When does the cervix begin to shorten during pregnancy? Causes of shortening of the cervix and possible threat of pregnancy

A short cervix during pregnancy is not such a rare problem, and the main feature of this pathological condition is the absence of pronounced clinical symptoms for a long time. A shortening of the cervix can be determined by an obstetrician-gynecologist when monitoring the expectant mother.

Shortening of the cervical canal is a dangerous pathology that can have a negative impact on pregnancy. Therefore, during pregnancy, you should regularly visit your doctor to promptly identify situations that require correction. It is important to know the probable causes, as well as the signs of shortening, and the expected complications that can be caused by this pathological condition.

ICD-10 code

According to the international classification of diseases ICD-10, the pathology has code O34.4 and refers to other anomalies of the cervix that require medical care for the expectant mother.

Causes of a short cervix

Very short cervix

Shortening the cervix may not cause the woman any discomfort, but still this situation is pathological due to the fact that the short cervical canal does not properly fix the closed state of the uterus. For this reason, when a problem is identified, a woman should be regularly observed by specialists to monitor the condition.

A very short length of the cervix (less than two centimeters) is extremely dangerous, as it provokes miscarriage or rapid labor. To correct ICI, the woman is prescribed glucocorticoid drugs, and, if necessary, temporary sutures are placed on the uterus. Another correction method is overlay. Physical activity should also be limited.

Complications and consequences

Complications with insufficient cervix length may include miscarriages, pathological delivery, early labor or its rapid course. All this negatively affects the health of mother and child.

Timely detection of the problem allows timely determination of measures to correct the ICI. It is important to follow all doctor's orders and follow all recommendations. Throughout pregnancy, ultrasound monitoring determines the length of the cervix, which makes it possible to detect any abnormalities as early as possible.

Diagnosis of a short cervix

Shortening of the cervix can be detected as early as 11 weeks of gestation. Diagnostics involves:

• digital examination of the vagina to assess the length of the cervix, patency and condition of the cervical canal;
• ultrasound examination, which is the main method of identifying and instrumental monitoring of ICI;
• examination in mirrors to record the condition of the external pharynx.

Diagnostic criteria for ICN are the length of the organ is 20-25 millimeters and the opening of the canal is more than 9 millimeters. This situation requires the immediate initiation of corrective measures.

Important! Natural opening of the cervix is ​​possible immediately before delivery, but not before the time predetermined by nature.

Analyzes

To clarify the diagnosis and determine the general health of the expectant mother, additional laboratory tests are prescribed:

1. Detection of bacterial infectious pathologies, sexually transmitted diseases (blood).
2. Determination of intrauterine infectious pathologies - herpes, rubella, toxoplasmosis, cytomegalovirus (blood).
3. Determination of the level of human chorionic gonadotropin hormone, testosterone, estrogen and progesterone, as well as thyroid hormones in the blood.
4. Urine analysis for ketosteroids.
5. Coagulogram.
6. Determination of lupus anticoagulant.

Instrumental diagnostics

The list of necessary instrumental diagnostic methods includes:

• transvaginal ultrasound examination;
• tocography, which is implemented to identify uterine tone and contractions;
• dynamic echography, which is important in case of threatened miscarriage;
• Doppler blood flow (uteroplacental and fetal);
• cardiac monitoring.

Shortening of the cervix during pregnancy

Shortening of the cervix is ​​a dangerous condition that requires strict dynamic monitoring and the adoption of timely measures if correction is necessary. The short length of the canal outside of gestation does not pose a threat to the woman, but during gestation it can cause serious health problems for both mother and child.

What can a short cervix cause during pregnancy?

This pathological condition in the early stages creates the threat of miscarriage and miscarriage, and in the later stages - the rapid progress of labor or its premature onset. A shortened cervix is ​​not capable of supporting the uterus with a growing child. In addition, due to the short length of the cervical canal, the barrier function deteriorates and the risk of intrauterine infection of the child increases.

To prevent problems during pregnancy, you must regularly visit your doctor. Currently, there are effective ways to correct ICI and prevent the negative consequences of this condition.

Childbirth and short cervix

In case of negative dynamics when monitoring a woman with ICI, hospitalization is required. The negative direction of dynamics is understood as a sharp decrease in the length and smoothing of the cervix. Hospitalization is also advisable if the woman has a history of early childbirth. Upon admission to the hospital, manifestations of premature birth are eliminated and the patient is transferred to the pathology department for subsequent therapy.

If the woman had stitches to allow her to bear the baby, the doctor removes them before giving birth. Since with a short cervical canal there is a high risk of rapid delivery, the woman in labor should be under the constant supervision of specialists to prevent ruptures and other complications of the birth process.

Treatment of a short cervix

In case of minor changes in the cervix, conservative therapeutic measures are sufficient. The expectant mother is prescribed medications to relieve excess uterine tone and return the cervix to an acceptable state. To do this, medications such as magnesia and are administered intravenously.

