Short cervix during pregnancy and the risk of premature birth. Shortening of the cervix before childbirth. Actions for a short cervix

Every woman dreams of an ideal pregnancy, which proceeds calmly, without complications associated with the threat of miscarriage and premature birth. But no one is immune from failure; sometimes things don’t end the way you want. If the cervix is ​​short during pregnancy, the risk of premature birth of the baby increases significantly.

Shortly before childbirth, the body begins to prepare for the upcoming event. The changes do not bypass the cervix - it becomes softer and shorter, so that at the crucial moment it is easier to open and release the baby from the birth canal. Sometimes this process, intended by nature, begins much earlier, and then the woman faces the threat of miscarriage or premature birth.

Normally, the length of the cervix is ​​3.5 cm, but if we are talking about its pathological condition, then this figure decreases to 2.5 cm or less. It is shaped like a cone. One third of its structure is represented by strong muscle fibers, which reliably fix the fetus in the reproductive organ during pregnancy.

If a woman’s shortened cervix is ​​due to heredity, then this fact can be recognized long before pregnancy. Girls who regularly visit a gynecologist from the onset of puberty are usually aware of their diagnosis. In order to avoid complications, it must be taken into account by the doctor at the stage of the patient’s planning for conception.

If a woman comes to the gynecologist while already pregnant, then the doctor will be able to establish the fact of a short cervix during a routine examination on the gynecological chair. As a rule, in these cases, the specialist additionally refers the patient to a transvaginal ultrasound examination, which can confirm his assumption.

Why is a short neck dangerous during pregnancy?

The greatest danger of a short cervix during pregnancy is isthmic-cervical insufficiency (ICI), leading to the threat of miscarriage. If its length is less than 2.5 cm, then it will not be able to hold the fetus for a long time and premature opening of the uterus will begin. Pathology not detected in time leads to pregnancy loss.

During the birth itself, there is a high probability of rapid progress and complications associated with this: injuries, ruptures, etc. In addition, the shortened neck of the reproductive organ does not reliably protect the fetus from infection, since in this case there is no complete barrier against pathogenic microflora penetrating from the outside.

Fortunately, this condition is not an obstacle to motherhood. Even in the presence of isthmic-cervical insufficiency, it is possible to carry and give birth to a child if the necessary treatment and preventive measures are taken in time.

Causes

A short cervix during pregnancy can negatively affect the entire process of bearing a child. This pathology is aggravated by such concomitant factors as a large fetus, polyhydramnios and multiple births.

Causes of shortening of the cervix:

• congenital pathologies caused by genetics: incomplete development of the cervical canal, abnormal structure of the uterus, sexual infantilism;
• hormonal abnormalities that arise during pregnancy;
• hyperandrogenism;
• acquired injuries to the cervix of the reproductive organ received during childbirth, abortion or curettage;
• organ dysplasia.

Symptoms

For the first time, symptoms of a shortened cervix make themselves felt from the 16th week of pregnancy. The fact is that from this moment the fetus begins to gain body weight faster, putting more pressure on the uterine os. The doctor can discover this during the next examination in the gynecological chair. The expectant mother usually does not have any complaints.

In rare cases, symptoms of a short cervix during pregnancy are manifested by minor discharge mixed with blood or copious mucous discharge from the genital tract, pain in the lower abdomen. If a woman has these signs, the doctor will definitely refer her for an ultrasound examination. The first symptom of a miscarriage or premature birth is bleeding at any stage.

Diagnostics

Diagnosis of the cervical condition is usually carried out before the 12th week of pregnancy, at the moment when a woman comes to the antenatal clinic to register for pregnancy.

A comprehensive examination includes the following stages:

1. Digital examination of the vagina, during which the doctor assesses the length of the cervix, its patency and the condition of the cervical canal.
2. Examination in the mirrors, which allows you to clarify the condition of the external os of the cervix.
3. An ultrasound examination, which not only confirms the presence of pathology, but also allows you to monitor its development in the future.

