Dilatation and shortening of the cervix during pregnancy. Short cervix during pregnancy: what to do? Short cervix during pregnancy: treatment Short cervix symptoms

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

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

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

The essence of the pathology and possible consequences

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

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

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

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

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

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

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

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

Causes of isthmic-cervical insufficiency and diagnosis

The pathology is both congenital and acquired.

Congenital pathology is usually associated with physiological characteristics body structure or genetic inheritance.

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

Ultrasound is performed using two methods:

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

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

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

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

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

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

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

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

How to avoid the occurrence of pathology?

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

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

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

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

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

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

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

As it turns out, the question of cervical dilatation, the timing and size of the opening in centimeters or transverse fingers and how to interpret this worries all pregnant women. However, many do not know a clear answer. We will try to cover this topic as much as possible and start with the anatomical features.

The uterus is an important organ of a woman's reproductive system and consists of the body of the uterus and the cervix. The cervix is a muscular tubular formation that starts from the body of the uterus and opens into the vagina. The part of the cervix that is visible when examined in speculums is called the vaginal part. The internal os is the transition of the cervix into the uterine cavity, and the external os is the border between the cervix and the vagina. In these places the muscle part is more pronounced.

During pregnancy, some of the muscle fibers in the cervix are replaced by connective tissue. Newly formed “young” collagen fibers are stretchable and elastic; when they are formed excessively, the cervix shortens and the internal os begins to expand.

Normally, throughout pregnancy, the cervix is long (about 35 - 45 mm), and the internal os is closed. This position helps prevent spontaneous miscarriage and also protects against infection entering the uterine cavity.

Only a few weeks before the expected date of birth (EDD), the cervix changes its structure, gradually becoming softer and shorter. If shortening, softening of the cervix and expansion of the internal os occurs during pregnancy, then this condition threatens termination of pregnancy or premature birth.

Causes of premature shortening of the cervix:

Aggravated obstetric history (abortions, miscarriages at different stages, history of premature birth, especially very early premature birth before 28 weeks)

Aggravated gynecological history (infertility, polycystic ovary syndrome and other gynecological diseases)

Cervical injuries (surgeries, ruptures in previous births, large fetus births)

Norms for the cervix by timing

Up to 32 weeks: the cervix is preserved (length 40 mm or more), dense, the internal os is closed (according to ultrasound results). On vaginal examination, the cervix is firm, deviated posteriorly from the pelvic axis, and the external os is closed.

The wire axis of the pelvis is a line connecting the midpoints of all direct dimensions of the pelvis. Since the sacrum has a bend, and then the birth canal is represented by the muscular-fascial part, the wire axis of the pelvis is represented by a curved line, reminiscent of a fishhook in shape.

32–36 weeks: the cervix begins to soften peripheral parts, but the area of the internal pharynx is dense. The length of the cervix is approximately 30 mm or more, the internal os is closed (according to ultrasound). On vaginal examination, the cervix is described as “tight” or “unevenly softened” (closer to 36 weeks), deviated posteriorly or located along the wire axis of the pelvis, the external pharynx in primiparous women may allow the tip of a finger to pass through, in multiparous women it allows 1 finger into the cervical canal.

From 37 weeks: the cervix is “mature” or “ripening”, that is, soft, shortened to 25 mm or less, the pharynx begins to expand (the length of the cervix, the funnel-shaped expansion of the uterine pharynx, is described by ultrasound). On vaginal examination, the external os may allow 1 or 2 fingers to pass through, the cervix is described as “softened” or “unevenly softened”, located along the wire axis of the pelvis. At this time, the fetus begins to lower its head into the pelvis and puts more pressure on the neck, which contributes to its ripening.

To assess the cervix as “mature” or “immature”, a special table (Bishop scale) is used, where the parameters of the cervix are assessed in points. Nowadays, the modified Bishop scale (simplified) is most often used.

Interpretation:

0 – 2 points - the cervix is “immature”;
3 – 4 points - the cervix is “not mature enough”
5 – 8 points - the cervix is “mature”

The ripening of the cervix begins in the area of the internal os. For primiparous and multiparous women, the process occurs slightly differently.

In primigravidas (A), the cervical canal becomes like a truncated cone, with its wide part facing upward. The fetal head, falling down and moving forward, gradually stretches the external pharynx.

In multiparous women (B), the expansion of the external and internal os occurs simultaneously, so repeated births, as a rule, proceed faster.

