Full disclosure how many fingers. Changes in the cervix during childbirth

Every woman in labor should know the symptoms of timely dilatation of the cervix during childbirth and exercises to speed up labor.

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Medical indications

Before finding out the signs of disclosure of the penis, it is necessary to consider its structure. The cervix is ​​the lower part of the uterus, presented as a narrow cylinder connecting the organ cavity with the vagina. In the neck there is a cervical canal with a pharynx. During pregnancy, there is a mucous plug in the canal. It prevents the development of an infectious process in the uterus, which is the female genital organ intended for bearing the fetus. It consists of the endometrium, middle muscle tissue and serosa. The muscle layer makes up the bulk of the organ. The myometrium is able to contract, so contractions occur during childbirth.

In this case, the opening of the pharynx and the expulsion of the fetus from the uterine cavity are observed. Normal and timely childbirth, as a rule, does not begin suddenly and violently. Before the birth of the baby, the woman in labor experiences various sensations that indicate the preparation of the uterus and her cervix for childbirth, which is a long and complex process, depending on the interaction of the uterus, her cervix and the state of hormones. In a primiparous woman, the birth process lasts 10-12 hours, and in a multiparous woman - 6-8 hours. In this case, childbirth consists of 3 periods:

• fight - the pharynx opens;
• attempts - the fetus is expelled;
• postpartum period - the child's place is separated.

The longest stage is the period of opening of the uterus. In this case, the woman in labor experiences uterine contractions. During this period, the fetal bladder is formed, and the baby's head moves forward. The neck of the organ opens.



Phases of the uterus

The first stage of childbirth is considered the longest. The uterine os opens during 2 phases: latent and active. The first of which lasts 5-6 hours from the first period. In this case, pain is absent or manifests itself to a slight extent. The frequency of contractions is less than 2 in 10 minutes. The uterus contracts every 30-40 seconds, and relaxes once every 80-120 seconds. After each contraction, the visible part of the neck is shortened, the lower segment of the organ is lengthened.



The ongoing processes contribute to the fixation of the child's head at the entrance to the small pelvis. Amniotic fluid is divided into anterior and posterior. In the first birth, the latent phase is longer than in subsequent ones. At the end of the phase, the neck is completely smoothed.

In the next phase, the uterus opens from 4-8 cm. The frequency of contractions increases to 3-5 times in 10 minutes. The uterus contracts and relaxes for the same period (60-90 seconds). The active phase lasts 3-4 hours. During this period, intensive labor activity is observed, the neck of the penis opens faster.

The baby's head moves through the birth canal. The cervix descended down the uterine segment. At the end of the phase, the pharynx opens, the fetal bladder opens, water pours out. If the neck has opened up to 8-10 cm, and the waters have departed, this is a timely outpouring of waters. If the waters have receded, and the cervix has opened up to 7 cm - an early outflow of waters. When opening the pharynx more than 10 cm, an amniotomy is indicated.





Symptoms of labor

When the female genital organ is opened, there are no symptoms. Such a phenomenon can only be determined by an obstetrician-gynecologist, examining the vagina. To find out what happens to the cervix during labor, you need to study obstetric terms. Obstetricians-gynecologists determine the opening of the cervix in the fingers.

The measurement of the "obstetric finger" is carried out in centimeters. The opening of the cervix in one finger is 2-3 cm. If the uterine os opens by 3-4 cm, the uterus opens equally. Regular contractions are evidenced by the opening of the neck by 4 fingers. If it is smoothed, then the passability of 5 fingers is allowed.



The first harbingers of childbirth appear 2 weeks before the birth of the baby. The bottom of the organ sinks within 2-3 weeks before the onset of contractions. In this case, the fetus is pressed against the small pelvis. The woman in labor experiences the following sensations:

• relieved breathing;
• frequent urination;
• constipation;
• high excitability of the body;
• rare and irregular false contractions.