The doctor will see that the cervix is ​​shortened after the first vaginal examination of the patient. But he will be able to make the diagnosis only based on the results of an ultrasound examination performed transvaginally.

Treatment

If a woman has a history of spontaneous miscarriages and premature births, or during this pregnancy she is diagnosed with isthmic-cervical insufficiency, then she will have to be closely monitored by a doctor throughout the entire gestation period.

If a short cervix is ​​detected during pregnancy, what should you do? Unfortunately, it is impossible to increase the length of a shortened organ. Therefore, treatment should be aimed at maintaining pregnancy and preventing premature onset of labor.

Doctors use two tactics in treating such patients. For therapeutic and prophylactic purposes, if the cervix has shortened slightly during pregnancy, a pessary is installed on its sphincter, which reduces the pressure of the amniotic sac, fixes the uterus in a certain projection and prevents the opening of the uterine pharynx prematurely.

If the cervix is ​​seriously shortened or the external os is opened, it becomes necessary to apply sutures that will mechanically prevent the subsequent opening of the cervix until the time of birth. This procedure cannot be postponed: a short cervix can be sutured during a pregnancy of 30 weeks or less.

If the shortening of the organ is caused by hormonal imbalance, the condition is corrected by prescribing hormone therapy to the woman. The doctor should also give the patient a number of recommendations, such as wearing a prenatal bandage, limiting physical activity, and sexual abstinence.

Prevention

Prevention of premature cervical dilatation during pregnancy should begin long before conception, even from the moment of sexual activity. It includes the following aspects:

• reliable contraception aimed at preventing unwanted pregnancy and subsequent abortions;
• regular observation by a gynecologist in order to timely identify health problems and eliminate them;
• adequate pregnancy planning, especially for women who have experienced abortions, miscarriages and premature onset of labor in the past;
• maintaining a healthy intimate life (absence of promiscuity, protected sexual intercourse, etc.).

A short cervix leads to serious problems during pregnancy. The health of the mother and child, namely the outcome of pregnancy, depends on its condition.

Probably the biggest danger facing a woman during pregnancy may be the threat of miscarriage or. Because if this happens, then neither illness, nor treatment, nor other factors will have any special significance - there is no pregnancy.

The threat can hang over each of the expectant mothers at any period of gestation and for one of the many possible reasons for this. One of these is a short cervix during pregnancy.

What are the dangers of a short cervix during pregnancy?

Normally, the size of a woman’s cervix is ​​on average 4 cm. But in some cases it can be shortened or even short. This diagnosis is made if the length of the cervix is ​​2 centimeters or less.

A short cervix may be one of the signs of the so-called cervical insufficiency (ICI). This is a condition in which pregnancy is at risk due to the physiological inability of the cervix and isthmus of the uterus to support the fetus in the cavity. That is, under the pressure of an ever-growing baby, the cervix opens and a miscarriage or premature birth occurs. In addition, a deformed cervix is ​​not able to protect the fetus from infections. And during childbirth, this condition is also dangerous due to the rapid course of events and, as a result, ruptures of the cervix and vagina.

The gynecologist may suspect that the cervix is ​​shortened during an examination, but usually the pathology is detected during a transvaginal ultrasound.

Why is the cervix short?

It can be congenitally short (when the anatomical features of the structure are present), but most often it is an acquired characteristic. In what cases does the cervix shorten?

Well, firstly, during pregnancy this can happen due to hormonal imbalances. The risk of developing this condition increases from 1 to 27 weeks of pregnancy, most often occurring at 16 weeks.

Also, the cervix often becomes shorter after mechanical damage due to various intrauterine interventions: abortion, curettage, or previous pregnancies. Scars form on it, as a result of which the cervix loses its ability to stretch, becomes deformed and shortens.

What to do if the cervix is ​​short during pregnancy?

The very first and true thing is complete peace and a particularly attentive and careful attitude towards yourself. If you have a short cervix, you must constantly be under medical supervision, periodically undergoing examinations with a gynecologist.