1 – internal pharynx
2 – external pharynx

Cervix during labor

Everything we described above applies to the condition of the cervix during pregnancy. During pregnancy, the terms “shortening of the cervix”, “dilation of the internal os”, “cervical maturity” are used. The term “dilation” or “opening” (they mean the same thing) begins to be used only with the onset of labor.

By the time of birth, the cervix, gradually shortening, is completely smoothed out. That is, it ceases to exist as an anatomical structure. The long tubular structure is completely smoothed out and only the concept of the “internal os of the cervix” remains. Its opening is calculated in centimeters. As labor progresses, the edges of the internal os become thinner, softer, and more pliable, which makes it easier for the fetal head to stretch them.

Depending on the degree of opening of the internal pharynx, labor is divided into periods I and II:

I stage of labor This is what is called “the period of dilatation of the internal os of the cervix.” The first period is divided into phases.

During the latent (hidden) phase, the internal os gradually opens up to 3–4 cm. Contractions during this period are moderately painful or painless, short, occurring in 6–10 minutes.

Then the active phase of the first stage of labor begins - the rate of opening of the uterine pharynx should be at least 1 cm per hour in primiparous women and at least 2 cm per hour in multiparous women, contractions in this period become more frequent and occur once every 2 to 5 minutes, becoming longer ( 25 – 45 seconds), strong and painful.

The internal os should open to 10 - 12 cm, then this is called “full opening/dilatation” and the second stage of labor begins.

II stage of labor called the period of “expulsion of the fetus.”

At this stage, the uterine os is fully opened, and the fetal head begins to move along the birth canal towards the exit.

The dynamics of the opening of the uterine pharynx is reflected in the partogram, which is maintained from the beginning of the latent phase and is filled out after each obstetric examination.

A partogram is a method of graphically describing childbirth, which reflects in the form of a graph the dilatation of the cervix in centimeters, time in hours, the advancement of the fetus along the pelvic planes, the quality of contractions, the color of the amniotic fluid and the fetal heartbeat. Below is a simplified version of the partogram, which reflects only the parameters that interest us in this topic, that is, the opening of the uterine pharynx over time.

In order to clarify the obstetric situation, the doctor conducts an internal obstetric examination, the frequency of which depends on the period and phase of labor. In the latent phase of the first period, the examination is carried out once every 6 hours, in the active phase of the first period, once every 2-4 hours, in the second period, once per hour. If any deviation from the physiological course of labor develops, the examination is carried out according to indications over time (the frequency of examinations is determined by the doctor leading the birth, examination by a council of doctors is possible).

Pathologies associated with the process of cervical dilatation:

1) Pathological condition associated with shortening of the cervix and/or expansion of the internal os during pregnancy:

2) Pathology of cervical dilatation in the preliminary period.

The preliminary period is a condition with rare, weak cramping pain in the lower abdomen and lower back, develops with full-term pregnancy and a mature cervix, lasts about 6 - 8 hours and gradually progresses into the first stage of labor. The preliminary period is not observed in all women.

The pathological preliminary period is irregular short painful contractions with a mature cervix, which last more than 8 hours and do not lead to cervical effacement.

3) Pathologies of cervical dilatation during childbirth.

-weakness of the ancestral forces. Weakness of labor forces is the contractile activity of the uterus that is insufficient in strength, duration and regularity. Weakness of labor is manifested by a slow rate of dilatation of the cervix, rare, short, insufficient contractions that do not lead to the advancement of the fetus. This diagnosis is made based on observation of the pregnant woman, the results of carditocography (CTG) and vaginal examination data. The above figure shows the result of CTG with weak labor forces, as we see contractions here of weak strength and short duration. For comparison with the norm, we provide the figure below.

Primary weakness of labor forces is a condition when contractions initially did not become sufficiently effective.

Secondary weakness of labor forces is a condition in which the developed regular and effective labor activity fades away and becomes ineffective.

- discoordination of labor. Discoordination of labor is a pathological condition in which there is no coordination between contractions of different parts of the uterus, contractions are uncoordinated and can be very painful if they are unproductive (the fetal head does not move along the birth canal). For example, the fundus of the uterus is actively contracting, but the cervix (uterine pharynx) is not opening sufficiently, or the cervix is opening, but the fundus of the uterus is not contracting effectively enough. The figure below shows the result of CTG during discoordinated labor, contractions have different strengths and frequency.

