To make the uterus open faster. How does the cervix change before childbirth?

Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and her cervix prepare for the birth process. In particular, the cervix begins to "ripen" and expand, that is, it enters the stage of opening the uterine os. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and the state of the hormonal background, which determines their successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity with the vagina. Directly in the neck, the vaginal part is distinguished - the visible part that protrudes into the vagina below its arches. And also there is supravaginal - the upper part, located above the arches. In the cervix passes the cervical (cervical) canal, the upper end of it is called the internal pharynx, respectively, the lower end is the outer one. During pregnancy, there is a mucous plug in the cervical canal, the function of which is to prevent the penetration of infection from the vagina into the uterine cavity.

The uterus is the female reproductive organ, the main purpose of which is the bearing of the fetus (fetal container). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is the muscular tissue and the outer one is the serous membrane. The main mass of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during the birth act.

Periods of childbirth

The birth process lasts quite a long time, and normally in primiparous women in labor it is 10-12 hours, while in multiparous women it lasts about 6-8 hours. Childbirth itself includes three periods:

I period - the period of contractions (opening of the uterine os);
II period is called the period of attempts (the period of expulsion of the fetus);
III period - this is the period of separation and discharge of the child's place (afterbirth), therefore it is called the afterbirth period.

The longest stage of the birth act is the period of opening of the uterine os. It is caused by uterine contractions, during which the fetal bladder is formed, the fetal head moves along the pelvic ring and cervical opening is provided.

Contraction period

First, contractions arise and are established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30 - 40 seconds, and relaxation of the uterus 80 - 120 seconds. Prolonged relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower uterine segment, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself is stretched and lengthened.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the small pelvis, separating the amniotic fluid, as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts as a hydraulic wedge, wedged into the internal os, opening it.

In first-borns, the latent phase of disclosure is always longer than in women giving birth for the second time, which causes a longer total duration of labor. Completion of the latent phase is marked by complete or almost complete smoothing of the neck.

The active phase begins with 4 cm of cervical dilatation and lasts up to 8 cm. At the same time, contractions become more frequent and their number reaches 3–5 in 10 minutes, the periods of contraction and relaxation of the uterus equalize and amount to 60–90 seconds. The active phase lasts for primiparous and multiparous 3-4 hours. It is in the active phase that labor activity becomes intense, and the cervix opens quickly. The fetal head moves along the birth canal, the cervix has completely passed into the lower uterine segment (merged with it), by the end of the active phase, the opening of the uterine os is complete or almost complete (within 8–10 cm).

At the end of the active phase, the fetal bladder opens and the water is poured out. If the cervical opening has reached 8 - 10 cm and the water has departed - this is called a timely outflow of water, the discharge of water at the opening of up to 7 cm is called early, with 10 or more cm of opening of the pharynx, an amniotomy is indicated (the procedure for opening the fetal bladder), which is called a belated outflow of water.

Terminology

The opening of the cervix does not have any symptoms, only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing the neck is progressing, one should decide on obstetric terms. In the recent past, obstetricians determined the opening of the uterine os in the fingers. Roughly speaking, how many fingers the uterine pharynx passes through, such is the opening. On average, the width of the "obstetric finger" is 2 cm, but, as you know, everyone's fingers are different, so measuring the opening in cm is considered more accurate. So:

if the cervix is opened by 1 finger, then they say about the opening of 2 - 3 cm;
if the opening of the uterine os has reached 3–4 cm, this is equivalent to opening the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
an almost complete opening is indicated by the opening of the neck by 8 cm or by 4 fingers;
full disclosure is fixed when the cervix is completely smoothed (the edges are thin) and passable for 5 fingers or 10 cm (the head falls to the pelvic floor, turning with an arrow-shaped seam in a straight size, there is an irresistible desire to push - it's time to go to the delivery room for the birth of a baby - the beginning of the second period childbirth).

How does the cervix mature?

The harbingers of childbirth that have appeared indicate the imminent onset of the birth act (from about 2 weeks to 2 hours):

the bottom of the uterus descends (for 2-3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the small pelvis, a woman feels this sign by easing breathing;
the pressed head of the fetus presses on the pelvic organs (bladder, intestines), which leads to frequent urination and constipation;
increased excitability of the uterus (the uterus “hardens” when the fetus moves, the woman moves abruptly, or when the abdomen is stroked / pinched);
appearance is possible - they are irregular and rare, pulling and short;
the cervix begins to "ripen" - softens, skips the tip of the finger, shortens and "centers".