Caused by hormonal imbalances, ICI is usually corrected with medications.

If the situation is critical, you will most likely have temporary sutures placed on your uterus, which will be removed before giving birth. This procedure is called cervical cerclage and is performed under general anesthesia, so there is no need to worry.

Your doctor may suggest that you wear a pessary - a special gynecological ring that will hold the cervix in a stable state, preventing its premature dilatation. Wearing a ring may cause some discomfort at first, but this quickly passes, and in order to maintain the pregnancy it is quite possible to endure it.

It should be said that women often refuse any safety measures, relying on chance. Sometimes they actually carry their babies to term safely and give birth on time. But many pay too high a price for their decision. So if your doctor insists on stitches or a pessary and you trust him, then the best thing to do is listen.

But ideally, of course, let everything be good and stable for you!

Especially for- Elena Kichak

Every pregnant woman worries about her baby. When pregnancy proceeds without pathology, this pleases not only the woman, but also her attending physician.

One of the common pathologies of pregnancy is a short cervix. In order to understand what kind of diagnosis this is, what this condition entails and how to treat it, our article is devoted to it.

The lower segment of the uterus is represented by the cervix, or cervix, the center of which is the canal connecting the uterus to the vagina. Normally, the length of the cervix is ​​3 - 4 cm, while the cervical canal is closed and filled with mucus.

During a gynecological examination, the vaginal part of the cervix is ​​visible, which is assessed by a gynecologist.

The cervix is ​​connected to the uterus through 4 vaginal vaults:

• anterior fornix, which is located under the pubis;
• posterior fornix, located closer to the sacrum;
• 2 side vaults.

There are external and internal pharynx. Available for visual inspection:

• vaginal part of cervix;
• external os.

Shortening of the cervix occurs with increasing gestational age, and smoothing and opening of the cervical canal by 10 cm occurs during the birth process.

However, pregnancy does not always proceed according to the textbook. It happens that the cervix shortens prematurely. This poses a risk of premature birth or late miscarriage.

Causes of shortening of the cervix

ICI, or isthmic-cervical insufficiency, is a pathological condition that is accompanied by a shortening of the length of the cervix compared to its original length, as well as its softening and opening of the pharynx. In this case, the external os is not closed during a vaginal examination, but is open from 0.5 cm or more, or the internal os is not closed during an ultrasound examination.

Among the reasons that can cause this pathological condition are:

1. Physiological characteristics of the pregnant woman's body.

In this case, the neck is initially short, and its length is less than 3.0 cm. This feature is not pathological if it does not shorten later.

1. Hormonal disorders.

In this case, a disruption occurs in the hormonal status of the pregnant woman. This pathology requires medical intervention.

1. History of traumatic lesion of the cervix.

This pathology is caused by surgical and other interventions on the cervix.

Among them, a special role is played by:

• forced instrumental expansion of the cervix during abortion;
• cauterization or conization;
• cervix ruptures during previous births;
• application of obstetric forceps or vacuum extractor;

1. The pathological course of this pregnancy, which is accompanied by increased stress on the cervix:
   • multiple pregnancy with two or more fetuses;
   • polyhydramnios;
   • large fruit;

1. Infectious lesions of a pregnant woman.

Require immediate treatment.

Close attention is paid to women who have a burdened obstetric and gynecological history:

• traumatic lesions of the cervix;
• spontaneous miscarriages in late stages, after the 12th week of pregnancy.

This group of women is observed as a group at risk of miscarriage and is examined for a short cervix more often.

Symptoms and signs

Objective symptoms with a short cervix may be absent. Pathology is determined by vaginal examination or ultrasound.

In some cases, shortening of the cervix may be accompanied by symptoms of threatening spontaneous miscarriage or premature birth in the form of:

• pain in the lower abdomen of a pulling or aching nature;
• bloody or mucous-bloody discharge from the genital tract;
• discharge of the mucus plug.

