractions started in the morning. It was like aching pain during menstruation. I didn't even know what it was right away! The doctor looked at the chair, confirmed that the process had begun. I was sent to the birth. The pain got worse every hour. Half a day has passed, but the uterus still does not fully open. I tried all the provided ways to endure the pain: both the fitball, and the bed, and standing, holding on to the pipe ...

Even at the examination in the morning, the doctor warned that she would probably need it. However, I did not understand why she made such a conclusion. At that moment, I objected with confidence and said that I would do my best to give birth to a child on my own, without third-party interventions. But I just did not understand what was waiting for me before. It's basically impossible to understand, it can only be experienced.

Contractions: short rest

When birth process it was the eighth hour, the gynecologist said that there was no way without anesthesia. Then I didn’t mind because of impotence ... An injection is made in the back, in a sitting position. I agreed in advance with the anesthesiologist that he would give an injection between contractions so as not to aggravate the pain. The anesthetic worked almost immediately, the pain subsided. It’s impossible to say that I didn’t feel anything at all, it just pulled my lower abdomen, as in the first contractions. I even wanted to sleep. She told the doctor. They took me in and let me rest. Of course, I didn’t manage to sleep fully, I had to constantly hold the sensor, which monitored the baby’s heartbeat, but I was able to take a nap a little.

After 30-40 minutes the pain returned. A second dose of anesthesia was required. True, the anesthesiologist was surprised that it was so fast. Another dose was given. Feel better. Lie. An hour later, the doctor looked and stated: full opening, give birth.

Attempts: the final chord

Sensitivity resumed again, I completely controlled my body and. And then a couple of attempts and the cherished: “Ah-ah-ah-ah!”

I want to add: when I give birth to the second and I feel that I no longer have the strength, then I myself will ask for anesthesia. And, of course, I will no longer worry that the “epidural” will harm my baby or me, or that it will turn my body into a plant and I won’t even understand how I gave birth - all that I was so afraid of before!

Dear, future mothers, be confident in yourself and in your baby, be calm, balanced and be sure to believe in a miracle, and this miracle will be in your hands in 9 months!

Specialist comments

Elizaveta Novoselova, obstetrician-gynecologist, Moscow

At the beginning of the story, Marina mentions the stitches on the cervix, which had to be applied in the first trimester. The pathology of pregnancy, in which the need for such an intervention arises, is correctly called. This is a condition characterized by incomplete closure of the uterine os - the opening in the uterus at the point where it connects to the cervix. For a successful pregnancy, this hole must be tightly closed throughout the entire period - otherwise, the risk of interruption or premature onset of labor is very high. In fairness, it should be noted that for no reason, like our heroine, ICI is extremely rare. More often, insufficient closure of the uterine os occurs against the background of cicatricial changes after ruptures of the cervix in previous births or as a complication after gynecological interventions (abortion, curettage), in which cervical canal expansion is used.

Marina is mistaken when she mentions a maternity hospital specializing in suturing the cervix - there is no such specialization of the maternity hospital, and cervical suture is a simple medical manipulation that can be performed not only in any maternity hospital, but also at the base antenatal clinic obstetrician-gynecologist leading pregnancy. However, most often, for suturing, the expectant mother is nevertheless hospitalized in the department of pathology of pregnant women of the maternity hospital in order to sanitize (clean) the vagina before surgery to reduce the risk of infection during suturing, as well as to monitor the sutures and general well-being patients a few days after surgery.