The opening of the cervix before childbirth proceeds very slowly and gradually over a month, and intensifies on the last day - two on the eve of childbirth. In nulliparous women, the dilatation of the cervical canal is about 2 cm, while in multiparous women, the dilatation exceeds 2 cm.

To determine the maturity of the cervix, a scale developed by Bishop is used, which includes an assessment of the following criteria:

the consistency (density) of the neck: if it is dense, this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both from the inside and outside - 2 points;
the length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - a score of 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
patency of the cervical canal: a closed external pharynx or skips the tip of a finger - a score of 0 points, the cervical canal is passable to a closed internal pharynx - this is estimated at 1 point, and if the canal passes one or 2 fingers through the internal pharynx - it is estimated at 2 points;
how the neck is located in relation to the wire axis of the pelvis: directed backwards - 0 points, shifted anteriorly - 1 point, located in the middle or "centered" - 2 points.

When summing the points, the maturity of the cervix is estimated. An immature neck is considered with a score of 0 - 2 points, 3 - 4 points is regarded as an insufficiently mature or ripening neck, and with 5 - 8 points they speak of a mature neck.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38-39 weeks at the appointment at the antenatal clinic).

If a woman is already in the maternity ward, a vaginal examination to determine the process of opening the uterine os every 4 to 6 hours or according to emergency indications:

discharge of amniotic fluid;
carrying out a possible amniotomy (weak birth forces, or a flat fetal bladder);
with the development of anomalies of generic forces (clinically narrow pelvis, excessive labor activity, discoordination);
before regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
the occurrence of discharge with blood from the genital tract;
in the case of established regular labor activity (preliminary period that turned into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of disclosure, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on the soft tissues of the genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the swept suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. Be sure to evaluate the fetal bladder (integrity, functionality).

According to the subjective signs of disclosure and the data of the vaginal examination, a partogram of childbirth is compiled and maintained. Contractions are considered subjective signs of childbirth, in particular, the opening of the uterine os. Criteria for evaluating contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). Partogram of childbirth allows you to visually record the dynamics of the opening of the uterine os. A graph is drawn up, horizontally indicating the duration of labor in hours, and vertically opening the cervix in cm. Based on the partogram, one can distinguish between the latent and active phases of labor. The steep rise of the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

The opening of the cervix during pregnancy, that is, long after childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not fulfill their main function in the process of gestation - obturator. In this case, the neck softens, shortens and smoothes, which does not allow the fetus to be kept in the fetus and leads to spontaneous abortion. Termination of pregnancy, as a rule, occurs in 2 - 3 trimesters. The failure of the cervix is evidenced by the fact of its shortening to 25 mm or less at 20-30 weeks of gestation.

Isthmic-cervical insufficiency is organic and functional. The organic form of the pathology develops as a result of various cervical injuries - artificial abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is due either to a hormonal imbalance or an increased load on the neck and isthmus during pregnancy (multiple pregnancies, excess water or a large fetus).

How to keep a pregnancy when dilating the cervix

But even with a cervical opening of 1 - 2 fingers in a period of 28 weeks or more, it is likely to keep the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases are appointed:

bed rest;
emotional peace;
sedatives;
antispasmodics (magne-B6, no-shpa,);
tocolytics (ginipral, partusisten).

Be sure to carry out treatment aimed at the production of surfactant in the lungs of the fetus (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature opening of the cervix is surgical - stitches are applied to the neck, which are removed at 37 weeks.

The cervix is immature - what then?

The opposite situation is possible, when the cervix is “not ready” for childbirth. That is, the hour X has come (the expected date of birth), and even several days or weeks have passed, but there are no structural changes in the cervix, it remains long, dense, rejected backwards or forwards, and the internal pharynx is impassable or passes the tip of the finger. How do doctors act in this case?

All methods of influencing the neck, leading to its maturation, are divided into drug and non-drug. Medical methods include the introduction into the vagina or into the cervix of special gels and suppositories with prostaglandins. Prostaglandins are hormones that accelerate the process of maturation of the cervix, increase the excitability of the uterus, and in childbirth, their intravenous administration is practiced in case of weakness of the birth forces. Local administration of prostaglandins has no systemic effect (no side effects) and contributes to the shortening and smoothing of the neck.