The appearance of dangerous signs of a threat is an indication for immediate hospitalization.

Diagnostics

Diagnosis of isthmic-cervical insufficiency is based on:

• vaginal examination;
• ultrasound examination.

During a vaginal examination, the doctor determines:

• length;
• consistency;
• condition of the external pharynx.

In a normal pregnancy, the cervix meets the following criteria: Length 3.0 - 4.0 cm, dense, external os closed.

An ultrasound examination can determine the length of the cervix and the condition of the internal os.

In order to monitor the condition of the cervix, a vaginal examination in the absence of pathology is carried out at the following times:

• when registering for pregnancy;
• 16 - 18 weeks;
• 30 weeks;
• 36 weeks.

If there are changes, the doctor performs vaginal examinations more often.

How dangerous is the disease?

The danger lies in the risk:

• development of late spontaneous miscarriage or premature birth. Due to the load that the cervix experiences, it may open early;
• infectious complications for the fetus, since there is no natural barrier in the form of mucus;
• rapid or rapid labor, which can lead to injuries to the cervix and vagina.

Prevention for short cervix

Prevention should begin before conception. Among the preventive measures are reliable contraception, which will help avoid abortions and cervical injuries.

In addition, an annual visit to the gynecologist can identify possible cervical problems and provide conservative treatment.

For a successful pregnancy, planning is necessary. An early visit to the gynecologist will help avoid many pitfalls when conceiving. Women with a burdened obstetric and gynecological history should pay special attention.

Treatment depending on the week of pregnancy

Treatment depends on the timing of diagnosis. May be:

• suture;
• introduction of an obstetric unloading pessary.

Sutures can be placed until the 27th week of pregnancy. Suture application is effective even with a slight opening of the cervical canal.

The introduction of a pessary has more of a preventive value and helps to ease the load of the fetus on the cervix. There is a redistribution of the pressure force, but it turns out to be minimal and falls on the pessary.

In some cases, it is possible to combine methods. Particularly with multiple births.

The sutures and unloading pessary are removed at 38 weeks. If regular labor develops, premature rupture of amniotic fluid or bleeding occurs, they are removed immediately.

Depending on the pathology that led to the shortening of the cervix, medications are prescribed individually for each pregnant woman.

Sexual life with ICN

If a pregnant woman has a short cervix, sexual activity is not recommended. This is due to the fact that during sexual intercourse the risks of premature birth or spontaneous miscarriage increase.

Sexual activity is strictly prohibited with concomitant uterine tone, nagging pain in the lower abdomen, as well as with a suture placed on the cervix or an obstetric unloading pessary inserted.

Case from practice

Woman, 32 years old. Third pregnancy, real one. Childbirth in 2010, abortion in 2014. From the anamnesis: cauterization of the cervix due to erosion in 2011.

When registering: The cervix is ​​up to 2.5 cm long, dense, the external os is closed.

Routine examination at 16 weeks of pregnancy: the cervix is ​​the same.

At 19 weeks, complaints of periodic pain in the lower abdomen, the cervix was unchanged. Sent to hospital. After discharge, the cervix is ​​the same. When examined at 21 weeks of pregnancy: The cervix is ​​up to 1.5 cm long, softened, the external os is open to 1.0 cm. There are no complaints. He categorically refuses hospitalization. Yeast-like fungi in the smear. Outpatient therapy was prescribed.

Examination after 7 days: the cervix is ​​unchanged. An obstetric relief pessary was inserted on an outpatient basis. Drug therapy was extended.

The woman is examined in a gynecological chair once every 14 days. He categorically refuses hospitalization.

At 38 weeks of pregnancy, the pessary is removed on an outpatient basis: The cervix is ​​up to 1.5 cm long, soft, the external os is open by 1.5 cm.

Childbirth through the birth canal at 39 - 40 weeks. A boy was born, 3670 g, 54 cm, 8/9 points on the Apgar scale.