The sutures are removed from the cervix no later than 37 weeks of pregnancy, and this manipulation is also preferable to be carried out in a maternity hospital. This time, the need for hospitalization is not due to the suture removal procedure itself, which takes only a few minutes, does not require anesthesia and any preparation on the part of doctors and the expectant mother herself, but possible consequences this manipulation. Recall that the seam artificially fixes the cervix in a closed state; when it is removed, nothing else keeps the cervix from opening, and under the pressure of the weight of the pregnant uterus, it can begin to open in the very first hours - and this, in fact, means that labor will begin. For the same reason, the sutures on the cervix are never left until the end of pregnancy, longer than the 37th week: in addition to the weight of the uterus, baby and amniotic fluid, the opening of the cervix is also associated with its softening under the action of hormones released in the last two to three weeks of pregnancy. In this case, the suture will no longer be able to keep the cervix from opening, it can cut through it, which, in turn, can provoke further ruptures and deformation of the cervix.

Already at the very beginning of labor, according to the results of the examination, Marina was warned that, most likely, she would need epidural anesthesia. Then the expectant mother did not take this information seriously, hoping to do without additional interventions. Marina was all the more surprised when, after eight hours of childbirth, the prognosis came true: the dilatation increased poorly, and the doctors again started talking about the need for an epidural. Most likely, our heroine was surprised how the doctor guessed in advance that she “couldn’t cope with the pain,” because that’s how most women explain to themselves the need to use anesthesia. In fact, in Marina's case, the indication for epidural anesthesia was not pain sensitivity at all, and even more so, not the patient's behavior. epidural anesthesia in obstetric practice It is used not only for the purpose of pain relief of contractions. It can be used to correct various violations development of labor activity. One of these complications is cervical dystocia, in which the cervix, against the background of intense growing contractions, does not open due to biological immaturity. birth canal. In the case of our heroine, due to isthmic-cervical insufficiency, labor activity developed earlier - in less than 38 weeks, and the cervix did not have time to become soft and elastic enough. If at the time of the onset of regular labor activity the cervix remains dense, as in the middle of pregnancy, dilation does not occur, despite active contractile activity uterus. This is what the doctor noted at the very beginning of labor, at the first vaginal examination. This variant of the development of childbirth, of course, is a pathology and is dangerous for the health of the mother and fetus: against the background of intensifying contractions, serious breaks the cervix, the uterus itself and the walls of the birth canal. These complications are extremely dangerous because they can be accompanied by massive bleeding. by the most effective method correction of such an unsuccessful scenario of childbirth is precisely epidural anesthesia. In the presence of strong contractions, the "epidural" works as a powerful antispasmodic, contributing to the rapid softening of the cervix and its non-traumatic opening.

The first dose of anesthesia lasted only 40 minutes, which surprised not only Marina, but also the anesthesiologist. In order to understand the reason for their surprise, it is necessary to understand how the drug is administered and how the drug works with this method of anesthesia. An anesthetic (pain reliever) is injected into the epidural space around the hard meninges spinal cord. After surface anesthesia the skin in the area of intervention, the doctor makes a puncture between the vertebrae with a special needle. Then to the puncture site (at the level of 3-4 vertebrae lumbar) conduct a soft flexible tube - a catheter, through which the medicine enters the spinal canal. During childbirth, if necessary, the doctor can add a dose of anesthetic through the catheter - one dose is calculated on average for an hour and a half of pain relief. At the end of the action, pain sensitivity gradually returns to the woman in labor. With absence full disclosure the anesthesiologist adds medicine through the catheter, and if the cervix has already opened completely, the anesthesia is not prolonged - so that during the attempts the woman in labor can feel her body and control the strength of the attempts. It turns out that our heroine has an action standard dose the medicine ended two to three times faster - that's why the doctor was so surprised when, after only 30-40 minutes, Marina reported full recovery sensitivity. This effect is explained by the individual sensitivity of each person to the action of drugs: the next dose of anesthesia also ceased to act on our heroine much earlier than usual.