Cervical evaluation criteria

Before you give birth, the uterus opens slowly, but gradually over the course of a month. Contractions intensify 1-2 days before delivery. In a nulliparous woman, the cervical canal opens by 2 cm, and in a multiparous woman - more than 2 cm. To establish the maturity of the cervix, obstetricians-gynecologists use a special Bishop scale. Based on it, the following neck criteria are evaluated:

1. 1. Density - a dense organ is assigned 0 points. If the neck is soft on the periphery, but dense inside, then it is assigned 1 point. A neck that is soft on the outside and inside has 2 points.
2. 2. Length. If more than 2 cm - 0 points, 1-2 cm - 1 point is assigned, less than 1 cm - 2 points.
3. 3. Patency. Closed pharynx - 0 points, patency of the cervical canal to the closed internal pharynx - 1 point, skipping 1-2 fingers for the pharynx - 2 points.
4. 4. The location of the neck relative to the axis of the pelvis. Direction to the back - 0 points, offset to the front - 1 point, located in the center - 2 points.



Summing up the scores, the maturity of the cervix is ​​​​estimated. An organ is considered immature if the score is between 0-2. If 3-4 points, insufficiently mature neck. If 5-8 points, the neck is mature.

Vaginal examination

To determine the degree of readiness of the female genital organ, the obstetrician-gynecologist examines the vagina. In the maternity hospital, such an examination is carried out every 4-6 hours or in the presence of emergency indications, such as:

• amniotic fluid broke;
• weak tribal forces;
• polyhydramnios;
• narrow pelvis;
• before regional anesthesia;
• bleeding;
• painful contractions.



When examining the vagina, the doctor evaluates the thickness and degree of smoothing of the cervix. At the same time, the presence of scars on the soft tissue of the genital tract is determined. The obstetrician-gynecologist evaluates the capacity of the pelvis and the fetal bladder.

On the basis of subjective signs of disclosure, a partogram of labor activity is compiled. This group of signs includes the opening of the pharynx and contractions. The latter are evaluated according to the following criteria:

• duration;
• power of manifestation;
• uterus activity.

With the help of a partogram, the dynamics of the opening of the pharynx is fixed. Obstetrician-gynecologist makes a schedule. The horizontal curve displays the duration of labor in hours, and the vertical curve shows the opening of the female genital organ in centimeters. With the help of the graph, the phase of the birth act is determined. If the curve rises steeply, then an effective birth act.



Opening of the penis

The cervix, which opened long before labor, is called isthmicocervical insufficiency. For such a pathology, it is characteristic that the uterus and its constituent parts do not perform a locking function during gestation. In this case, the neck becomes soft, shortened and smoothed. This leads to a miscarriage. Pregnancy is interrupted in 2-3 trimesters.



If the cervix is ​​defective, then it shortens to 25 mm at 20-30 weeks of gestation. ICI can be organic and functional. The first pathology develops after a neck injury (abortion, rupture during childbirth). The functional form is associated with hormonal imbalance or a high load on the neck.

But if the cervix has opened by 1-2 fingers at 28 weeks, then the pregnancy can be saved or prolonged until the birth of a viable child. In such a case, bed rest and complete emotional rest, the use of antispasmodics and tocolytics are indicated. The treatment is aimed at producing surfactant in the baby's lungs to speed up their maturation. For this, a pregnant woman is prescribed glucocorticoids.

The therapy prevents subsequent premature opening of the cervix. Stitches are applied to the woman in labor, which are removed at 37 weeks. If the neck is immature, long and dense, then medical and other methods are used. A special gel and suppositories with prostaglandins are introduced into the vagina or cervix of the uterus (to speed up the process of maturation of the cervix). This increases the excitability of the female genital organ. A similar technique is used during childbirth if a weak birth act is detected. When administered topically, there are no side effects.



Additional techniques with which you can shorten the prenatal period:

1. 1. The use of kelp - sticks made from dried algae with high hygroscopicity. The required number of sticks is introduced into the canal to fill it tightly. They absorb liquid, swell, stretch and open the neck.
2. 2. Catheter and balloon - they are inserted into the cervical canal. The balloon is filled with air and left in the channel for a day. Under mechanical action, the cervix opens, and prostaglandins are produced.
3. 3. Enema - cleansing manipulation increases the excitability of the organ, speeding up the birth act.