Isthmic-cervical insufficiency cannot be equated with spontaneous miscarriage or premature birth. This pathological condition may be a factor in their development. However, with timely diagnosis and initiation of treatment, it is possible to successfully prolong pregnancy to full term.

The condition of the female genital organs changes during pregnancy. If the doctor reveals that the expectant mother has a shortened cervix, the course of pregnancy may be complicated. This article will tell expectant mothers more about this common pathology.

What it is?

The main reproductive organ in which the baby develops is the uterus. It is located in the lower half of the abdomen. During pregnancy, the size of the uterus changes significantly. This is necessary so that the baby during childbirth passed unhindered through the birth canal.

The cervix is ​​a kind of entrance to the uterine cavity. Its sizes vary for different women. The average length of this organ is, as a rule, 3.5 cm. For most women, this size is from 3 to 5 cm.

Changes in cervical length are a very important clinical indicator. Doctors note that this organ can be shortened to 2 cm or less. It is this pathology that is called shortening.

The cervix changes significantly during pregnancy. During this period, uterine and then placental blood flow in the female body increases significantly. This process contributes to the strong proliferation of the cervical epithelium. This situation, as it develops, leads to the fact that the length of the cervix decreases significantly.

The proliferation of epithelial cells occurs during pregnancy under the influence of various specific hormones. Estrogens promote too much hypertrophy of the muscular layer of the uterus, which leads to changes in the tone and condition of the cervix and cervical canal.

This situation in many women can even lead to the development of many pathologies, which may lead to the need for surgical gynecological treatment.

Reasons for shortening

A narrow and short cervix is ​​often a congenital pathology. Also, this pathological condition in the expectant mother can appear as a result of exposure to various traumatic actions. The cervix is ​​shortened after abortions, as well as during other surgical interventions.

Heredity is an important feature that can contribute to the development of such a disorder. In this case, similar changes occur in the mother, grandmother or sister of a pregnant woman.

In such a situation, quite often they even develop similar pathologies that appeared during pregnancy. Quite often, adverse symptoms develop at 25-30 weeks of pregnancy.

Significant physical activity can also lead to shortening of the cervix. It is for this reason that doctors prohibit the expectant mother from engaging in active sports or putting a lot of stress on her body. Regular walks in the fresh air are suitable for optimal physical activity.

Another possible reason for the development of this condition is the consequences of various infectious diseases. Pregnancy is a period in a woman’s life accompanied by a decrease in immunity. This condition contributes to the fact that any pathogenic microbes can easily get to the cervix and cause inflammation there.

In order to reduce the likelihood of developing this condition even before pregnancy, a woman should definitely visit her doctor regularly.

The appearance of various scars on the cervix can also contribute to the shortening of this organ. These formations appear after any surgical interventions on the cervix, which are performed by obstetricians-gynecologists.

Pathologies that led to the treatment of this organ using a laser or alternative techniques can also contribute to the formation of various scars on this organ.

If the expectant mother is carrying a large baby or twins, then the risk of developing shortening also increases significantly. In this case adverse symptoms progress as pregnancy progresses.

This situation is due to the fact that the baby, developing in the mother’s womb, puts strong pressure on the cervix. Compression of this organ leads to the fact that it shortens significantly and becomes narrower.

Pathological conditions of the placenta can also lead to the development of this pathology. One of these pathological conditions is its presentation. The large size of the placenta, putting pressure on the cervix, causes its compression, which contributes to the development of shortening of this organ.

Experts identify several of the most dangerous periods during pregnancy. This includes the time from 20 to 30 weeks of pregnancy. The most dangerous period for the development of this condition is the 16th week.

Symptoms

During the entire period of pregnancy, a woman should closely monitor her health. She may develop unfavorable signs at any time.

If the expectant mother begins to feel that her health is deteriorating, it is better for her to contact her obstetrician-gynecologist unscheduled.