Suturing the cervix

In a number of clinical situations, prompt measures to correct the condition may be required. Their list should include:

1. Mechanical narrowing of the internal pharynx (the most acceptable technique).
2. Suturing the external pharynx.
3. Strengthening the muscle structures along the lateral walls of the cervix to narrow the canal.

Surgery may be prescribed if there is a history of miscarriages and early births, or with intensive progression of ICI. However, surgical correction may be contraindicated in pathological conditions of the cardiovascular system, liver, kidneys, hereditary and mental pathologies, uncorrectable increased excitability of the uterine walls, bleeding, and developmental abnormalities of the child.

The operation can be performed between 13 and 27 weeks of pregnancy. To prevent upward transmission of infection, intervention can be done from 7 to 13 weeks. If there are contraindications, conservative therapy is carried out, bed rest and drug reduction of uterine excitability are recommended.

There are also non-surgical methods for correcting the condition. They are safe, non-invasive and easy to perform in an outpatient setting. These include the installation of a pessary or Golgi ring. These correction methods show effectiveness in cases of mild manifestations of pathology. However, these techniques are also advisable after surgical correction to reduce pressure on the sutured neck.

Prevention

Shortening of the cervix is ​​most often detected when a woman is registered to monitor the pregnancy process. After all diagnostic studies, when determining the threat of miscarriage, the doctor must select a set of measures to maintain the pregnancy.

In order to prevent the consequences of this pathology, you need to understand the importance of early preventive measures. Prevention should be aimed at implementing the following recommendations:

1. Regular visits to the gynecologist for early diagnosis of pathological conditions of the reproductive system and their timely correction.
2. Use reliable contraception to protect against unwanted pregnancy, abortion and infections.
3. The right approach to planning the birth of a child, especially rational for women who have a history of miscarriages or early births.
4. A healthy lifestyle, including regarding its intimate sphere.
5. Monitoring your health status and promptly contacting a specialist if alarming signs appear.

If shortening is detected after pregnancy, the woman should be attentive to her health and follow all medical prescriptions and recommendations. It is important to limit physical activity, wear a bandage, and abstain from active sex life.

The cervix is ​​the lower part of this organ, which is connected to the vagina.

Its normal length should be from three to four cm, but in some women in labor the length of this organ may be too short (up to two cm).

Such indicators are not the norm.

Let us consider in more detail what needs to be done with a short cervix, and what is the prognosis for childbirth in such women.

Causes of a short cervix during pregnancy

A short cervix has a separate term: isthmic-cervical insufficiency. Its main symptom is pathological dilatation of the cervix ahead of time.

Most often, this pathology is determined at 15-18 weeks of pregnancy, when the fetus in the womb is gaining weight very rapidly, which leads to heavy loads on the uterus.

ICI can be detected by a doctor during examination or an ultrasound procedure. In addition, the woman herself may begin to notice a slight discharge of mucus or blood from the vagina. This will be the warning signal after which she should visit a doctor as soon as possible.

There are many reasons for the development of ICN.

Most often this pathology results from:

1. Traumatic damage to the uterus during abortion.

2. Damage to the uterus during previous births.

3. Congenital pathology of underdevelopment of the cervix, which can even be genetic and transmitted from mother to daughter. It is important to undergo an examination by a gynecologist to determine the pathology before pregnancy. This will make it possible to understand what exactly provoked ICI, and based on such information, a treatment method will be selected.

4. Pregnancy with multiple fetuses.

5. Very large fruit.

6. Rupture or injury to the cervix during a previous birth.

7. Shortening of the cervix, which is associated with hormonal imbalance in the body, which often occurs during pregnancy.

8. Changes after surgery of the uterus (in this case, scars will form on it, which will lead to loss of the ability to stretch and shorten).

9. Increased levels of male hormone in the body of a pregnant woman.

To minimize the risk of detecting this pathology, even during pregnancy planning, it is recommended to undergo a full course of examinations, donate blood for analysis, perform an ultrasound scan and be examined by a gynecologist. Such actions can prevent possible complications in advance.

What can cause a short cervix during pregnancy?

This pathology poses the greatest danger to the fetus, namely to premature termination of pregnancy - miscarriage. This is explained by the fact that if the cervix is ​​not long enough, the uterine organ itself is simply not able to properly hold the fetus, which, by the way, is constantly growing and gaining weight. This fact, in turn, provokes premature dilatation of the uterus.

Also, with a short cervix, there is a serious risk of labor occurring too quickly, which can lead to tissue rupture, injury, infection and other complications. Moreover, a short cervix is ​​not able to properly protect the fetus from harmful bacteria and microbes, so the child may be born with reduced immunity.

Despite these rather dire prognoses, with proper medical therapy, pregnant women with this pathology have every chance of bearing a healthy child and successfully giving birth to him.