You can prepare your cervix for childbirth at home. It is recommended to take long walks in the fresh air. Hiking contributes to the presentation and fixation of the baby at the entrance to the small pelvis. In addition, the opening of the penis is stimulated. At the same time, a woman should monitor the intestines and urinary tract, avoiding constipation. The diet includes salads and a decoction of raspberry leaves. At the same time it is recommended to stimulate the nipples.



You can speed up labor by doing exercises such as:

• swimming;
• walking up the stairs;
• twists and turns of the body;
• massage of the little finger and ear;
• warm bath;
• breathing exercises;
• gymnastics that strengthens the perineal muscles;
• yoga.

A woman in labor can practice on a gym ball. This speeds up the opening of the uterus. Sex in the last week of pregnancy accelerates the process of maturation of the cervix. But an intimate life is indicated if the woman in labor has a whole fetal bladder and there is a mucous plug in the cervical canal. Sex is effective because:

• during orgasm, oxytocin is released, which stimulates the activity of the uterus;
• semen contains prostaglandins, which have a positive effect on the process of maturation of the cervix.

Before applying the above methods, it is recommended to consult with your doctor. A woman in labor should know that when the uterus opens by 8 cm, there is a desire to push. Pushing refers to the voluntary contraction of the abdominal muscles. But if the neck has not opened up to 10 cm, and the child's head has not sunk to the bottom of the small pelvis, it is forbidden to push.



Performing gymnastics

To make childbirth easy and without breaks, when the first contractions appear, it is recommended to perform special exercises. Such gymnastics relieves pain, stimulates the uterus, relieves tension and stress. During pregnancy, it is recommended to constantly perform special gymnastics, which:

• promotes the development of mobility and flexibility of the pelvic bones, preventing the appearance of back pain during labor activity;
• provides comfortable sitting in the delivery chair by stretching the muscles of the thighs;
• prevents the appearance of hemorrhoids after childbirth as a result of support in the tone of the muscles of the pelvis and vagina;
• contributes to the timely opening of the cervix.



To give birth to a child with minimal consequences and without pain, it is recommended to perform exercises for each muscle group from the 5th month of pregnancy. The pelvic bones can be prepared for labor in the following way:

1. 1. The woman in labor kneels, leaning on her hands.
2. 2. The palms are placed at a distance of 30 cm from each other, and the knees at a distance of 20 cm.
3. 3. Hips are perpendicular to the floor.
4. 4. The back slowly bends, and the buttocks rise as high as possible.
5. 5. The exercise is performed on a deep breath.
1. 1. Feet connect and knees move apart.
2. 2. Hands wrap around the ankles.
3. 3. The body bends forward.
• breaststroke swimming relieves tension and weight from the joints;
• walking and squatting - gradually contributes to the lowering of the fetus along the channel;
• swing ride.

The above methods are the impetus for the natural birth of a full-term baby. With the help of such exercises, the shape of the woman in labor is maintained. But if contractions have already begun, special exercises are shown to relieve pain. At the same time, it provides a comfortable state during labor activity, reduces the tension of the National Assembly and muscles, provides the uterus with the maximum amount of oxygen.



Between fights, the following exercises are allowed:

1. 1. The legs are placed shoulder-width apart, hands down. On inhalation, the upper limbs are bred to the sides, and on the way out they are lowered. The brushes are shaken.
2. 2. In the same starting position, the elbows are pulled back, lifting the legs forward one by one.
3. 3. In a similar starting position, the arms and torso are taken to the side.
4. 4. Sit on a chair, bending your knees, connecting the soles. The knees are spread apart.
5. 5. Lying on the floor, alternately bend the legs, while bending the knees in different directions.
6. 6. Slow walking with a cross step.

Pain management techniques

To reduce pain, breathing exercises are indicated during childbirth. With its help, the body of the fetus and the woman in labor are saturated with oxygen. Before giving birth, it is recommended to perform relaxing breathing exercises: inhale through the nose, and after a few minutes exhale through the mouth. You need to breathe smoothly.

Normal and timely childbirth 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 discovery. 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 descends 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.

At the very end of pregnancy, a woman's body begins to prepare for childbirth. Opening the cervix by 2 fingers is one of the signals that the long-awaited meeting with the baby should happen very soon. However, this does not always mean that the process of future childbirth has already been started and is proceeding correctly. There are various situations when obvious symptoms of disclosure may indicate a pathological course of pregnancy and threaten the health and life of the fetus. To understand what signs indicate the approach of childbirth, you need to know the structure of the female reproductive system and the processes that occur with it as the child is born.