In her story, Marina admits that before giving birth, she was afraid that anesthesia would harm her or the baby, turn the body into a “plant” and not let you feel the birth of a child, but the fears turned out to be in vain. Many expectant mothers experience similar fears. Among the most common fears are the risk of damage to the spinal cord and further paralysis, the effect of "anesthesia" on the fetus ... Even our heroine, who was convinced of own experience in the groundlessness of such fears, mistakenly calls epidural anesthesia anesthesia, although this method has nothing to do with anesthesia. How does an epidural really work? The word "anesthesia" can be literally translated into Russian as "desensitization". In physiology, this term refers to a decrease in the sensitivity of the body or part of it, up to the complete cessation of the perception of information about one's state. As a result of such anesthesia, pain signals from the uterus to the brain are “cut off”. That is, in fact, the pain remains, but the “distress signal” sent by the pain receptors does not reach the pain center of the brain, since as a result of the introduction of an anesthetic into the spinal canal, transmission is blocked. nerve impulse. The well-being of the expectant mother, anesthetized in this way, differs significantly from the effect of conventional painkillers.

This has its pros and cons.

The advantage is the absence negative influence to the central nervous system. The drugs used for anesthesia do not have a hypnotic effect, do not change the mind of the expectant mother in any way, and do not cause a gag reflex. During the period of anesthesia, the woman in labor still feels contractions, but only as a muscle contraction, and there is no pain sensitivity. The disadvantages include the forced position of the woman in labor - after the administration of the medicine, she cannot get up, since the sensitivity below the injection site disappears. The drugs used for anesthesia do not cross the placental barrier and do not cause the release of endorphins - hormones that control the threshold pain sensitivity in the body of the expectant mother. In other words, this is the only method of pain relief that works only on the woman in labor. It is impossible to damage the spinal cord during this type of anesthesia: contrary to a common misconception, the drug is not injected directly into the spinal cord, but into the spinal canal, and dissolves in the cerebrospinal fluid, the fluid that surrounds the spinal cord. The fear of paralysis, just as common and just as unfounded, seems to be associated with an unusual sensation of loss of sensation directly during the action of the drug - for example, a woman during this period may notice that her legs have become "cottony" and do not obey her. However, after the end of the action of the anesthetic, the sensitivity in all organs and the ability to control them are completely restored - immediately and in the original volume, as we see from Marina's story.

Due to the fact that in recent years the indications for the use of epidural anesthesia during childbirth have significantly expanded, during pregnancy it is advisable for all expectant mothers to consult a neurologist in order to identify possible contraindications. This can significantly reduce the risk of complications from anesthesia (headaches, back pain).

Pregnancy without complications and pathologies is the pink dream of every woman. The harsh reality, unfortunately, often presents unpleasant surprises. One of them may be isthmic-church insufficiency, or abbreviated ICI.

What is CI and why is it dangerous?

ICI during pregnancy is relatively rare, only 1-9% of women. What is hidden behind this phrase? To understand what it is, and what processes lead to this pathology, you need to understand the structure of the uterus.

It consists of a body - a muscular hollow sac in which a child is born, and a neck that closes the entrance to the uterus. Together with the isthmus, the cervix forms the first part of the birth canal. Both the neck and isthmus consist of two types of tissues: connective and muscular.

And muscle concentrated in the upper part of the neck, internal os uterus. The muscles form a sphincter ring that does not release the fetal egg from the uterus ahead of time.

However, in some cases, this very muscular ring is unable to withstand the increasing load: the weight of the fetus and amniotic fluid, the tone of the uterus. As a result, under the pressure of the fetal egg, the cervix shortens and opens ahead of time.

Why is it dangerous for ICI during pregnancy? Firstly, open neck uterus causes fetal descent , the fetal membrane enters the uterine canal. During this period, it can open literally from any sudden movement.

Second, a woman's vagina is never sterile. It always contains various bacteria, and often infections. As a result, it happens infection of the fetal membrane . In this place, it becomes thinner and can break just under the weight of the amniotic fluid.

Opening amniotic sac and the outpouring of waters cause the onset of labor. Thus, the ICI becomes one of the most common causes miscarriages on later dates (before 22 weeks), or premature birth (from 22 to 37 weeks).