With a short cervix, expectant mothers need to follow exactly the following doctor’s recommendations:

1. Wear a support bandage. It will not only prevent premature birth, but will also relieve the burden from the back of a pregnant woman. It should be worn during the 4-5th month of pregnancy, when the baby’s weight increases quite quickly, which additionally makes the cervix heavier.

2. Completely eliminate any active stress on the body (running, sports, weight lifting, etc.).

3. Maintain rest (often women with ICI are hospitalized in the hospital for “conservation”).

4. Don’t worry so as not to provoke stress. Keep calm.

5. Be under the supervision of a doctor, periodically doing gynecological examinations.

6. If the pathology is caused by hormonal disorders, then in this case the patient is prescribed special groups of medications.

7. Monitor the tone of the uterus.

8. It is very important to maintain a proper balanced diet so that the fetus receives the maximum amount of nutrients and is strong, because in case of a difficult birth it is better if the child has sufficient weight.

10. Some women are allowed to request special gymnastics for pregnant women, but not everyone can do this. It all depends on each specific case.

Additional treatment methods include surgical correction of the cervix:

1. Cervical cerclage. This procedure involves placing temporary sutures on the uterus to provide additional support and prevent premature dilatation. The operation is always performed under anesthesia, so you should not be afraid of it. These sutures can only be applied until the 27th week of pregnancy, since there is no point in doing it later.

2. Wearing a pessary can also prevent miscarriage. A pessary is a special ring-shaped device that will hold the short neck in a stable position, preventing it from opening prematurely. Wearing such a ring may be uncomfortable, but for a normal pregnancy and pregnancy, a woman must make a choice and simply endure the inconvenience.

The pessary is removed at 36 weeks of pregnancy, when most of the danger has passed and the woman can give birth to a fully formed child.

The most important mistake of many women who have been diagnosed with a short cervix during pregnancy is distrust of doctors, procedures, and refusal to follow medical recommendations.

The fact is that each body is very individual, so it is impossible to say for sure that all women will have miscarriages, no. Many women, without any treatment, can carry a fetus to term and give birth to it with a shortened cervix during pregnancy.

Despite this, no one is immune from premature dilatation of the uterus, which can lead to heavy bleeding and even the inability to get pregnant a second time. For this reason, it is better not to expose yourself and your baby to such a risk and still carry out treatment and prevention for ICI.

Separately, it is worth mentioning about self-treatment. In order not to harm yourself and your unborn child, you should not be treated with drugs that were not prescribed by the attending physician. It is also better not to do any warming, etc., otherwise you can only worsen your condition.

Short cervix: prognosis for childbirth

As mentioned above, a short cervix needs to be treated, because this is not only reinsurance “just in case,” it is a necessity that will make it possible to reduce the risk of premature birth, in which an incompletely formed child may be born.

It is important to know that a too short cervix during pregnancy always affects the birth process itself. This, in turn, affects the following functions in the body:

1. At the very beginning of labor, the patient already has sufficient dilatation of the cervix. That is, this process will be somewhat ahead of the natural course of events. Thus, at the first stage of labor, a woman’s cervix will dilate by 3-5 cm, as it should already be in the active phase of labor.

2. If constant contractions occur, the rate of cervical dilatation will occur very quickly. It is for this reason that gynecologists advise securing the cervix with temporary sutures so that it is not so pliable and soft, since during a rapid birth, a woman in labor may experience many complications, the most common of which are:

Kidney failure;

Bleeding;

Injuries to the perineum and the uterus itself;

Birth injuries to the fetus;

Increased protein levels in the blood;

The occurrence of problems with the cardiovascular system.

To better understand the difference between births with normal cervical length and deviation, here is an example of a normal birth and the birth of a child with ICI:

1. During the first birth in patients with a traditional cervical length, the birth of the baby takes at least six hours. This is a natural process that simply cannot be faster. If a woman in labor is diagnosed with ICI, then the total duration of her labor will take 4 hours. Such a birth will be rapid and can cause a lot of unforeseen complications.

2. In multiparous women, the duration of labor usually takes 4-5 hours. They pass somewhat faster and easier than during the first birth. If such a patient is diagnosed with ICI, then the duration of her labor will not exceed two hours, which is certainly not the norm and can cause many complications.

Thus, a short cervix during pregnancy will not create unnecessary obstacles during childbirth, but it is dangerous precisely because the process of giving birth to a child is too rapid, for which the mother’s body itself may simply not be ready.

Today, to be on the safe side, doctors often practice a planned cesarean section, after which a full-fledged child is born. In this case, the restraining sutures may not be removed at all.

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. The expectant mother herself may notice heavy 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.

In addition, it is recommended to ensure that the uterus is not in good shape during pregnancy, as this also provokes ripening of the cervix. Minimal physical activity and wearing a bandage are recommended.

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.

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?

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. 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