The uterus consists of 3 parts: the fundus, the body of the uterus and the cervix. It has a cervical canal that connects the body of this hollow muscular organ and the vagina. During pregnancy, the internal uterine os is tightly closed. This helps prevent premature birth and protect the baby from infections. An additional barrier to infection of the fetus from the outside is the mucous plug. Before childbirth, the ratio of hormones in a woman's body changes dramatically. The main female hormone estrogen decreases, and the level of oxytocin and prostaglandins increases. It is these hormones that affect the preparation of the reproductive system for an early birth.

What happens before childbirth?

Before childbirth, natural preparation begins for the opening of the internal pharynx, laid down by nature. In the normal course of pregnancy, these processes begin in the body at approximately 36-37 weeks. By 38 weeks of pregnancy, a number of serious transformations should already have occurred in the cervix. From her degree of readiness for childbirth largely depends on how the labor activity will take place. The cervix, in which the necessary changes have occurred for the birth of a child, is called mature. Obstetricians distinguish the following signs:

• the uterus goes down;
• the birth canal becomes softer and more elastic;
• the neck is smoothed and shortened to about 1-2 cm, the entrance to it expands.

Symptoms of cervical dilatation by 1 cm, as a rule, proceed without any features, the expectant mother does not experience discomfort. Only a doctor can see the disclosure, which is at the initial stage, during a routine examination of a pregnant woman. Such examinations in late pregnancy are weekly. The opening of 1 finger is 1.5-2 cm. In women who are pregnant for the first time, this condition may persist for 10-14 days before delivery and is not an indication for urgent hospitalization if all other indicators are normal and the gestational age is less than 40 weeks.

In multiparous women after 37-38 weeks, any symptoms of cervical dilatation may mean that labor will occur within a few hours, since labor can develop much faster than in primiparas. If a woman is expecting a second child, then opening the uterine os by 2 fingers means that she is in labor and hospitalization is necessary.

Finger measurements

Symptoms of uterine dilatation do not appear in any way at the first stage. To find out how the body is ready for childbirth, a woman is examined on a gynecological chair. This procedure includes visual and manual inspection. One of the methods for determining the degree of disclosure, which is most accessible to an obstetrician-gynecologist, is the introduction of fingers into the cervical canal. The unit of measurement adopted in obstetric terminology is the width of the finger. The degree of opening of the neck is deciphered as follows:

1. The opening of 1 finger is 1.5-2 cm. It is typical for the preparatory stage for childbirth. May be accompanied by sensations of heaviness in the lower abdomen, mild and irregular aching pain in the lumbar region.
2. Two fingers, freely passing into the cervical canal, indicate the beginning of the active phase of labor, which is accompanied by regular contractions with equal intervals between them. The width of the cervical canal is already approximately 4 cm. The frequency of contractions at this stage is approximately 2-3 contractions per 10 minutes. The fetal head descends into the pelvic area and presses on the uterus, causing it to contract more strongly. This process contributes to the further opening of the pharynx, which reaches 8-10 cm by the beginning of the next stage of childbirth.
3. Opening for 4-5 fingers is 8-10 cm and is full. At this point, the body is ready to expel the fetus. This means that the baby will be born very soon.

After the transition of labor into the active phase, starting from 2 fingers, the opening of the cervix in women giving birth for the first time occurs at 1 cm per hour, in those waiting for the second and subsequent children, this process occurs much faster.

Premature manifestation

Symptoms of uterine dilatation may indicate a pregnancy pathology that is dangerous to the fetus if the period is less than 38 weeks, and the cervix is ​​open by 2 cm or more. In this case, the pregnant woman needs urgent hospitalization, since such a condition can turn into premature birth. If the opening is 1 finger, then usually doctors prescribe drug therapy and complete rest. While a woman is in the hospital, the condition of the fetus is constantly checked, the heart rate is monitored using cardiotocography, and, if necessary, ultrasound diagnostics with Dopplerography are performed.