As a rule, ICI develops for a period of 16 to 27 weeks. IN rare cases pathology can develop earlier, even at 11 weeks.

Types and causes of isthmic-cervical insufficiency

What causes of CCI? They can be very different, and depending on the reasons, they distinguish traumatic and functional insufficiency.

With the first view, everything is clear from the name. Traumatic CCI develops if the muscles of the cervix have been injured in one way or another. What can cause injury? Any procedure associated with the expansion of the cervix is fraught with injury. These are abortions, and curettage after miscarriages, and diagnostic curettage. In addition, the muscles of the cervix can be injured during childbirth, as well as after IVF (in vitro fertilization).

In this case, the mechanism of formation of ICI during pregnancy is extremely simple: at the site of any injury, a scar from the connective tissue appears. Unlike muscle, connective tissue not able to stretch, this becomes the cause of insufficiency.

WITH functional ICI everything is a bit more complicated. Its reasons may lie in various factors. However, most often this species insufficiency is associated with hormonal disruptions. Usually, we are talking about a lack of progesterone, or about an excess of male hormones - androgens. By the way, this is the second most common cause of CI.

In this case, insufficiency begins to develop in the early stages, from about 11 weeks of pregnancy. This is due to the fact that at this time the pancreas of the fetus begins to work. She works out male hormones, and if the mother has an increased number of them or is sensitive to them, the consequences will not be slow to affect: the muscles in the cervix weaken, and the cervix opens.

ICI can also develop for more prosaic reasons. For example, if the pregnancy is multiple or there is polyhydramnios. In this case, the load on the cervix is more than with normal pregnancy which can also lead to insufficiency. Do not forget about the pathologies of the development of the uterus.

Symptoms of ICI

Unfortunately, isthmic-cervical insufficiency is asymptomatic. Only in some cases, ICI in the early stages can manifest itself in much the same way as a threatened miscarriage: spotting spotting, pulling pains in the abdomen, bursting sensations in the vagina. Usually, there are no symptoms in ICI during pregnancy.

Diagnosis of CCI

Due to the fact that CCI is almost asymptomatic, it is very difficult to diagnose it. To do this, you need to regularly visit a gynecologist and carry out vaginal examination every visit. Unfortunately, many doctors believe that it is enough to examine the birth canal when registering and already in the hospital before childbirth.

As a result, the woman attends a consultation, but the doctor only measures the weight, size of the abdomen and blood pressure. Under such conditions, a woman can find out about the diagnosis of CCI during pregnancy when it is already too late.

Often, the field of miscarriage or premature birth is already known about with the help of a special study: hysterosalpingography - X-ray uterus and tubes with the use of a radiopaque substance.

Of course, if a woman has previously had this pathology her health will be monitored much more closely. However, you can insist that a vaginal examination be performed every time you visit a gynecologist.

During the examination, the doctor should pay attention to the softening of the cervix, a decrease in its length by initial stage ICI, and opening of the cervix at a later stage.

One question remains, how long is the cervix considered normal? Much depends on the period, because closer to childbirth, a decrease in length is considered normal:

for a period of 24-28 weeks: 35-45 mm;
after 28 weeks: 30-35 mm.

However, at the disposal of the doctor only his own feelings and a gynecological mirror. And if the external os of the uterus is not yet open, the gynecologist can only assume ICI, and more accurately make a diagnosis using ultrasound.

The study is carried out with a vaginal probe. The following factors are noted that make it possible to determine whether isthmic-cervical insufficiency occurs:

length of the cervix;
opening of the internal os.

If the internal os has already begun to open, and the external one is still closed, the cervix takes on a V-shape, and this is clearly visible on ultrasound. There are several additional tests that allow you to clarify the diagnosis in complex cases. For example, a woman can provoke a cough or put pressure on the bottom of the uterus (that is, in her upper part). This is necessarily reflected in the cervix, and the ICI makes itself felt.