Quite often, unfavorable symptoms appear in women at 21 weeks of pregnancy. This period of bearing a child is very important. At this time, the woman usually begins to feel the active movements of her baby

Reviews from many mothers indicate that they feel “jolts” or “kicks” in their tummy. This state causes them a sea of ​​positive emotions and greatly inspires them.

If, against the background of such symptoms, a pregnant woman begins to notice that she has some kind of pain in the lower abdomen or bloody discharge from the vagina, then she should Be sure to quickly contact your doctor.

31-32 weeks of pregnancy is another dangerous period of pregnancy when a woman’s condition may worsen. Expectant mothers who are carrying twins or triplets should watch themselves most closely at this time.

Women suffering from polyhydramnios are also at increased risk for the development of this pathology. To prevent unfavorable symptoms from progressing during this period, doctors recommend that the expectant mother Get plenty of rest and limit physical activity.

Any psycho-emotional stress is also excluded. A correct and rational daily routine is a very important task.

Danger to the expectant mother and fetus

Shortening of the cervix can lead to a significant threat to the course of labor. This condition threatens the development of isthmic-cervical insufficiency. This pathology can lead to premature birth.

Strong physical activity in this case can contribute to the deterioration of the general condition of the mother and her baby. This situation cannot be avoided without medical intervention.

If the mucous membranes of this organ begin to soften greatly against the background of shortening, the lumen of the cervix expands. This contributes to the fact that the risk of infection of the baby increases many times over. This situation also contributes to the penetration of pathogenic microbes into the uterine cavity and into the cervical canal.

A uterus that is too short, according to statistics, leads to an increase in premature births. Doctors note that women suffering from this pathology may require emergency obstetric care at 34-37 weeks of pregnancy.

A narrow and short uterus, especially in petite women, means that they may experience various injuries and ruptures during childbirth. In this case, stitches may be required. This condition requires longer rehabilitation and can significantly aggravate the first weeks of life after the long-awaited birth.

The risk of developing this pathology increases significantly in women who are carrying an overly large baby or several children at the same time.

Cervical ruptures

Quite often, a short cervix leads to the development of hypertonicity. This pathology also increases the risk of premature birth. This condition is manifested by the appearance of pain in the abdomen, bleeding from the vagina, dizziness and severe fatigue. Only an obstetrician-gynecologist can identify this pathology during an extensive gynecological examination.

If hypertonicity against the background of a short cervix is ​​detected already in late pregnancy, then in a dangerous situation, hospitalization may even be required. In this case, the expectant mother will undergo intensive treatment in a hospital setting. In this situation, “conservation” will also be offered to women with multiple pregnancies.

What to do?

It is important to note that if a woman has a short cervix before pregnancy, she should regularly visit her gynecologist. This is necessary in order to monitor the condition of this organ. Quite often, shortening of the uterus leads to the development of many dangerous pathologies.

However, in most cases, this pathological condition is determined only during pregnancy. It is identified by a gynecologist during an examination of the expectant mother on a chair. If violations are detected, the doctor must refer the woman for additional transvaginal ultrasound examination.

Maintaining a daily routine

Doctors recommend that expectant mothers strictly monitor what they do during the day. The daily routine is very important. In order to normalize the tone of the uterus, you should definitely get enough sleep regularly. Sleep should be at least 8-9 hours a day.

To prevent the cervix from further shrinking, The expectant mother should monitor her excessive emotions. Severe anxiety or worry over trifles leads to disruption of nervous activity and spastic contraction of smooth muscles. This condition can only increase the shortening of the cervix.

Optimal physical activity helps the expectant mother maintain the tone of the female genital muscles. To normalize it, yoga classes for pregnant women or regular walks in the fresh air are suitable. Also, to prevent the worsening of this pathology, doctors prohibit the expectant mother from lifting weights.

Normalizing excess body weight is a very important condition for maintaining the health of the female genital organs. During pregnancy, the expectant mother already gains weight. This is due to the baby growing in her tummy, as well as the entire mass of all the placental membranes. Too much weight can lead to compression of the reproductive organs, which also causes shortening of the cervix.