Of the non-drug methods of stimulating the opening of the cervix, the following are used:

Sticks - kelp

Sticks are made from dried kelp algae, which are highly hygroscopic (absorb water well). Such a number of sticks are introduced into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for opening the cervix is represented by a flexible tube with a balloon fixed at one end. A catheter with a balloon at the end is inserted into the cervical canal by a doctor, the balloon is filled with air and left in the neck for 24 hours. Mechanical action on the neck stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, in some maternity hospitals they refused to conduct a cleansing enema for a woman who came to give birth, but in vain. The free intestine, as well as its peristalsis during defecation, increases the excitability of the uterus, increases its tone, and, consequently, accelerates the process of opening the cervix.

Question answer

How can you speed up the opening of the cervix at home?

prolonged walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the small pelvis, further stimulating the opening of the cervix;
watch the bladder and intestines, avoid constipation and prolonged abstinence from urination;
eat more salads from fresh vegetables seasoned with vegetable oil;
take a decoction of raspberry leaves;
stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
Are there any specific neck opening exercises?

At home, walking up the stairs, swimming and diving, bending and turning the torso accelerates the maturation of the neck. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, yoga. In maternity hospitals there are special gymnastic balls, the seat and jumps on which, during the period of contractions, accelerate the opening of the uterine os.

Does sex really help prepare the cervix for childbirth?

Yes, having sex in the last days and weeks of pregnancy (subject to the integrity of the fetal bladder and the presence of a mucous plug in the cervical canal) contributes to the maturation of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, the semen contains prostaglandins, which have a beneficial effect on the process of maturation of the cervix.

At what opening do attempts begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in a woman in labor already at 8 cm. But until the cervix opens completely (10 cm), and the head sinks to the bottom of the small pelvis (that is, it can be felt by a doctor by pressing on the labia) - you can’t push.

The neck of the reproductive organ plays the role of a ring that closes the entrance, holding the child inside. For 9 months, the baby grows, the volume of amniotic fluid increases. The pressure on the pelvic bones becomes more and more. The body does not always withstand the load. Often there are symptoms and signs of dilatation of the cervix during preterm pregnancy. The phenomenon is dangerous, quite common. If timely treatment is not taken, a miscarriage will occur.

In the course of bearing a child, failures occur in the body. Muscle tissue is partially replaced by connective tissue. New collagen fibers begin to form. Unlike the previous ones, they are more flexible and elastic. A small amount is absorbed, forming the main substance. You can understand that the neck is opening by appearance. It looks loose, shortened, with a visible channel.

The body begins to prepare for labor at 32 to 34 weeks. This is manifested by softness on the outside. The channel is still quite dense. Complete softening of the cervix occurs at 36-38 weeks. The baby moves into the pelvis at this stage of pregnancy. The pressure on the reproductive organ increases, forcing it to open.

The process begins with the internal pharynx. The baby moves along the birth canal, which has the form of a cone with a wide side at the exit. The fabrics are gradually stretched. In women who give birth again, the procedure is faster. The channel opens from both sides at the same time, the opening of the cervix during pregnancy is practically not felt.

Immediately before the onset of the birth process, it is depleted, it looks too short. 2 or more fingers will fit inside. However, the action does not stop. The limit is 10 - 12 cm. This width of the hole is required for the successful exit of the baby's head. The degree of cervical maturity is determined according to the Bishop scale.

There are 3 types:

immature;
maturing;
mature.

The first is characterized by density, length more than 2 cm, closeness of the external pharynx. The second corresponds to external softness, internal hardness. There is a shortening to 1 - 1.5 cm. Half of the path becomes passable. The third type is marked by softness, the ability to insert 2 fingers.

A couple of hours before the start of the birth process, cramping pains appear when the cervix opens. They do not differ in long-term nature, are not very intense, and do not cause structural changes. The duration is normally about 6 hours.

Signs of ICI

It is difficult to consider isthmic-cervical insufficiency in the second trimester of bearing a baby. The doctor receives data when examining the vagina with an ultrasound, examining it using a mirror. You need to find the problem quickly so that a miscarriage does not happen.

Can you feel the dilatation of the cervix? Yes and no. Some women in labor come to the maternity hospital with an opening of 2 cm, without feeling anything. Others experience pain with contractions.

Signs of dilatation of the cervix in the second trimester:

bleeding;
pain in the lower abdomen;
shortening, softening;
pressure on the vagina;
on examination, the amniotic sac is visible;
length discrepancy with the parameters of the norm;
pharynx is open.

If at least one of these symptoms is detected, immediate therapy is required. Two or more are considered a signal for the placement of a woman in labor in the clinic. Diarrhea, nausea when opening the cervix are also observed. Speaks of insufficiency protrusion of the fetal bladder.

Accommodation options:

on top of the internal pharynx;
on the line of the hole, but invisible to the eye;
in the canal, visible during inspection;
moved into the vagina.