Treatment of ICI

Only after the diagnosis is accurately established, as well as the cause of the pathology, it is possible to proceed with the treatment of ICN during pregnancy. Without knowing the cause, as in any other case, it will not be possible to choose an adequate treatment.

First of all, there is a functional ICI that occurs against the background of hormonal disruptions. In this case, assigned hormone therapy designed to restore normal level hormones. The drug is continued for 1-2 weeks, after which the patient is re-examined. If the situation has stabilized, and the cervix no longer opens, then the medication is continued, while maintaining constant monitoring of the condition of the pregnant woman. If the situation worsens, other methods of treatment are preferred.

The second way to treat ICI during pregnancy is installation of an unloading pessary , it is also called the Meyer ring. In fact, it is a small plastic structure of a special shape. It is placed in the vagina, and it supports the cervix, redistributes the weight of the fetus and amniotic fluid, and allows you to keep the pregnancy.

Meyer's ring can be installed at almost any time when it is generally advisable to delay childbirth. It is he who is used in cases of unlaunched ICI against the background of multiple pregnancy or polyhydramnios. If the ICI is pronounced, then this way can only be used as an aid.

No matter how useful a pessary is, it is still foreign body, which can provoke vaginal dysbiosis. To avoid this, the woman regularly takes swabs, and also carry out preventive sanitation with antiseptics. In rare cases, antibiotics may be prescribed.

The ring is removed after 37 weeks, or if labor begins.

In cases where the plastic ring is clearly not enough, the following method of treating ICI during pregnancy is chosen: suturing . The internal os of the uterus is narrowed and sutured with non-absorbable threads. The most commonly used silk.

How long is the operation? In this case, everything is determined individually. Most often, stitches are applied in the early stages, that is, up to 17 weeks. Depending on individual indications, the operation can be performed later, but no later than 28 weeks. In this matter, the pessary compares favorably with sutures; it can also be installed at a later date.

Suturing is a rather serious operation. It is carried out in a hospital, under local, short-term anesthesia. Particular attention is paid to the selection of anesthesia. It must not harm the child. To avoid complications, a smear for microflora is taken a few days before the operation, and immediately before the procedure, the vagina is sanitized. Smears and sanitation are done after suturing.

Increased uterine tone with stitches already in place is a serious risk. Therefore, patients are often prescribed drugs that reduce the tone of the uterus, such as magnesia and ginipral, as well as antispasmodics, for example, the same papaverine.

You can remove the stitches in a simple gynecologist's office on a chair. Do this in the following cases:

At 38 weeks, since the pregnancy is already considered full-term, and labor can begin at any time;
If stable labor activity begins at any time;
If amniotic fluid depart or begin to leak, since in this case there is a risk of infection of the fetus, and we are already talking about urgent delivery;
If bleeding is observed;
When cutting seams.

If the sutures are not removed at the appropriate time, but due to complications that arise, doctors correct and treat these complications. After that, a decision is made whether to re-correct.

Unfortunately, this procedure, like almost all medical procedures, there are a number of contraindications. Including:

various serious illnesses mothers;
pathology of fetal development;
placenta previa.

Compliance with the regime

Any pathology during pregnancy requires not only timely treatment, but also compliance with one or another regimen. Isthmic-cervical insufficiency is no exception. A woman with this pathology needs to give up unnecessary physical activity, exclude sexual contacts, lie more. Let your loved ones do the household chores for you. Remember to take all your prescribed medications on time.

Not the last role is played by mental attitude women. During this period, optimism, faith in success and a positive outcome of the situation are very important. And of course, don't miss your scheduled checkups. Your health and the birth of your child depend on it.

Childbirth with ICI

Since ICI is, in fact, the inability of the muscle ring to remain closed, often childbirth with ICI is rapid. Of course, here everything is individual, and the time of delivery may be different.

Timely therapy and adherence to the regimen, as a rule, help expectant mother bring the child to the due date. Then the woman is placed in a hospital in advance, where she is under constant supervision.

