Unfortunately, not every pregnancy can go smoothly and without complications. Among all the negative factors, the threat of miscarriage or premature birth is the greatest danger that can lie in wait for every woman during the entire period of bearing a child. Often the cause of such consequences lies in the short cervix. The result of this is its early disclosure. In such situations, to preserve pregnancy, women are invited to install a ring on the cervix, which is otherwise referred to as the pessary.
Every woman wants to endure, and then give birth to a healthy baby in the absence of any complications. But far from always pregnancy proceeds according to expectations. However, some violations in the female body can lead to a threat to the fetus during the first trimester. Because of others, pregnancy is interrupted in the second or already third period, which is even sadder. One of these problems is isthmic-cervical insufficiency or ICI. But what is this disease?
Cervical insufficiency during pregnancy
Usually, this term is understood not so much as a disease, but as a condition that is not characteristic of the norm. The uterus is a muscular organ composed of the body and neck. An embryo develops in her cavity. Thanks to the cervix, the baby is held inside the uterus and does not leave it prematurely.
In addition, the neck provides protection against infection. In this case, the channel from the side of the cavity of the genital organ limits the internal pharynx, and from the reverse side it closes the external.
Under normal conditions, the muscular structure of the neck closes, forming a ring, and as the delivery approaches, it gradually relaxes. But this does not always happen. In some cases, the muscles of the cervix begin to relax ahead of schedule. As a result, it is shortened and revealed, which, for obvious reasons, should not happen.
Such a condition in the medical language among specialists is called isthmic-cervical insufficiency. During pregnancy, such a case can occur in 9% of the total number of women. As for miscarriage, the percentage here is slightly higher - 15-42%.
Due to the expansion of the neck of the genital organ, the fetal bladder sinks to the bottom of the uterus. This leads to the fact that the membrane may be infected or open prematurely. And if this happened, then the birth occurs prematurely. Ultimately, everything ends with a late miscarriage (before the onset of 22 weeks) or premature birth (up to 37 weeks). In the latter case, a premature baby is born.
Characteristic signs of CPI
Signs of a short neck of the genital organ can be detected with the onset of 15-20 weeks of pregnancy during a routine diagnosis. During this period of time, the child gains weight, and quite quickly. As a result, the load on the neck muscles increases.
To determine the need to install a cubic pessary or device of any other form can only a doctor who is pregnant during a gynecological examination. At the same time, he may notice softening and shortening of the neck, including the opening of the canal through which the fetal bladder is visible. Since the external pharynx in women who have not yet given birth is usually closed, an ultrasound is prescribed to confirm the diagnosis.
In this case, pay attention to the following characteristic features:
- The neck length of the genital organ - for the period from 24 to 28 weeks, should normally be 35-45 mm, after 32 weeks - 30-35 mm. The doctor’s fears are confirmed when shortening to 25 mm (or less) is detected for a period of 20-30 weeks.
- V-shaped expansion of the internal pharynx - this is precisely the reason for the installation of the ring. This can also be checked with the help of an additional test - pressure on the bottom of the uterus or cough.
And if a disappointing diagnosis is established, the doctor must make a responsible decision regarding the installation of the pessary in order to maintain pregnancy.
Reasons for shortening
The neck of the genital organ can be short due to the congenital and anatomical features of its structure. However, in most cases, this condition is acquired in nature. This is facilitated by a wide variety of reasons, among which the following factors can be noted:
- Injuries to the cervix during natural childbirth or artificial termination of pregnancy.
- Treatment of neck pathology through conization surgery.
- Abnormal development of the genital organ.
- Conducting IVF.
- Large child, polyhydramnios or multiple births.
In addition, a shortened cervix may be due to hormonal imbalance during pregnancy. In addition, various interventions in the uterine cavity, such as abortion and curettage, also adversely affect the condition of the cervix, which makes it shortened.
As a result, the cervix is covered with scars, which, in turn, leads to a loss of muscle ability to stretch. Ultimately, the neck is deformed and shortened.
What is a pessary?
This medical term should be understood as a special uterine ring, which is inserted into the vagina and fixed on the cervix. Due to this, a correction of the anatomical or functional CPI is carried out.
Although many doctors call the pessary a ring, this device does not always have such an outline. In most cases, the product is made in the form of a concave pyramid from a number of connected rings. The device has smooth semicircular edges. When the product is installed, its wide base is directed towards the rectum, and the narrow part is facing the pubic joint.
It is due to the concave shape of the base that pressure on adjacent organs can be avoided. A hole is provided in the center of the fixture, which is offset towards the wide base. On the side of it there are smaller openings for the release of secretions. Bridges are located between them to give rigidity to the structure.