What does it feel like when the cervix opens?

pain of a pulling nature, radiating to the hips;
a feeling of discomfort due to a lowered baby;
spasms in the vagina.

A gynecologist is able to diagnose CCI by having:

information about previous miscarriages that occurred in the last trimester of gestation;
data on premature termination of pregnancy by labor activity at an early stage;
information that conception occurred after IVF;
results of prolapse of the fetal bladder;
mirror inspection indicators.

Quite often, many signs are absent. Therefore, it is difficult to understand that the opening of the cervix is difficult. Ultrasound is considered the most effective method. The method will promptly indicate the insufficiency, and will also determine why it appeared.

Sometimes women enter the maternity hospital with an opening of 1 - 2 cm. They are not even aware of the ongoing process. Everything is carried out imperceptibly, the opening of the cervix begins without contractions. Sipping, tingling is rarely observed.

Causes

Premature opening of the cervix in early pregnancy often ends in miscarriages. Softening provokes expansion, opening. It is difficult for the fetus to hold on.

ICI is of 2 types:

organic;
functional.

What a particular woman will have will be determined by the reasons that formed her. Organic is also called traumatic because it is caused by trauma. The neck loses its elasticity, becomes scarred.

abortions;
miscarriages;
neck injury;
treatment of polyps, erosion;
scraping.

Scar tissue cannot stretch. It is made up of connective fibers. They differ in increased rigidity. The ability to contract is lost. As a result, the baby is not kept inside. IC appears.

Function call:

restructuring of hormones;
polyhydramnios;
pathology of the genital organ;
tissue imbalance.

A large amount of androgen produced or a small amount of progesterone leads to hormone failure. A consequence is revealed at the 11th week of bearing a child. The neck weakens, opens.

A large accumulation of water is also considered a serious cause. This phenomenon is observed in multiple pregnancies. The load on the reproductive organ increases, insufficiency is formed.

These reasons contribute to softening of varying degrees. The uterus prepares for childbirth ahead of time, becomes supple. The baby grows, the ability to keep inside decreases. Functional insufficiency affects women who have problems with the work of the ovaries. Congenital CI is also sometimes present.

This disease varies from woman to woman. Instead of one reason, it can be caused by two or more. In any case, it is difficult for the child to hold on, he is heading for the exit. As you go down, the pressure increases. A low position leads to infection. As a result, a miscarriage or premature labor is obtained.

Treatment

The doctor establishes the exact causes of the insufficiency, then recommends a course of therapy. With functional hormonal drugs are often prescribed. They restore hormone levels in 1-2 weeks. After the situation improves, the treatment does not stop.

How to check the cervix before childbirth:

manual inspection;
ultrasound diagnostics.

It is necessary to observe bed rest, when all signs of the opening of the cervix before childbirth are observed in a woman in the early stages of bearing a child. The gynecologist recommends complete calm. Any load should be limited.

Conservative treatments involve the use of the Meyer ring. The product is made of plastic. Purpose: to restrain the pressure of the child on the neck. Manipulation is suitable for women in labor with a small opening at a gestation period of 28 weeks or more. Thanks to him, the weight of the baby is evenly distributed. This method is used as an auxiliary.

At an earlier period, in the absence of infectious diseases, surgical intervention is prescribed. The goal is to suture the cervix so that dilatation does not occur until after delivery. During surgery, no discomfort is felt. Anesthesia is administered in advance. The suture material is removed before the onset of labor, when the fetal bladder is opened.

Both types of treatment of the disease involve the appointment of antibacterial drugs. They are needed to exclude birth, to prevent the infectious process. To enhance effectiveness, antispasmodics are prescribed. Reduce hypertonicity by tocolytic means. Hormonal drugs are prescribed if the opening is observed due to a malfunction of the endocrine system.

Stimulation of dilation during childbirth

With a mature cervix, labor begins at 38 weeks and ends with the birth of a baby. Sometimes doctors stimulate the process. Indications are premature, late labor activity. The beginning is spontaneous, weakly flowing, with an unexpected stop.

How to open the uterus before childbirth:

with the help of the introduction of medicines;
use amniotomy;
manually.

The obstetrician ascertains the weakness of the process, stimulates, if the reproductive organ stops contracting, contractions are not enough to fully open. The doctor uses medicines when 12 hours have passed after the waters have broken, and the process of giving birth to a child does not begin. Such stimulation is carried out carefully under the supervision of medical staff. The absence of an allergic reaction to drugs is checked prematurely.