In cases where childbirth still begins before the term, the situation is somewhat more complicated. It is very important to get to the maternity hospital in a timely manner, and at the same time be fully armed, that is, at least with your dad's documents: an exchange card, a policy, a passport. The exchange card is especially important, as it contains information about your pregnancy, which is necessary for obstetricians to proper management childbirth. Therefore, it is especially important for women with ICI to carry all documents with them.

Fortunately, isthmic-cervical insufficiency is still quite rare. A modern medicine allows you to solve this problem, and without harm to the woman and her baby. Therefore, this diagnosis should not be afraid. The main thing is to follow all the recommendations of your doctor.

I like!

Among various reasons miscarriage isthmic-cervical insufficiency (ICN) occupies an important place. In its presence, the risk of miscarriage increases by almost 16 times.

The overall incidence of CI during pregnancy is 0.2 to 2%. This pathology is main reason miscarriage in the second trimester (about 40%) and premature birth - in every third case. It is detected in 34% of women with habitual spontaneous abortion. According to most authors, almost 50% of late pregnancy losses are caused precisely by isthmic-cervical incompetence.

In women with a full-term pregnancy, childbirth with ICI often has a rapid character, which negatively affects the child's condition. Besides, rapid delivery very often complicated by significant ruptures of the birth canal, accompanied by massive bleeding. ICN - what is it?

Definition of the concept and risk factors

Isthmic-cervical insufficiency is a pathological premature shortening of the cervix, as well as the expansion of its internal os (muscular "obturator" ring) and the cervical canal as a result of an increase in intrauterine pressure during pregnancy. This can cause the fetal membranes to fall into the vagina, rupture and lose the pregnancy.

Reasons for the development of ICI

In accordance with modern concepts, the main causes of inferiority of the cervix are three groups of factors:

Organic - the formation of cicatricial changes after traumatic injury necks.
Functional.
Congenital - genital infantilism and malformations of the uterus.

The most frequent provoking factors are organic (anatomical and structural) changes. They may result from:

cervical rupture during childbirth large fruit, And ;
and extraction of the fetus by the pelvic end;
rapid childbirth;
overlays obstetric forceps and vacuum extraction of the fetus;
manual separation and allocation of the placenta;
carrying out fruit-destroying operations;
artificial instrumental abortions and;
operations on the cervix;
various other manipulations accompanied by its instrumental extension.

The functional factor is represented by:

dysplastic changes in the uterus;
ovarian hypofunction and high content in the body of a woman, male sex hormones (hyperandrogenism);
elevated levels of relaxin in the blood in cases of multiple pregnancy, induction of ovulation by gonadotropic hormones;
long-term chronic or acute inflammatory diseases internal genital organs.

Risk factors are also age over 30 years, overweight bodies and obesity, in vitro fertilization.

In this regard, it should be noted that the prevention of CI consists in the correction of the existing pathology and in the exclusion (if possible) of the causes that cause organic changes cervix.

Clinical manifestations and diagnostic possibilities

It is quite difficult to make a diagnosis of isthmic-cervical insufficiency, except for cases of gross post-traumatic anatomical changes and some developmental anomalies, since currently existing tests are not completely informative and reliable.

The main symptom in the diagnosis, most authors consider a decrease in the length of the cervix. During vaginal examination in the mirrors, this sign is characterized by flaccid edges of the external pharynx and the gaping of the latter, and the internal pharynx freely passes the gynecologist's finger.

Diagnosis before pregnancy is established if it is possible to introduce into cervical canal during the secretory phase of expander No. 6. It is desirable to determine the state of the internal pharynx on the 18th - 20th day from the onset of menstruation, that is, in the second phase of the cycle, with the help of which the width of the internal pharynx is determined. Normally, its value is 2.6 mm, and a prognostically unfavorable sign is 6-8 mm.