When opening the cervix by 2 fingers in women who are at a gestational age of up to 34-35 weeks, doctors take emergency measures to stop preterm labor. One of the ways to stop the process that has begun is suturing the cervical canal. Another common method of stopping premature dilatation is the placement of a pessary.

These measures, combined with taking medications and maintaining complete rest, can stop the onset of labor. Depending on the state of health of the expectant mother and the characteristics of the course of pregnancy, after taking emergency measures, a woman can carry the child to term, despite a slight opening of the cervix.

Organ immaturity

But there is also the opposite situation, when the gestational age is 40-41 weeks, and the symptoms of opening the pharynx are partially or completely absent. This indicates the immaturity of the cervix and its unpreparedness for childbirth. This condition also poses a danger to the unborn child, since by 40 weeks the placenta has exhausted its ability to deliver oxygen and nutrients to the fetus. Prolongation of pregnancy can lead to hypoxia and even asphyxia of the baby.

There are many reasons why cervical dilation symptoms may be absent or false:

• structural features of the pelvic organs;
• severe stress that interferes with disclosure;
• lack of necessary hormones;
• severe muscle spasms;
• oligohydramnios;
• erosion;
• age over 35 years.

If the gestational age approaches the day of the expected birth, and the condition of the cervical canal indicates unpreparedness for childbirth, then the attending physician may prescribe some procedures and medications in order to speed up the process. There are several methods, drug and non-drug.

Non-drug methods of accelerating labor activity include:

• physical exercises that stimulate the expansion of the cervical canal and the opening of the uterine os (cleaning, long walks, climbing stairs);
• sexual contacts (during intercourse, blood circulation in the uterus increases, and seminal fluid contains a large number of prostaglandins that affect the opening of the cervix and provoke the onset of contractions);
• cleansing enema (provokes irritation of the posterior uterine wall, which causes expansion of the uterine os).

These methods must be used with caution. After all, excessive physical activity can harm the child. Unprotected sexual intercourse after the mucosal plug has passed can lead to infection of the fetus. Therefore, it is not worth making a decision on the need for such measures on your own. All actions must be coordinated with the gynecologist observing the woman during pregnancy.

Medical stimulation of labor

There are cases when there are symptoms of cervical dilatation, such as discharge of the mucous plug, regular contractions, outpouring of amniotic fluid, but the pharynx of the cervical canal passes no more than 1-2 fingers. This indicates a weak labor activity and requires its stimulation with the help of medications. In medicine, there are several ways to speed up childbirth:

1. Stimulation with pills containing prostaglandins. This is one of the easiest ways to speed up disclosure. It is a method of preparing for childbirth, and not an emergency measure.
2. The introduction of a gel with synthetic prostaglandins into the vagina. The procedure is carried out several times a day, monitoring the condition of the patient and the fetus.
3. Laminaria sticks. They are inserted into the cervical canal, where they swell and gradually mechanically open the cervix.
4. The Foley catheter also mechanically opens the uterine os and is considered the fastest way to prepare for childbirth.
5. A dropper with the hormone oxytocin. This method is used most often. Oxytocin stimulates labor activity. Under its influence, disclosure goes much faster, and contractions become more intense.

If medications to stimulate labor do not work, the cervix does not open, and there is a threat to the life of the child, then doctors usually decide to perform an emergency caesarean section.

Cervical dilatation symptoms should not be ignored at any stage of pregnancy. A woman should immediately report any changes in her condition to her doctor. This will help to prevent possible pathologies in time and take all measures to normalize the course of pregnancy and labor.

All organs of the female reproductive system are formed in such a way that on the necessary day a little man is born. One of the organs that takes an active part in holding the fetus during pregnancy is the cervix. At the same time, its deformation during pregnancy and childbirth provides an easy process for the birth of crumbs.

Anatomy of the cervix

The cervix is ​​a tube, the ends of which pass into the external and internal pharynx. The main purpose of the cervix is ​​to connect the vagina with the uterus - the organ in which the fetus is located throughout the entire period of its development. During the course of pregnancy, the cervix has a dense structure, and the cervical canal is tightly closed. This is what ensures the safety of the fetus in the womb while protecting it from any infections from the vagina.