Signs of the need to stimulate the opening of the uterus during childbirth:

hypertension;
preeclampsia;
early discharge of water;
stretch;
weak contractions, complete absence;
the reproductive organ is not disclosed;
heart failure;
detachment of the placenta;
late toxicosis.

The obstetrician, based on the indicators of the state of health of the woman in labor, makes a decision on stimulation. If symptoms of premature cervical dilatation appear during pregnancy in the third trimester, the doctor will recommend that the woman in labor go to the clinic for a couple of weeks. The medical staff will monitor the condition of the woman and the baby. If necessary, use the operational method.

The method of amniotomy is widely known. The bottom line is to pierce the bubble. The main indication for manipulation is a sudden stop of disclosure, which has already occurred by 2 cm. Piercing will speed up labor. Amniotic fluid will depart, pressure on the pelvic bones will decrease. The method is considered safe, absolutely painless.

Another way of stimulation is the opening of the cervix manually. Often used special tools - expanders. A prominent representative is an inflatable balloon filled with liquid. It acts on the neck, seeking an opening. During the application of the method, there is a danger of rupture of the bubble. Therefore, it is carried out in case of emergency.

Straightening of the cervix before childbirth occurs on the eve of the process. If during the examination the gynecologist finds that this did not happen, the procedure is carried out manually. Sometimes accompanied by severe pain. Manipulation is necessary to facilitate the exit of the child.

Signs of disclosure begin imperceptibly in many cases. Then a pulling pain sensation appears, the mucous, blood plug leaves. The main indicator of the approach of labor is uterine contractions. If these symptoms have made themselves felt in the middle of pregnancy, inform the gynecologist. There was a threat of premature birth of the baby.

By the time childbirth occurs, the cervix, imperceptibly to the woman herself, has completely changed. And this makes it possible for the baby to be born in a completely natural way. But not always the cervix can change itself to the extent that is necessary for independent childbirth. In this case, medical intervention is simply necessary.

How to check the dilatation of the cervix during childbirth

There are several parameters by which doctors determine the readiness of the cervix for childbirth. This is its placement in the small pelvis, the length and how soft it has become. If its softness allows you to pass 1-2 fingers inside, then this is a completely ripe and ready for childbirth cervix.

Also, these changes are confirmed by such a process as the discharge of the mucous plug. The cork can move away long before the appointed time, and this indicates that contractions will soon begin. Also, before childbirth, the neck should be shortened and its length should be within one centimeter. And when it comes to her position, the most optimal position is in the middle of the small pelvis.

Although during pregnancy, the cervix is slightly tilted back. Based on the indicators of these parameters, doctors put an estimate, the maximum can be equal to five. According to the same assessment, it is possible to determine the readiness of the cervix for labor. If the score is five, then they say that the cervix is ripe.

But quite often it happens that labor should begin soon, but the cervix is still completely unprepared. Then stimulation will be used to open it. If you do not resort to this method, then the child will soon begin to experience a lack of oxygen due to the fact that the placenta ages very quickly before childbirth, and the functions that it should perform become beyond its power.

How to help dilate the cervix during childbirth

Today, in order to stimulate the opening of the cervix, doctors use four methods.

Sinestrol injections into the muscles. Thanks to this drug, you can make the cervix mature, but it has nothing to do with contractions.

Laminaria sticks. The doctor places these 5 cm sticks into the cervical canal. As moisture acts on them, they swell and mechanically open the cervix.

Gel with prostaglandins. This is one of the most effective methods. Under its influence, the cervix will open in 2-3 hours.

Enzaprost intravenously. This drug also contains prostaglandins. Therefore, when using it, you can also reduce the duration of contractions.

There are cases when women prefer to stimulate their body on their own. The most common way is an enema, which promotes the discharge of the cork. But this can be done only for those pregnant women who have reached the appointed term of delivery, and the child is fully full-term.

If there are no contractions, but the water and the cork have already departed, then in this case stimulation with a warm bath is strictly prohibited. So, as there is a risk of catching some kind of infection. You can also use a variety of physical activities. The best thing for the body will be walking. But you can also clean up. But in such cases, you need to monitor your well-being, because the consequences will not always be the most pleasant.

Stages of cervical dilatation

The cervix does not open immediately during childbirth. Doctors distinguish several periods. The first period of cervical opening during childbirth is called slow, because in 4-6 hours the opening will be no more than 10 cm. At this time, the contractions are not too frequent - every 6-7 minutes. The second stage is called fast because the opening is 1 cm per hour. At this stage, contractions come every minute and so on until the opening is 10 cm. The third period is full disclosure, which indicates complete readiness for labor.