The principle of action of the gynecological ring is based on the following factors:
- The pressure exerted on the uterus is redistributed to the front wall.
- The cervical canal is tightly fixed to one of the vaginal arches.
- During the use of the device, the risk of disturbance of the vaginal microflora is minimal.
- Prevention of premature opening of the channel.
In addition, thanks to this product, a thick plug of mucus is formed, as a result of which a barrier is created that prevents the penetration of infection.
Variety of products
The pessary is the latest development, which is made using silicone or some soft and flexible material. These devices are easy to use and also diverse in shape, size and even purpose.
These obstetric products are used not only in the field of gynecology for pregnant women, but are also relevant in other areas of medicine, for example, in urology. As for the shape of obstetric products, the following are found:
- ordinary rings;
- in the shape of a donut;
- oval products;
- cup devices;
- cubic pessaries;
- mushroom devices.
In addition, pessaries are selected according to the individual parameters of the cervix and depend on the number of pregnancies. These features must be taken into account, since the product must fully correspond to the anatomical structure of the woman in each case.
It is due to this that such obstetric products effectively keep the cervix from premature opening. In addition, the surrounding tissue is not damaged.
Indications
The main reason or indication for the appointment of an obstetric device is the risk of premature delivery. Also included here are the symptoms of a threatened miscarriage in the early stages. Other cases may include the following situations:
- pregnancy with several children;
- isthmic-cervical insufficiency;
- after the treatment course of the ICI;
- as a preventive measure against seam divergence;
- burdened history.
At the same time, most of the clinical indications are due precisely to the failure of the neck of the genital organ. Thanks to the device, the load is removed not only from the cervix, but also from the bladder, rectum.
In what cases can not be installed pessary
Often, such a procedure is the only way to prevent miscarriage and premature delivery. However, despite such a significant benefit of the gynecological ring, this manipulation has its own medical contraindications:
- the presence of spotting and spotting;
- the development of the inflammatory process;
- genital tract infection;
- frozen pregnancy.
In other words, as with medicines - not all women may benefit from such a procedure.
Symptoms of a Threatened Miscarriage
As mentioned above, the main indication for installing an obstetric ring may be the risk of a miscarriage. But is it possible for a woman to determine the presence of such a risk?
It is possible, but there are certain difficulties in making a clinical diagnosis:
- First, the symptoms of a miscarriage threat are minor!
- Secondly, the appearance of characteristic signs may indicate completely different processes and pathologies of pregnancy.
Nevertheless, it is worth paying attention and not ignoring the three important and possible symptoms of the threat of miscarriage in the early stages:
- Vaginal discharge. If there is a threat of miscarriage, they can be of a different nature: smearing, profuse, prolonged, transient, bright or, conversely, a pale shade. In addition, they may cease with subsequent resumption.
- Pain syndrome. As a rule, pulling sensations appear, accompanied by heaviness in the lower abdomen and lower back.
- Temperature. In the event of a potential threat, it rises to rather high limits - 38-39 ° . At the same time, it should be understood that this particular symptom does not always indicate precisely the threat of a miscarriage.
Usually this is the main triad (bleeding - pain - temperature) of the signs of this serious pathology. During pregnancy, the presence of all of them or at least one separately should already be alarming. In this case, you should visit the hospital in order to avoid more dangerous consequences.
Seam advantages
Should I put a pessary? Previously, in order to prevent isthmic-cervical insufficiency, stitches were placed on the neck of the genital organ. This procedure was carried out no earlier than 20 weeks of pregnancy, since anesthesia was used. Fortunately, in modern gynecological practice, such an invasive technique has been replaced by a more sparing solution in the form of an obstetric ring.
Now, instead of sutures, many gynecologists look in favor of a new device. This is largely due to the presence of certain advantages:
- non-invasive nature of the manipulation;
- the risk of infection is markedly reduced;
- installation is possible on an outpatient basis - that is, there is no need for hospitalization;
- the procedure is easy;
- anesthesia is not needed;
- the introduction of the device does not injure the cervix.
At the same time, it should be borne in mind that a number of clinical cases require suturing with the subsequent installation of the ring on the cervix during pregnancy. In other words, the surgical correction method in some cases is still carried out.
As for the advisability of carrying out one or another method, here the right to choose is the prerogative of the doctor only. It is up to him to decide which methodology to give preference in each particular case.
Description
The procedure for installing a gynecological device is not very pleasant due to the peculiarities of its implementation. However, according to many doctors, women do not experience strong pain. In many respects, it all depends on how well the preparation for the procedure was carried out. And if a woman has an overestimated sensitive threshold, then during the manipulation she may feel discomfort, which can easily be sustained.