A form of incoordination of labor, in which the body of the uterus actively contracts, and the cervix does not have sufficient dilatation due to scar changes (consequences of abortion, old ruptures, cauterization of erosion) or an undiagnosed condition (there is no indication of pathology or trauma to the cervix in the history) is called dystocia cervix. This form of pathology is characterized by painful nonproductive contractions and pain in the sacral area. During an internal obstetric examination, the doctor sees a spasm of the uterine pharynx during contractions and rigidity of the edges of the internal pharynx of the cervix (tightness, inflexibility).

- rapid and rapid birth. Normally, the duration of the labor process is 9–12 hours; for multiparous women it may be less, approximately 7–10 hours.

For first-time mothers, a rapid birth is considered to be a birth of less than 6 hours, and a rapid birth is considered to be less than 4 hours.

In multiparous women, rapid labor is considered to be labor of less than 4 hours, and rapid labor is considered to be less than 2 hours.

Fast and rapid labor is characterized by an accelerated rate of opening of the cervix and expulsion of the fetus. In some cases, this is a blessing, since delay can lead to complications (pathologies of the umbilical cord, placenta, and others). But often, due to the rapid pace of labor, the child does not have time to correctly go through all the stages of the biomechanism of childbirth (adaptation of the soft bones of the child’s skull to all the bends of the mother’s pelvic bones, timely turns of the body and head, flexion and extension of the head), and the risk of birth trauma is increased (as in mother and newborn).

Treatment for premature cervical dilatation:

1) Isthmic - cervical insufficiency treated by placing circular sutures on the cervix (from 20 weeks) or installing an obstetric pessary (from approximately 15-18 weeks).

2) Pathological preliminary period. After the observation period has expired (8 hours) and there is no dynamics during a repeated vaginal examination, an amniotomy is performed (opening the amniotic sac). If the cervix remains shortened, but does not smooth out, then oxytocin may be administered to stimulate labor. If the cervix has smoothed out, but there is no regular labor, then they talk about the transition of the pathological preliminary period into primary weakness of labor.

3) Weakness of generic forces. Amniotomy is performed as the first treatment measure for weak labor. After amniotomy, dynamic monitoring of the woman in labor, counting of contractions, CTG monitoring of the fetal condition and obstetric examination after 2 hours are indicated. If there is no effect, drug treatment is indicated.

With primary weakness, labor is induced, with secondary weakness, labor is intensified. In both cases, the drug oxytocin is used, the difference is in the initial dose and the rate of delivery of the drug through the infusion pump (drip dosage administration). If there is no effect of treatment, delivery by cesarean section is indicated.

4) Discoordination of labor (cervical dystocia). When discoordinated labor develops, the woman in labor must undergo labor anesthesia using narcotic analgesics (promedol intravenously in an individual dose under CTG control) or therapeutic epidural anesthesia (single injection of anesthetic or prolonged anesthesia with periodic administration of the drug). The type of anesthesia is selected individually after a joint examination by an obstetrician-gynecologist and an anesthesiologist-resuscitator. If there is no effect of treatment, delivery by cesarean section is indicated.

5) Rapid and rapid birth. In this case, the most important thing is to end up in a maternity facility. It is impossible to stop labor, but it is necessary to monitor the condition of the mother and fetus as carefully as possible. Cardiotocography is performed (the main thing is to clarify the condition of the fetus, whether there is hypoxia), and, if necessary, ultrasound examination (suspecting placental abruption). In the event of a rapid birth, there must be a neonatologist (micropediatrician) in the delivery room and there must be conditions for providing resuscitation care newborn. Caesarean section is indicated in the event of an emergency clinical situation (placental abruption, acute hypoxia or incipient fetal asphyxia)

After reading the article, you realized what an important and unique formation the cervix is. Pathologies of the cervix and in particular pathologies of cervical dilatation, unfortunately, do and will continue to occur, but any deviations from the norm can be treated the more successfully the sooner you see a doctor. And then the chances of maintaining your health and the timely birth of a healthy baby increase significantly. Take care of yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

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

Why is a short cervix dangerous?

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

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

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

Causes

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

Examination and diagnosis

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

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

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

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

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

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

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

Short cervix during pregnancy

Causes, prevention and treatment of short cervix during pregnancy

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

Why the cervix opens prematurely and diagnosis of pathology

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

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

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

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

Methods of prevention and treatment

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

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

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

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

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Shortening of the cervix during pregnancy

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

Cervix and pregnancy

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

Why does the cervix shorten during pregnancy?