But sometimes there are cases when the cervix can open ahead of time. Therefore, in the last trimester, a woman should be ready for absolutely everything.

Before childbirth, a woman's body undergoes a number of processes that are aimed at the successful resolution of the burden and the birth of a viable fetus. The birth process itself is divided into three stages, each of which is characterized by certain characteristics.

Throughout pregnancy, and especially in the first stage of childbirth, the cervix plays an important role. This part of the uterus is the "lock" that locks the fetus for nine months and then releases it. The correct functioning of the cervix, its adequate condition during pregnancy is the key to the full bearing of the fetus.

In the event that the cervix is not able to close tightly, this can lead to miscarriages at any stage of pregnancy and premature birth. Then it is worth talking about isthmic-cervical insufficiency. This process is controlled by a leading gynecologist who monitors the state of the female genital area throughout the pregnancy. When viewed on a gynecological chair, it is not difficult to diagnose a slight opening or softening of the cervix. This pathology is a threat to a normal pregnancy. And if in the first months, while the fetus is small, a miscarriage will not occur, since the pressure on the cervix is still small, then already during the period of active growth of the child, the cervix may not withstand such pressure. In such cases, miscarriages occur most often from 20 to 30 weeks.

It is very important for a woman to visit a gynecologist in a timely manner, because symptoms of cervical dilatation for the woman herself may not appear, due to the fact that the disclosure did not occur under the influence of the hormonal system. Often, a pregnant woman does not feel any symptoms of disclosure at all and learns about this trouble only upon examination. And in some cases, a woman may experience tingling pain in the vaginal area, which must be consulted. The sooner the pathology is diagnosed, the sooner doctors will take the necessary measures to preserve the pregnancy. In this case, the process of maintaining pregnancy will be controlled in other ways (suturing the cervix, applying a pessary, wearing a bandage).

The cervix, as one of the most important organs in the entire process of pregnancy, undergoes changes throughout the entire period of gestation. For a woman and for a child, the processes that take place in the cervix at the very end of pregnancy are important - they signal that childbirth will begin soon. Every expectant mother needs to know the symptoms of cervical dilatation in order to seek help from a medical institution in time - perhaps to maintain pregnancy, and possibly for childbirth (depending on the stage at which these signs appear).

Changes that affect the opening of the cervix take place at 38-40 weeks. At this time, the placenta begins to age, which secretes hormones that serve for the normal course of pregnancy. At this time, the uterus and its cervix have such a tone that does not allow the child to grow, but, nevertheless, still does not allow to be born. After the placenta stops producing hormones aimed at maintaining the uterus, antagonist hormones appear in the woman's body, the task of which is to help the cervix to open up and the uterus itself to contract. Thus, the level of estrogen increases and the level of progesterone decreases, oxytocin, prostaglandins, acetylcholine, and serotonin accumulate. All these hormones will affect the course of labor and directly on the opening of the cervix.

Recently, while in the mother's abdomen, the child, under the influence of a slightly infantile uterus, descends into the pelvic cavity. As a result of pressure on the cervix, the body receives signals about the upcoming birth. The uterus is slightly strengthened in tone to facilitate childbirth. Thus, we are talking about the harbingers of childbirth - false contractions due to short-term prenatal hypertonicity. During this period, despite the pressure on the cervix, it does not open, although the uterus can contract.

The main feature of the cervix during the birth period is its smoothing (shortening) and softening. At the moments of smoothing the cervix, it expands its space for entry, this does not happen immediately, but gradually, over several hours. In fact, the entire first stage of labor consists of preparing the uterus and its cervix for subsequent active actions.

10 cm is the norm for the baby to be born

All the time for nine months the cervix is called immature. At this time, it is closed, does not let a finger inside, the length is about two centimeters. In the first few hours of the birth process, the uterus opens up quite a bit - just one centimeter, which is determined by the free passage of one finger.

Briefly about the opening of the cervix before childbirth in the video.

The neck is slightly softened and shortened. This condition of the cervix is called insufficiently mature. After a few hours, the cervix opens up so much that it can no longer hold the mucous plug - it quickly comes out, which signals the imminent start of the second stage. In the process of its opening, the cervix changes its location - in relation to the body of the uterus, it becomes larger in the center, and during pregnancy it can be shifted all the time. You can talk about the maturity of the cervix when it passes more than one finger inside, its length is less than one centimeter, and the cervix itself is soft. Usually, this condition of the cervix is determined by thirty-nine weeks, and with repeated births a little earlier. Physiologically, a woman is ready for childbirth, but in practice, most often pregnant women walk around with an open neck for a couple of weeks and give birth completely without pathologies at forty to forty-one weeks. Symptoms of cervical dilatation for a woman are practically not noticeable. Only sometimes can sip at the bottom of the stomach, which indicates the pressure of the fetus on the softened neck.