This structure persists throughout almost the entire period of pregnancy, and only approaching the date of birth gradually changes. Alas, there are cases when changes in the cervix begin in advance, which is often an alarming sign of the onset of preterm labor or miscarriage.

The reason for the early opening of the cervix may be:

• abortions or miscarriages that were before the current pregnancy;
• damage to the cervix during operations, injuries or ruptures during previous births;
• hormonal imbalance, which consists in an insufficient amount of progesterone ensuring the safety of the fetus during pregnancy;
• cervical erosion.

Opening the cervix

Immediately before childbirth, the woman's body is rebuilt and preparing to provide the baby with the opportunity to freely enter the world. One of the first and main processes before childbirth is the timely opening of the cervix.

Changes in this organ occur immediately before childbirth, almost imperceptibly for the woman herself and has several stages:

1. From the moment of pregnancy, the cells that make up the cervix change into muscle fibers, which are characterized by considerable flexibility and elasticity. It is these collagen fibers that provide the best preservation of the fetus.
2. At 32-34 weeks there is a gradual softening of the tissues of the cervix. At the same time, the tissues along the cervical canal do not change, retain their density and flexibility. Softening occurs by replacing muscle tissue with connective tissue. If a woman is pregnant for the first time, then when examined by a gynecologist, a fingertip can be placed in the canal. If a woman has already undergone childbirth, then a finger can be completely placed in the channel.
3. At 36-38 weeks, softening of almost all tissues of the cervix occurs. The child, under the pressure of his body, descends down the pelvis and prepares for an early exit through the birth canal. There is an initial opening of the cervix, which starts from the internal os. Taking into account the advancement of the crumbs, the cervix takes the form of an inverted truncated cone.
4. Immediately before childbirth, the external pharynx opens, the walls of the cervix become soft, loose and completely depleted. The length of the channel is significantly reduced, and 2 fingers or more can be passed through the channel. The further, the stronger the walls of the cervix are heard, forming a cavity with a diameter of 10-12 cm, through which the child can easily squeeze the head and shoulders.

Sometimes the opening of the cervix does not occur in a timely manner, thus delaying the birth process. This situation can lead to fetal prematurity or lack of oxygen saturation, since the placenta has already “given away” all the beneficial substances that exist in it in the 40 weeks provided.

The main causes of non-opening of the cervix:

• Fear of childbirth. Experiencing fear, a pregnant woman experiences significant stress, setting herself psychologically to desire to delay the date of birth. Against the background of this condition, a hormonal failure may occur in which the amount of progesterone will be insufficient to carry out the required changes.
• Irregular labor activity. In case of weak contractions, incomplete opening of the cervix is ​​possible, since the process stops if there is no activity of the uterus, which at this moment is already an expelling organ.
• Age. Women who give birth after the age of 35 may experience an incomplete opening of the cervix due to the loss of increased tissue elasticity that comes with age.

Stimulation of the opening of the cervix

Nature has thought out the whole chain of events that must take place for the birth of a child, and if at any of the stages a failure occurs, then the process may end in failure. That is why, before the immediate start of childbirth, the obstetrician-gynecologist carefully monitors the performance of all necessary actions by the female body. In case of any deviations, the doctor takes over the functions of Nature.

Given the fact that the opening of the cervix is ​​the first and most important stage before childbirth, its untimely implementation can have disastrous consequences. Therefore, sometimes there is a use of stimulation of the opening of the cervix. There are several ways to stimulate, both medicinal and folk:

1. Medications:

◦ Laminaria sticks. The sticks are inserted into the canal and left to swell. In the process of increasing the volume of the introduced sticks, the channel expands, the tissues of which are loosened and distributed, giving the baby a free path. The required period of influence of kelp is at least 4-5 hours. At the same time, along with the mechanical action of the stick, a biochemical one occurs, which consists in the production of certain hormones by the laminaria, which provoke the maturation of the uterus.

◦ Prostaglandin. The mechanical introduction of a substance in the form of suppositories or gel allows you to locally affect the cervix, loosening its structure and expanding the channel.

◦ Puncture of the amniotic sac. When performing this procedure, a quick departure of water occurs, and the head of the crumbs drops in the direction of the "exit". Under the pressure of the baby's body, the cervix expands, as if pushed apart by the baby.