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

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

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

Why is a short cervix dangerous during childbirth?

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

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

To avoid the negative impact of cervical shortening on childbirth, a pregnant woman must constantly and strictly follow the doctor’s prescriptions and undergo medical examinations and visit the gynecologist at the times indicated to her.

Especially for beremennost.net Elena TOLOCHIK

Short cervix: causes of pathology and its elimination

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

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

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

Short neck. Physiological side of the issue

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

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

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

Here we describe another female pathology- bicornuate uterus, this is a congenital defect of the anatomical structure of the uterus.
Interest in the phenomenon of “uterine rabies” does not decrease over time. It was known even before our era. In this article, we look at why this diagnosis is considered outdated and how modern doctors view the problem of uterine rabies.
There are opinions that the diagnosis of “curvature of the uterus” interferes with the moment of conception. Is it so? To find out, read our publication.

Short cervix: causes of pathology

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

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

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

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

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

How to maintain pregnancy with a short cervix?

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

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

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

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

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

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

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Diagnosis and treatment of a short cervix

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

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

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

A little anatomy

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

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

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

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

Why is a shortened cervix dangerous?

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

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

Symptoms

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

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

Causes

Why is such a pathology suddenly discovered during pregnancy?

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

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

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

multiple pregnancy,
polyhydramnios.

Diagnostics

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

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

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

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

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

Prevention

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

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

Treatment

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

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

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

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

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

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

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

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

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

Cervix and pregnancy

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

Why does the cervix shorten during pregnancy?

Why is a short cervix dangerous during childbirth?

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

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

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

Especially for Elena TOLOCHIK

Not every pregnancy goes flawlessly, so most women sooner or later hear from their doctor about the threat of miscarriage. Basically, this diagnosis is made when the cervix is shortened. What does the diagnosis of “short cervix” mean during pregnancy, why does it shorten and what is the danger of this pathology? These are common questions that arise in pregnant women when a narrow cervix is detected and require detailed explanation.

Cervical length during pregnancy: what does it affect and what does it depend on?

The length of the cervix varies from woman to woman, and this largely depends on the individual structure of the cervix. female body or other factors:

operations;
abortions;
hormonal imbalances in the body;
some diseases;
reception medicines, including contraceptives.

However, after conception and implantation of the embryo, it lengthens and becomes shorter towards the end of pregnancy. What does this affect?

At normal pregnancy the fetus attaches and develops in the uterine cavity. A protective barrier against infection is the cervix formed by muscle tissue with a narrow cervical canal inside. During pregnancy, under the influence of hormones, a mucus plug is formed in it, which prevents microorganisms from entering and infecting the fetus. Usually, the presence of a short cervix does not cause a woman any inconvenience and does not have pronounced symptoms, so many do not even suspect that they have a pathology.

The problem becomes significant when a new life is born inside the female body. In this case, the main task of the cervix becomes not only a barrier protective function, it is entrusted with maintaining the pregnancy, that is, keeping the fetus inside the uterus until birth. As the baby grows in size, it puts pressure on the walls and cervix, which in turn can cause it to shrink and dilate. This can cause spontaneous abortion in the early stages or premature birth in later stages.

How is the length of the neck determined and what should it be normally?

Each body is individual, and the size of the cervix will vary among women, but during pregnancy, under the influence of certain hormones, its indicators in most pregnant women become almost the same. In this regard, specialists accept average indicators for orientation and control of its condition, therefore any deviations from the norm are considered to be pathology.

If a woman has a short cervix or too long, she will not feel it at all, since with such a pathology there are usually no symptoms. However, during pregnancy, every expectant mother must undergo an examination, as a result of which the doctor can determine that she has a shortened cervix.

The doctor may notice that a woman has a short cervix during a vaginal examination. However, the final diagnosis will be made only if there is data from an ultrasound examination, which the pregnant woman undergoes at least 3 times during the entire period. It is ultrasound diagnostics that allows us to identify pathology.

During an ultrasound examination, the doctor looks at the size of the cervix starting from the 12th week. Until week 20, its normal range is 40–45 mm. In the second trimester, the fetus begins to grow rapidly and gain weight. The pressure on the cervix increases, and it shortens slightly - up to 30–40 mm. From 30–32 weeks, the normal length is 30–35 mm. Closer to childbirth, it may shorten, and at 38 weeks it reaches 2 cm.