A very reliable sign of dilatation of the cervix - expulsion of the mucous plug. But the leakage of amniotic fluid - a signal that hospitalization is needed - either labor is approaching, or they will be stimulated so as not to leave the child without amniotic fluid. Gynecologists determine the signs of cervical dilatation more clearly.

While waiting for a baby, a woman feels anxiety and fear of the upcoming birth. In late pregnancy, this feeling intensifies. Women who have this first pregnancy are most worried. Uncertainty and complex medical terms scare expectant mothers. To reduce anxiety, a woman needs to understand what awaits her. Minimal knowledge will help prevent serious pathologies, since, knowing atypical symptoms, you can consult a doctor in a timely manner.

Why does the cervix dilate during childbirth?

The uterus itself is a hollow muscular organ. The inner walls are covered with a mucous membrane, the state of which changes on different days of the menstrual cycle. When pregnancy occurs, the fetus develops in the uterus. It is connected to the vagina with a special tube called the cervix. The inside of the neck is tightly closed. This is necessary to securely hold the baby inside and protect the fetus from the penetration of pathogenic microorganisms. The uterus consists of the body, fundus and cervix.

During childbirth, the cervix opens (see photo). This process is necessary for the unhindered passage of the child through the birth canal. Cervical preparation begins at the 32nd week of pregnancy (more in the article:). At this time, its walls become looser due to the partial replacement of muscle tissue with connective tissue. In addition, due to the production of the hormones estrogen and collagen, tissues become softer and more stretchable.

After the 38th week of pregnancy, the placenta ages. At the same time, the production of special hormones begins in the uterus, which provokes the preparation of the organ before childbirth.

How do doctors determine dilatation?

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Labor activity and the readiness of organs for the birth of a child are determined by the degree of cervical dilatation. As a rule, this condition is checked by palpation, when doctors determine how many fingers freely pass into the cervical lumen. Currently, the method of measuring in centimeters is often used. The opening for one finger is equal to two centimeters.
When opening the cervix by 3 cm, many pregnant women are concerned about the question, after how long will childbirth begin? Doctors determine the onset of labor depending on how open the birth canal is. After 4 cm, the cervix opens a centimeter every hour. For birth, the clearance should be 10–12 cm.
Can a pregnant woman check dilation on her own?
The opening of the cervix by 1-2 centimeters (per 1 finger) passes without characteristic signs. As a rule, a woman does not feel that changes have begun to occur in her body. In rare cases, pregnant women complain of heaviness in the lower abdomen and minor pain.
If the expectant mother noticed thick mucous brownish discharge, it means that the cork has come off. This symptom indicates the onset of labor. The amount of discharge depends on whether the protective plug has completely or partially come off. In any case, if suspicious discharge is found, you should contact a gynecologist.
Sometimes childbirth begins with the release of amniotic fluid. They are normally colorless and odorless. It is necessary to remember the time when the waters broke (see also:). In this case, the neck may not open. This process requires the presence of a doctor, it is better for a woman to immediately contact the maternity hospital. If the cervix does not pass several fingers 5–7 hours after the release of the fluid, labor should be stimulated, since prolonged exposure of the fetus without amniotic fluid leads to its hypoxia.
It is impossible to determine the exact disclosure in centimeters on your own at home. In order to examine the cervix before childbirth, check its readiness and understand the course of childbirth, you need special skills and knowledge that only specialists possess. In addition, the woman in labor is physically unable to do it herself.