2. Folk:

◦ Enema. Performing this procedure irritates the wall of the uterus, which activates its contractions and provokes the exit of the cork. These processes are accompanied by a natural and fairly rapid opening of the cervix. Please note that the method is acceptable for ladies whose date has already passed.

◦ Sex. In the process of sexual intercourse, blood flow to the pelvic organs increases, in addition, sperm is a “carrier” of a significant amount of prostaglandin, which provokes the activation of labor. The use of the method is prohibited in case of cork departure, which can cause infections.

◦ Loads. Some physical activity (for example, an active walk) causes a significant blood flow to the pelvic organs, which causes the activation of their activity. The method is contraindicated in pregnant women with hypertension.

Please note that the period of childbirth and preparation for them is very difficult and you need to act very carefully during it. Therefore, be sure to think before applying any methods without consulting a doctor. The best option may be to contact a gynecologist-obstetrician, who will definitely help you survive this difficult period as easily as possible.

In the female body during pregnancy, there are many changes aimed at a successful delivery. The cervix is ​​important, ensuring that the fetus is in the right place throughout the entire period. At the onset of childbirth, it forms the path for the passage of the baby.

Only a doctor knows how to determine the dilatation of the cervix. The cervix connects the vagina and the uterine cavity. The cervical canal passes through it. The place where it enters the uterine cavity is the internal os, and the external os into the vagina. The degree of their disclosure is of great clinical importance.

For short periods, there may be a threat of miscarriage. It is diagnosed by detecting the disclosure of the cervix during pregnancy, which is an alarming sign. The cause is chronic untreated inflammation in the genital tract, numerous surgeries, hormonal imbalance.

Signs of cervical dilatation, while the pregnant woman sometimes notes herself. However, there are often no complaints. Symptoms of the opening of the cervix are reduced to the occurrence of periodic pain in the lower abdomen, accompanied by discharge mixed with blood.

If such a situation arises, an urgent visit to the doctor is mandatory. With timely diagnosis, miscarriage or premature delivery can be avoided. The opening of the cervix before childbirth is a normal step in preparing for the birth of the baby. Changes can begin from 35 weeks.

Changes in the cervix during pregnancy and the degree of disclosure

Throughout the entire period, the birth canal is prepared for the passage of the child through them. At the same time, the neck changes its consistency due to the formation of new collagen fibers in it, capable of better stretching. It becomes softer and looser. The dimensions are changing. The closer the term, the shorter the neck becomes. In the early stages, the amount of mucus produced in it increases, while creating a cork. This prevents the development of infection inside the uterus and in the fetus.

With a normal pregnancy, the gynecologist evaluates the condition of the cervix several times:

• when registering;
• for short periods.

This is done to prevent the development of complications with its insufficient functioning. This phenomenon is determined during a vaginal examination. The doctor evaluates the closeness of the external os. Inspection is carried out with II and III fingers of the right hand inserted into the vagina. If it misses at least one of them, then the cervix is ​​dilated by 1 cm, if two - by 2 cm.

Next, look at the internal os. If he skips a few fingers, then this indicates the onset of labor. That is, when assessing a gynecologist's finger passed through the pharynx, it is equated to 1 centimeter of its opening.

In childbirth, examination is done according to indications (possibly with an interval of 3 hours). Cervical opening is their initial period! The adequacy of its development will determine the duration of contractions, the further management of the woman in labor.

An important concept is the degree of maturity, which is assessed by the following parameters:

• degree of softening;
• size;
• patency of the cervical canal;
• position.

The higher the maturity, the faster the expulsion of the fetus will begin.

In the first birth, the internal os opens first. The channel in the neck becomes like a funnel. Then it expands. The neck is shortened and smoothed, the external pharynx is still closed. Then its edges stretch and become thinner. It opens up with successive contractions. It happens 10 - 12 hours.

When opening the cervix in nulliparous 1 finger before delivery, careful observation is necessary. In multiparous, the external os is often slightly open in the later stages. This is due to its mechanical injury during the previous passage of the baby. In the later stages and in childbirth, the tip of the finger passes through the pharynx.

