Pregnancy is an important and happy event in a woman’s life. But sometimes this period can be overshadowed by premature birth. One reason for this condition is cervical failure. This means that there is still a lot of time before childbirth, but the cervix begins to soften and open, which can provoke an untimely birth. Previously, with this diagnosis, the baby could not survive, but in modern times a woman is offered to put a device that will minimize the threat of premature birth.
What is a pessary
A device used to prevent premature birth is called a pessary or uterine ring. The pessary during pregnancy is a device made of silicone or plastic, which is worn on the cervix, supports some internal organs, including the uterus, rectum and bladder. When used, internal tissues are not injured, since the product is made with perfectly even edges and is completely sterile. Suitable for individual reusable use. The pessary during pregnancy mainly has the shape of a ring, bowl, mushroom or oval, but a hole in the middle for the neck itself is a prerequisite. In some models, at the edges there are additional holes for the exit of vaginal secretions.
What particular type will be used, the appointment will be decided by the attending physician after the examination.
Pessary types
Obstetric pessary during pregnancy is of three types, depending on the parameters of the cervix and vagina:
- 1st view. Used for women during the first and second pregnancy. The diameter of the cervix should not exceed 30 mm, and the size of the upper third of the vagina should be no more than 65 mm.
- 2nd view. A device of this type is usually installed in women during the second or third pregnancy. The length of the cervix in this case should be no more than 30 mm, while the length of the upper third of the vagina should not be more than 75 mm.
- 3rd view. It is established when the upper third of the vagina has dimensions greater than 76 mm, and the diameter of the cervix has a size greater than 30 mm. Basically, this type is put to women with multiple pregnancy.
Indications for the installation of a pessary
Pessary during pregnancy is recommended for women in the following cases:
- Isthmic-cervical insufficiency (ICI). In this case, the cervix for some reason can not cope with the function given to it and begins to unfold under the weight of the fetus or amniotic fluid, which can lead to premature birth or infection in the water.
- With a shortened cervix.
- For the prevention of ICI.
- In cases where a woman has already had premature birth or miscarriage.
- Sometimes the installation of a pessary during pregnancy is performed in cases where surgical treatment of isthmic-cervical insufficiency was unsuccessful. Also, the pessary can serve as a preventive measure for the divergence of sutures after they are applied to the cervix.
- Multiple pregnancy.
Contraindications to the installation of the device
But there are situations in which it is strictly forbidden to put a pessary during pregnancy.
These include:
- bloody or blood discharge;
- inflammatory processes on the cervix or vagina (in this case, the use of the device is possible after removing the inflammation);
- suspicion of a frozen pregnancy;
- severe fetal malformations;
- diseases of a woman in which pregnancy is a contraindication;
- pronounced degree of CPI;
- violation of the integrity of the fetal bladder.
Pessary installation principle
Installation of the pessary during pregnancy, as a rule, takes place after the 24-26th week, but according to the indications it can be used after the 13th week.
Before manipulation, it is necessary to pass smears for infections and pathological changes in the vaginal microflora and completely cure them. This point of preparation is very important, because during pregnancy, many women encounter thrush.
Many are afraid of this procedure and are interested in whether during the installation of the pessary during pregnancy it hurts. Most doctors argue that the introduction of the device is not a painful procedure, it can only cause a little discomfort. It all depends on the degree of sensitivity of the uterus and cervix. In rare cases, local anesthesia may be used. The procedure is carried out during the appointment with your doctor.
- A few days before installation, it is advisable to use vaginal suppositories to cleanse microflora from various bacteria.
- About half an hour before the procedure, it is recommended to take an antispasmodic to exclude uterine contractions in response to medical manipulations.
- Then the doctor selects the optimal form and type of device for the patient, since the administration technique is very dependent on this.
To date, the most common types are:
Plastic "Juno" (made in Belarus). It has only three sizes, has high efficiency. But with his displacement, a woman can experience painful sensations. In this case, it is recommended to see a doctor as soon as possible.