The installation of the ring on the cervix during pregnancy is carried out from 16 to 34 weeks of pregnancy. In most cases, the procedure falls on the period of the II trimester. However, previously a woman needs special training, during which various necessary procedures are carried out:
- The first step is to exclude diseases of the genital tract of an inflammatory or infectious nature. Reorganize if the situation requires it. Even at this stage, a smear and biomaterial of the cervix are taken to detect susceptibility to medications.
- If an excessive concentration of leukocytes is detected in the absence of pathogen growth, the doctor prescribes suppositories with an antiseptic effect. Sometimes it may be necessary to use antibiotic drugs.
- Immediately at the time of the manipulation, the bladder must be emptied, which, if necessary, should be done in advance.
- An hour before the procedure, the woman needs to take an antispasmodic (for example, Drotaverinum).
Now, in fact, how to put the pessary. For this, the woman is conveniently located on the gynecological chair. An obstetric device, cervix and vagina are treated with an antiseptic. Next, the doctor inserts the already prepared product into the vagina in a compressed form, and already inside the pessary straightens.
All manipulation is painless and lasts for several minutes. If the size of the device is chosen correctly, a woman should not feel it inside.
After the procedure
After installing the ring on the cervix, women need to closely monitor their own health. First of all, you should ensure complete peace. Sexual contact is completely prohibited! The same applies to taking a bath, swimming in a pool or pond. Although these issues can be discussed with the doctor in each case individually.
Also, you can not expose yourself to excessive physical exertion, which, in fact, is relevant in general during pregnancy. Sometimes a doctor prescribes a course of using vaginal suppositories to avoid infection of the genital tract.
Subsequently, it is required to take a smear every 2 or 3 weeks to observe the condition of the microflora of the vagina. In addition, the expectant mother during the entire period of operation of the obstetric device should regularly visit a personal gynecologist who is pregnant, in order to control the position of the ring.
Expectant mother
In some cases, after installing the ring on the cervix, a woman may notice specific vaginal discharge: translucent or white. At the same time, she does not feel itching or burning in the genital tract. This should not be scared, since this is the response of the female body to the introduction of a foreign object.
It is worth notifying expectant mothers in advance so that they do not worry much about the life of their child. A stressful situation will only bring harm to pregnancy, up to premature delivery.
Nevertheless, after installation, there may be cases when you should not hesitate to visit a doctor (it does not matter what week it is - 39 or earlier) in order to avoid the worst. This refers to the color and nature of the discharge:
- bloody
- bloodthirsty;
- greenish;
- yellow.
In addition, there may be abundant transparent secretions, which in their consistency resemble water. In this case, you need to see a doctor as soon as possible.
When is the ring removed?
Further, after the installation of the obstetric device, if the pregnancy proceeds normally, it is removed with the arrival of 37-39 weeks in the case of one child. When waiting for twins, triplets, etc., the product is removed a little earlier - at 34 weeks. After removal of the ring, genital tract sanitation is also mandatory.
In some cases, before the 39th week of pregnancy, situations may arise for premature removal of the device:
- Infection of the membranes, including amniotic fluid, has occurred.
- As a result of the outflow of amniotic fluid.
- Premature onset of delivery.
- The need for premature birth, due to medical conditions, based on the condition of the mother and child.
As a rule, an established gynecological product allows you to maintain pregnancy, preventing the prolapse of the fetus and premature onset of labor.
Possible complications
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For example, the obstetric device shifts or falls completely. This can happen due to improper installation or due to the wrong choice of pessary size. A woman can determine its displacement by characteristic signs. She begins to feel pressure and discomfort. In addition, being in a sitting position becomes uncomfortable, or even painful.
In some cases, displacement of the ring can provoke the development of colpitis. Then an appropriate course of treatment is carried out. However, if within 10 days the therapy does not bring the desired effect, the pessary must be removed. For this reason, it is worth visiting a doctor regularly to monitor the position of the product.
As practice shows, complications after installing the ring are extremely rare. At the same time, their complete absence cannot be ruled out - no one can guarantee that in each case a woman will be on the list of lucky ones.
We now know how many weeks the pessary is removed. However, after installing it, the main thing is to listen to your own body and, at the slightest occasion, visit a doctor.
In conclusion
The condition of the ICI is not the case when a pregnant woman has much to choose from. A good option is to install a special device on the neck of the genital organ in order to avoid the threat of miscarriage and the onset of premature birth.
In addition, it is worth noting that only this procedure for the expectant mother does not end there - it is necessary to strictly observe all the recommendations of the doctor. Only in this case, women can count on the successful preservation of pregnancy. As obstetric practice shows, the efficiency of installing the ring on the cervix (provided it is worn correctly) is about 70-80%. And these are already good results in favor of this method of correction of the ICI.