During pregnancy itself, as a rule, women do not present any complaints, and clinical signs suggesting the possibility of a threatened abortion are usually absent.

In rare cases, indirect symptoms of CI are possible, such as:

sensations of discomfort, "bursting" and pressure in lower sections abdomen
stabbing pains in the vaginal area;
discharge from the genital tract of a mucous or sanious nature.

During the period of observation in the antenatal clinic, such a symptom as prolapse (protrusion) of the fetal bladder is of considerable importance in relation to the diagnosis and management of a pregnant woman. At the same time, the degree of threat of termination of pregnancy is judged by 4 degrees of location of the latter:

I degree - above the internal pharynx.
II degree - at the level of the internal pharynx, but not visually determined.
III degree - below the internal pharynx, that is, in the lumen of the cervical canal, which already indicates a late detection of its pathological condition.
IV degree - in the vagina.

Thus, the criteria for preliminary clinical diagnostics isthmic-cervical insufficiency and the inclusion of patients in risk groups are:

Past history of mildly painful miscarriages in late gestation or rapid preterm labor.
. This takes into account that each subsequent pregnancy ended premature birth at ever earlier gestational dates.
Pregnancy after long period infertility and use .
The presence of prolapse of the membranes in the cervical canal at the end of the previous pregnancy, which is established according to the anamnesis or from the dispensary record card located in the antenatal clinic.
Data of vaginal examination and examination in the mirrors, during which signs of softening of the vaginal part of the cervix and its shortening, as well as prolapse of the fetal bladder into the vagina, are determined.

However, in most cases, even a pronounced degree of prolapse of the fetal bladder proceeds without clinical signs, especially in primiparas, due to a closed external os, and risk factors cannot be identified until the onset of labor.

In this regard, ultrasound in isthmic-cervical insufficiency with the determination of the length of the cervix and the width of its internal pharynx (cervicometry) acquires a high diagnostic value. More reliable is the technique of echographic examination by means of a transvaginal sensor.

How often should cervicometry be done in CCI?

It is carried out at the usual screening terms of pregnancy, corresponding to 10-14, 20-24 and 32-34 weeks. In women with habitual miscarriage in the second trimester, in cases of an obvious presence of an organic factor or if there is a suspicion of the possibility of post-traumatic changes from 12 to 22 weeks of pregnancy, it is recommended to conduct a dynamic study - every week or 1 time in two weeks (depending on the results of examining the cervix in the mirrors ). Assuming the presence of a functional factor, cervicometry is carried out from 16 weeks of gestation.

The criteria for evaluating the data of an echographic study, mainly on the basis of which the final diagnosis is carried out and selected treatment of ICI during pregnancy are:

In first- and second-pregnant women at terms less than 20 weeks, the length of the neck, which is 3 cm, is critical in terms of threatening spontaneous abortion. Such women need intensive monitoring and inclusion in the risk group.
Up to 28 weeks at multiple pregnancy bottom line the norm of the length of the neck is 3.7 cm in primigravidas, and 4.5 cm in recurrent pregnancies.
The norm of the length of the neck in multiparous healthy pregnant women and women with ICI at 13-14 weeks is from 3.6 to 3.7 cm, and at 17-20 weeks the cervix with insufficiency is shortened to 2.9 cm.
An absolute sign of miscarriage, in which an appropriate surgical correction with ICI, this is the length of the cervix, which is 2 cm.
The width of the internal os is normal, which is 2.58 cm by the 10th week, gradually increases and reaches 4.02 cm by the 36th week. predictive value has a decrease in the ratio of the length of the neck to its diameter in the area of the internal pharynx to 1.12-1.2. Normally, this parameter is 1.53-1.56.

At the same time, the variability of all these parameters is affected by the tone of the uterus and its contractile activity, low placental attachment and the degree of intrauterine pressure, creating certain difficulties in interpreting the results in terms of differential diagnosis reasons for threatened miscarriage.