In some cases, doctors may recommend that women suffering from this pathology wear special bandage. It helps to fix certain parts of the spine, and also somewhat reduces the likelihood of premature birth.

Shortening of the cervix is ​​not a contraindication for sexual intercourse. Only in certain acute pathologies can doctors recommend that women limit their sexual activity. As a rule, such recommendations are given to expectant mothers in the last stages of their pregnancy.

Gynecological treatment

If, against the background of a short cervix, a woman has developed isthmic-cervical insufficiency, then she will require special treatment methods. In this case, doctors usually apply sutures that fix the os of the uterus. They will be removed only immediately before childbirth.

Some of the methods are surgical and are performed in an operating room. As a rule, in this case, mandatory intervention of an anesthesiologist is required.

Cervical cerclage is an invasive procedure that is performed to correct disorders that have arisen on the cervix. In this case, temporary sutures are placed on the cervix. They are necessary to ensure that it remains “closed” until the birth itself. Usually in this situation, sutures are applied before 26-27 weeks of pregnancy, since in the future this measure will be ineffective.

Another method of treating isthmic-cervical insufficiency caused by a too short cervix is ​​the application of an obstetric pessary. This special device is inserted into the cervical canal and fixes the pharynx from the inside. An obstetrician-gynecologist installs an obstetric pessary.

This procedure is invasive, so requires mandatory training. It is better that it is performed only by an experienced and qualified doctor. After installing an obstetric pessary, doctors limit physical activity and recommend that expectant mothers get plenty of rest.

Drug therapy

In some situations, doctors may recommend hormonal treatment to the expectant mother. This is possible in cases where pathological changes in a woman occur against the background of existing dishormonal disorders. In such a situation, doctors prescribe medications that compensate for the lack of specific female hormones.

"Utrozhestan"- This is one of the medications prescribed to correct the problems that have arisen. Gynecologists can prescribe this drug at various periods of pregnancy. For up to 12 weeks, taking Utrozhestan promotes the attachment of the fetus to the wall of the uterus, as well as the beginning of its intrauterine development.

Taking this drug also significantly reduces the risk of spontaneous miscarriage. By the later weeks of pregnancy, the increase in progesterone in the blood decreases slightly. This physiological reaction is necessary for the expulsion of the fetus from the mother's womb. In this case, taking Utrozhestan may lead to a worsening of the final stage of pregnancy.

This drug can be prescribed in the form of capsules or various suppositories. In most cases, it is taken three times a day. Dosages are selected individually, taking into account the patient’s weight, the presence of concomitant diseases, as well as the nature of the pregnancy.

Expectant mothers should remember that Any hormonal medications must be prescribed by a doctor. Self-use of such drugs can lead to the development of quite dangerous conditions for the fetus and her own health.

A short cervix is ​​not at all a contraindication for planning pregnancy. With such a physiological feature, a woman can become a mother more than once. For the normal course of pregnancy, only timely monitoring of the baby’s condition while he is in the mother’s tummy is required.

It is better to determine the shortening of the cervix before conceiving the baby. The only exception is if this pathology occurs in a pregnant woman directly during pregnancy. Timely diagnosis of this condition can reduce the significant risk of developing various diseases in both the pregnant woman and her baby.

Gynecologist Lyudmila Shupenyuk will talk about how long the cervix should be during pregnancy in the next video.

A short cervix is ​​a typical pathology, detected mainly in pregnant women, usually detected from 11–18 weeks of gestation. Does this problem pose a threat to the expectant mother and child? How to detect it in time? Is it possible to cure the pathology? You will read about this and much more in our article.