Stages of cervical dilatation in pregnant women
Disclosure occurs in 3 stages:
Latent. It is characterized by mild contractions that occur without any periodicity. Painful sensations do not occur. If a woman is at home at this time, she rarely notices changes in her condition. During this period, it is recommended not to focus on contractions, try to get distracted or sleep. Favorably affects the muscles of breathing exercises and calm music. Medical intervention in the natural process during the latent period is not required. In rare cases, with the development of pathologies, the use of stimulants is possible. The period lasts from several hours to several days.
Fast. This increases the duration of contractions and reduces the interval between them. Contractions appear periodically, after 2-5 minutes. They become painful, with severe unbearable pain, painkillers are used. During this period, a woman needs to be under the supervision of a doctor so that he can correctly assess labor activity and provide the necessary assistance. It is not recommended to sit or lie down. A pregnant woman needs to stand, leaning on a stable surface, or walking. Thus, the maximum pressure of the weight of the child is achieved, the cervix should open faster. If it is more convenient for a woman to wait out the time of contractions while sitting, it is better to use a large ball - a fitball. In the fast period, there is an opening of 4–6 cm within 8–10 hours for women with a first pregnancy (primiparous) and 5–7 for pregnant women for the second and subsequent times (multiparous).
Full disclosure. At this time, the pregnant woman is under the supervision of doctors. The child's head descends into the small pelvis, as the cervix is completely opened, or, as obstetricians say, smoothed out. The obstetrician sits the woman in labor on a special chair, examines and asks to push. The time of the fast period and full disclosure depends on the individual characteristics of the body of the expectant mother and the readiness of her birth canal.

Possible problems
Why are there no contractions and the cervix is not ready if it's time to give birth? With the approach of the date of childbirth, the excitement of women intensifies. Primiparas are afraid of possible pain and uncertainty, women with a second pregnancy are frightened by previous experience, especially for those who have encountered problems during childbirth. The emotional state affects the functioning of the endocrine system. Due to stress, adrenaline is produced, which leads to the fact that the cervix is closed at the time of delivery.
Other causes of weak labor activity:
polyhydramnios - with a large amount of amniotic fluid, the walls of the uterus are unnecessarily stretched, which reduces their contractility;
oligohydramnios - with a lack of fluid, it is difficult for a child to pass through the birth canal, since the force of pressure on the neck is provided by the fetal bladder;
pathology of the endocrine system in a pregnant woman - the production of the necessary hormones is necessary for normal labor activity.

If dilatation is not observed after the 40th week of pregnancy, stimulation is applied. At this time, the placenta ages and ceases to perform its functions, as a result, the child receives insufficient nutrients and oxygen. This can cause the development of hypoxia.
If dilatation occurs before due date, it can lead to miscarriage. They try to stop the increase in the lumen from the 28th week of pregnancy. With an increase in the lumen by 1–2 cm, the inner edges of the cervix are sutured before delivery, which slows down further opening. If the lumen reaches 3-4 cm and the fetal head has fallen, then the woman is prescribed complete rest and the introduction of special drugs that accelerate the development of the child.
Ways to open the cervix in the hospital
If dilatation does not occur by the 40th week of pregnancy, uterine stimulation is used. The procedure should take place in the hospital under the supervision of doctors. The main methods include drug therapy. The use of various agents can lead to full disclosure in 5-7 hours after application. Most often used:
Miropriston. It helps to increase the contractile activity of the walls of the uterus. It is allowed to use 1 tablet per day.
Oxytocin. It is a solution for intramuscular injections. Stimulates opening.
No-Shpa (more details in the article:). It is a strong antispasmodic, relaxes muscles, reduces their tone, which contributes to rapid disclosure. Taken 2-3 tablets per day.
Papaverine. It is used in the form of tablets and injections. The action is aimed at reducing muscle tone. The dosage is determined individually, taking into account the condition of the birth canal.

Other methods of stimulation in the hospital:
suppositories and gels with prostaglandin - are inserted into the vagina, childbirth will begin a few hours after the injection (there are contraindications);
kelp sticks (look at the photo) - special sticks are placed in the neck, due to swelling they increase the lumen, in addition, they contain substances that prepare the neck for the passage of the child;
manual exposure - during a gynecological examination, the doctor expands the organ with his fingers;
amniotomy - puncture of the fetal bladder using a special device.

Is it possible to stimulate disclosure at home?
Ways to induce labor at home:
Compliance with the diet and taking special decoctions. A woman's diet should include more fresh vegetables and fruits. A decoction of raspberry leaves and berries helps to stimulate the opening of the neck, as it contains substances that relax muscles and reduce tone.
Cleansing enema. In this case, the effect on the back wall of the uterus occurs. In addition, this leads to the discharge of the cork, which provokes the onset of labor.
Sex. During orgasm, the uterus naturally contracts. Semen contains substances that soften the tissues of the cervix.
Physical exercise. The exercise should be agreed with the doctor, since muscle tension is contraindicated in preeclampsia and other pathological conditions. The complex is better to choose with an experienced instructor. Long walks, slow squats and fitball exercises are beneficial (see photo). You can't jump. In addition, high arm exercises should be avoided. During gymnastics, you need to monitor your breathing and relax your muscles in a timely manner.