"Dr. Arabin Pessary" (made in Germany). It has the shape of a bowl. Painless administration, does not cause irritation and discomfort when worn. Pessary Arabin during pregnancy has 13 sizes, which makes it difficult to buy the right size for a particular person. Before purchasing, it is recommended to consult a doctor for help. It is worth noting that sometimes silicone can stick to tissues, which causes pain and discomfort.
How to put a pessary during pregnancy?
- Empty the bladder before the procedure.
- The woman is located on the gynecological chair, the doctor carries out sanitation of the genital tract and the pessary.
- The pessary, pre-lubricated with petroleum jelly or glycerin, is carefully inserted into the vagina with a wide base.
- Then the device is deployed so that the narrow part is under the pubic bones of the pelvis, and the wide part is deep in the vagina.
If a round pessary is used, then the doctor, having groped the cervix, gently inserts a ring on it.
The procedure in total lasts no more than 20-30 minutes, after which the woman will need to stay under observation for some time. If nothing bothers her, they let her go home.
When installing a pessary, the skill of the doctor is very important, since improper administration and installation can greatly harm both the baby and the mother.
Recommendations after introduction
After installing the pessary during pregnancy, a woman improves the quality of life, as some restrictions on physical activity are removed. Despite this, she needs to adhere to certain rules:
- A definitive ban on sexuality.
- Exclusion of physical activity, especially inclines and squats.
- Every 2-3 weeks, you must take tests for infection.
- You can not swim in pools, open water.
- As a rule, the doctor prescribes the introduction of vaginal suppositories for the entire period of use of the pessary in order to exclude sexual infections.
- It is forbidden to try to correct or remove the device yourself. In case of any discomfort, you should immediately consult a doctor.
Possible complications after the introduction of the pessary
The use of a pessary does not exclude side effects, since the body can respond differently to a foreign body. Possible complications include:
- Allocations. If you notice an increase in their number, do not immediately panic. A slight increase in leucorrhoea is a completely normal response of the body to the introduction of a foreign object. It is necessary to immediately consult a doctor if there are blood or blood discharge; yellowish or green (may indicate the presence of a bacterial infection); transparent, liquid with a slightly sweet smell (probability of violation of the integrity of the fetal bladder).
- The development of inflammation, colpitis. Sometimes with the displacement of the pessary, colpitis can develop - inflammation of the vaginal mucosa. In this case, pain from the lower abdomen and itching, similar to thrush, can be felt. In this case, it is necessary to begin treatment as soon as possible.
Pessary Removal
If the pregnancy proceeded normally, the removal of the device occurs after 38 weeks of carrying the baby, when it begins to be considered full-term. The procedure is performed by a gynecologist strictly in a medical institution. Removing the pessary is very quick and usually painless. After this, sanitation of the birth canal is carried out.
Reasons for premature removal of the device.
It happens that the pessary must be removed urgently in the following cases:
- if labor has begun;
- if amniotic fluid has departed;
- with infection of amniotic fluid;
- if necessary, emergency delivery;
- if there are inflammatory diseases of the female organs in the mother.
Efficiency
The pessary during pregnancy receives mostly positive reviews. Many women note its effectiveness, painless administration. As a rule, the pessary very rarely shifts or causes inflammatory processes. Unlike surgical suturing, the installation of this device does not require anesthesia and is less traumatic.
Conclusion
Summing up, it is worth noting that after removing the pessary during pregnancy, childbirth does not necessarily occur in the coming days. Many women carry the baby up to 40 weeks, and some give birth a couple of days after the withdrawal.
It is very important that the installation of the device is done by a qualified doctor whom you will trust. Its effectiveness and the absence of side effects will depend on its actions and the correct selection of the size and type of pessary.
Childbirth after removing the device is no different from normal.
Expectant mothers should remember that for a successful pregnancy one pessary will not be enough. It is necessary to follow all the doctor's recommendations and take the necessary tests in time.