This is not a pathology. It is possible to dilate the cervix by 2 fingers. During labor, the internal and external os open quickly and almost at the same time, shortening the neck. The process takes 6-8 hours.

The phases of disclosure begin with the onset of regular labor activity and end with an opening of 10 - 12 cm and the outflow of amniotic fluid. The interval between contractions becomes shorter, and the contractions increase in duration. This time is different for primiparous and multiparous. Contractions of 20-25 seconds every 10-15 minutes are considered regular labor activity.

Opening phases:

1. First (latent).
2. Second (active).
3. slowdown.

The first phase is counted from the beginning of a regular rhythm and ends with an opening of 4 cm. It lasts 5-6 hours. During a contraction, the pain is tolerable. Brown discharge from the cervix during childbirth with streaks of blood is possible, which is due to injury to small vessels during uterine contractions. Medicines are rarely prescribed.

Perhaps the introduction of antispasmodics: papaverine, no-shpa. A woman in labor may experience a discharge of a cork, which is a thick mucous discharge with streaks of blood. The second phase begins with the opening of the pharynx by 4 cm. Violent labor activity develops. The uterine os opens up to 8 cm within 3-4 hours 3-5 contractions go in 10 minutes. They are painful, so doctors often prescribe painkillers.

At this time, there is a rupture of the fetal bladder and discharge of water. If this does not happen, an amniotomy is performed. The essence of the procedure is to puncture the fetal bladder. The consequence of the active phase is the almost complete opening of the uterine os. The fetus descends to the birth canal.

The deceleration phase begins with the opening of the pharynx at 8 cm and ends with its complete opening. A woman in labor may experience a weakening of labor activity. In primiparous, the phase reaches 2 hours, and in multiparous, its absence is observed. The full dilatation of the cervix is ​​10-12 cm.

How can disclosure be affected?

Many pregnant women, afraid to carry a baby, want to know how to speed up the opening of the cervix before giving birth. The gynecologist gives general recommendations:

Drug therapy is carried out only in a hospital! After it is carried out, childbirth can begin almost immediately. Such measures are carried out after 40 weeks, when the placenta cannot deliver the necessary substances to the fetus in sufficient quantities.

Acceleration of disclosure in the hospital is carried out in the following ways:

• introduction of kelp sticks into the cervical canal;
• puncture of the fetal bladder;
• medicinal prescriptions.

Laminaria sticks are seaweed. When they are in the humid and warm environment of the vagina for several hours, they draw in fluid and swell. This provides a soft mechanical opening.

This method is used when labor begins and the cervix opens by 1 finger. Amniotomy (puncture of the fetal bladder) is done under sterile conditions. The consequence is the insertion of the fetal head into the pelvic cavity, increasing the pressure "from above" on the cervix. There is an acceleration of its maturation.

It should be carried out only if there are certain indications: the opening of the cervix by 2 cm and the weakness of labor. Medicines are used in various forms: tablets, suppositories, gels, injection solutions. They contain prostaglandins - hormones necessary for adequate labor activity.

The necessary medication and dosage is selected by the doctor, taking into account the overall picture! Gel and suppositories are preferred due to the minimum side effects and the maximum local effect.

From local preparations appoint: Prepidil-gel, Prostin E2 gel. They are found in the vagina, have a mild effect. The effect after their application occurs after 30 minutes. Every 6 hours, the patient's condition and the cervix are monitored. A positive effect is considered to be an opening of 3 cm within 6 hours from the introduction. If this is not observed, the gel is not re-appointed.

Oxytocin is administered intravenously. Its effect develops "on the needle" and lasts up to 3 hours. Enter it when opening the cervix on one finger and generic weakness. The dose is estimated in drops. However, contractions with the introduction of this drug are much more painful than with the natural course of childbirth. Often, for pain relief against the background of oxytocin, doctors resort to spinal (epidural) anesthesia.

Cervical dilatation of 1 or 2 cm after 37 weeks of a normal pregnancy is acceptable and does not require medical intervention. In childbirth, it is an integral part of the whole process. It is impossible to assess its degree at home! This can lead to sad results, because the only way to diagnose is a vaginal examination. How to speed up the opening of the cervix and whether the attending physician needs to explain.