If at these times a woman’s length and size differ from the norm, then it would be appropriate to talk about the presence of a pathology. When the organ is shortened, the pregnant woman should be under constant supervision. It is possible to diagnose ICI (isthmic-cervical insufficiency).

Can the indicator increase or decrease?

The question of whether the cervix can decrease and then increase, and what this depends on, is especially relevant for those who have a small cervix. Pregnancy is a time full of surprises, so there are often cases when a woman’s shortened cervix can quickly lengthen and vice versa.

This depends mainly on the state of health of the pregnant woman, her lifestyle and individual characteristics. If a woman is healthy, the cervix may become short due to heavy physical activity, and after a good rest it will lengthen again. If you have an ICN, you won’t be able to lengthen it yourself (we recommend reading:). These women are usually hospitalized and treated under observation.

Is there a way to lengthen the cervix?

If a pregnant woman has a shortened cervix, she must understand the dangers of this and approach the problem responsibly, since not only her health, but also her life is at stake. born child. She must follow all the instructions of the doctor who will prescribe the treatment. For minor shortening, to enlarge the cervix, they may prescribe sedatives, antispasmodics to relieve uterine tone, magnesium preparations, a complex of vitamins. A woman with a short neck needs to rest more, taking a comfortable lying position.

If a pregnant woman’s cervix has significantly shortened, and there are also signs of spontaneous abortion or premature birth (contractions, nagging pain in the lower back and lower abdomen, spotting or bleeding), she urgently needs to be hospitalized. With timely treatment, doctors are usually able to enlarge the cervix and save the child.

Features of pregnancy with a shortened cervix

What should pregnant women do if they have a small cervix? Significant deviation can be dangerous. If there are indications for hospitalization, it means that treatment will have to be done in a hospital.

In most expectant mothers, the cervix becomes short due to insufficient production of progesterone by the body. In the case of isthmic-cervical insufficiency and significant shortening of the cervix, the woman is prescribed hormonal therapy. One of the common drugs that has proven itself is Utrozhestan (see also:). However, it must be taken only as directed and in a specific regimen prescribed by a doctor.

This remedy can be used throughout pregnancy and is gradually discontinued by the 36th week. Abruptly stopping the drug can significantly reduce progesterone levels and provoke signs of ICI. This condition is very dangerous and can lead to shortening and full dilatation of the cervix. When a woman feels unwell while taking this remedy, it is necessary to consult a doctor who will adjust the dosage.

In addition to hormonal therapy, Magnesia and Ginipral are administered intravenously in the hospital, which help relieve tone and enlarge the cervix (more details in the article:). If it can be restored, the pregnant woman can have the uterus sutured or a pessary placed on it (we recommend reading:).

Surgery effectively carried out from 13 to 27 weeks. Indications for intervention may include pathologies of the cervix, its dilatation, the threat of premature birth or spontaneous abortion.

This operation is aimed at mechanically narrowing the pharynx and walls of the cervix and applying sutures, which helps it overcome the load and not dilate. However, this procedure also has contraindications. Surgery is contraindicated:

pregnant women with mental illness or genetic abnormalities;
in the presence of intrauterine malformations in the fetus;
with bleeding;
with increased excitability of the mother;
for diseases of cardio-vascular system, liver or kidney disease.

Women with a pathological structure of the uterine organs must take precautions to help maintain pregnancy. If a problem is detected in a pregnant woman, certain rules should be followed:

eat right, eating healthy foods rich in vitamins and microelements;
avoid heavy physical activity;
as prescribed, stay in bed;
rest in a lying position up to 5–6 times a day;
take evening walks;
reduce sexual activity, and if there are obvious contraindications, refuse intimate life before the baby is born (see also:);
follow the schedule of visits established by the attending physician to monitor the condition, follow all his recommendations and seek help at the slightest ailment.

Shortening of the cervix before childbirth

Before childbirth, the cervix undergoes significant changes, and the doctor can judge its readiness based on several parameters:

Density. This parameter is determined during examination of the pregnant woman and palpation. When ready to give birth, it should become soft. The density and hardness of the organ being examined indicates its unpreparedness for childbirth.
Length. The action of hormones before childbirth allows you to shorten the cervix to 10–20 mm. Excess this indicator indicates unpreparedness for childbirth.
Location. When ready to give birth, she leans forward.
Patency. This indicator is determined by the size of the cervical canal (how many fingers the throat has opened).