Ways to maintain and prolong pregnancy

When choosing methods and drugs for the correction of pathology in pregnant women, a differentiated approach is necessary.

These methods are:

conservative - clinical guidelines, treatment with drugs, the use of a pessary;
surgical methods;
their combination.

Includes psychological impact by explaining the possibility of successful gestation and childbirth, and the importance of following all the recommendations of a gynecologist. Advice is given regarding the elimination of psychological stress, the degree physical activity depending on the severity of the pathology, the possibility of decompression gymnastics. It is not allowed to carry loads weighing more than 1 - 2 kg, long walking, etc.

Can I sit with ICI?

Long stay in sitting position, as well as the vertical position in general, contributes to an increase in intra-abdominal and intrauterine pressure. In this regard, during the day it is desirable to be in a horizontal position more often and longer.

How to lie down with ICI?

You need to rest on your back. The foot end of the bed should be raised. In many cases, strict bed rest is recommended, mainly following the above provisions. All these measures can reduce the degree of intrauterine pressure and the risk of prolapse of the fetal bladder.

Medical therapy

Treatment begins with a course of anti-inflammatory and antibiotic therapy drugs from the fluoroquinolone or cephalosporin group of the third generation, taking into account the results of a preliminary bacteriological study.

To reduce and, accordingly, intrauterine pressure, such antispasmodic drugs, as Papaverine inside or in suppositories, No-shpa inside, intramuscularly or intravenously by drip. With their insufficient effectiveness, tocolytic therapy is used, which contributes to a significant decrease in uterine contractility. The optimal tocolytic is Nifedipine, which has the smallest number side effects and their low intensity.

In addition, with ICI, it is recommended to strengthen the cervix with Utrozhestan of organic origin up to 34 weeks of pregnancy, and with a functional form through Proginov's preparation for up to 5-6 weeks, after which Utrozhestan is prescribed for up to 34 weeks. Instead of Utrozhestan, active ingredient which is progesterone, analogues of the latter (Dufaston, or dydrogesterone) can be prescribed. In cases of hyperandrogenism, the basic drugs in the treatment program are glucocorticoids (Metipred).

Surgical and conservative methods of correction of CI

Can the cervix lengthen with CCI?

In order to increase its length and reduce the diameter of the internal os, such methods as surgical (suturing) and conservative are also used in the form of installing perforated silicone obstetric pessaries of various designs that help to shift the cervix towards the sacrum and keep it in this position. However, in most cases, the lengthening of the neck to the required (physiological for a given period) value does not occur. Usage surgical method and the pessary is carried out against the background of hormonal and, if necessary, antibiotic therapy.

What is better - sutures or a pessary for CCI?

The procedure for inserting a pessary, as opposed to surgical technique suturing is relatively simple in terms of technical implementation, does not require the use of anesthesia, is easily tolerated by a woman and, most importantly, does not cause circulatory disorders in the tissues. Its function is to reduce the pressure of the fetal egg on the incompetent cervix, preserve the mucous plug and reduce the risk of infection.

Obstetric unloading pessary

However, any technique requires differentiated approach. At organic form ICI the imposition of circular or U-shaped (better) sutures is advisable in terms of 14-22 weeks of pregnancy. If a woman has a functional form of pathology, an obstetric pessary can be installed within a period of 14 to 34 weeks. In case of progression of shortening of the cervix to 2.5 cm (or less) or an increase in the diameter of the internal os to 8 mm (or more), in addition to the pessary, surgical sutures. Removal of the pessary and removal of sutures in CCI is carried out in a hospital at the 37th - 38th weeks of pregnancy.

Thus, ICI is one of the most common causes of abortion before 33 weeks. This problem has been studied to a sufficient extent and an adequately corrected ICI of 87% or more makes it possible to achieve the desired results. At the same time, correction methods, ways to control their effectiveness, as well as the question of optimal timing surgical treatment are still debatable.