Causes

There are many reasons for the formation of a short cervix. Some of them are congenital, while others are acquired. The most common:

• Genetic predisposition. A proven factor in the congenital form of pathology is heredity, which provokes a special structure of the genital organs and their elements;
• Congenital anomalies. In addition to heredity, during the intrauterine development of the expectant mother, as well as at the stage of maturation of the body (up to puberty), there is a chance of the formation of anomalies - various defects and underdevelopment of the uterus in general and the cervical canal in particular, genital infantilism;
• Hormonal imbalances. Due to the influence of various negative factors that provoke hormonal disorders (for example, with hyperandrogenism), there is a high probability of secondary changes in the soft tissue of the genital organs;
• Mechanical injuries. Difficult previous births, abortions, various surgical interventions contribute to the formation of a short cervix;
• Connective tissue dysplasia. The problem most often occurs against the background of an increase in relaxin levels;
• Volumetric internal formations. Both malignant and benign formations inside the organ create the prerequisites for the development of various pathologies, including structural changes in the cervix.

As modern gynecological practice shows, in the vast majority of cases, a short cervix is ​​diagnosed during a woman’s pregnancy - previously this pathology is asymptomatic and does not manifest itself in any way.

Potential external symptoms that may indicate a problem are also not specific. It can be attributed to a number of other negative circumstances. Moreover, the problem does not appear from the beginning of pregnancy, but as the fetus grows, starting from 15–20 weeks and later. The most significant primary signs:

• Unusual vaginal discharge. They can be either watery or mixed with blood clots;
• Mild pain in the lower abdomen, usually developing during physical activity. Sometimes, the pain radiates to the lower back.

The main danger of a negative condition lies in the formation of isthmic-cervical insufficiency (ICI), which ultimately leads to the inability of the uterus to hold the fetus. The cervix gradually comes off, which provokes a miscarriage (in the early stages), premature pregnancy (in the middle stages) or a rapid course of labor during physical pregnancy.

In addition to the dangers described above, a partially open cervix provokes the penetration of various infections in the form of bacterial and viral agents, since the physical barrier between the placenta and the external environment is de facto broken. The problem can be aggravated by polyhydramnios (a large amount of amniotic fluid), the large size of the unborn child, its low or incorrect presentation.

The following parameters are considered pathology:

• The length of the uterine element is from 2 to 3 centimeters, the diameter of the internal os is from 0.9 to 1.2 centimeters - a shortened or short cervix;
• The length of the uterine element is less than 2 centimeters, the diameter of the internal pharynx is from 1.2 centimeters - a very short cervix.

As a rule, pathology can be visually and instrumentally diagnosed as early as 11–12 weeks of pregnancy, naturally with a highly qualified specialist and modern equipment. In case of subjective complaints from the patient or the doctor, the following diagnostic procedures are applied:

• Digital examination of the organ with a qualitative assessment of the length of the neck, the condition of the canal and its patency;
• Examination using a gynecological speculum, allowing monitoring of the external pharynx;
• Ultrasonography.

Based on the procedures described above, an appropriate preliminary diagnosis is made to clarify the degree of threat of miscarriage within the framework of the development of isthmic-cervical insufficiency.

Typical laboratory methods used in this situation:

• Coagulogram;
• Determination of levels of individual hormones (progesterone, testosterone and estrogen);
• Taking a smear for bacterial infections;
• Analysis for the presence of intrauterine infections and antibodies in hCG (human chorionic gonadotropin);
• Detailed biochemical blood test;
• Urine test for ketosteroids;
• Other techniques if necessary.

Only after the complex diagnostic procedures described above, a specialized specialist prescribes appropriate treatment, taking into account the individual characteristics of the woman’s body, the presence of concomitant chronic diseases, the current state of the pathology and other factors.

It is impossible to completely get rid of the pathology of a short cervix during pregnancy - the only method available for this (a fairly complex plastic surgery) can only be performed if the fair sex is not in an interesting position, and conception is only planned in the future.

All the main efforts of complex therapy, including conservative treatment, physiotherapeutic techniques and surgical intervention, are aimed at preventing complete premature dilatation of the cervix and the onset of labor, leading to miscarriage in the early stages and or the birth of a very premature baby in later stages. If the expectant mother was able to carry the fetus to term before the expected date of physiological birth, then in most cases it proceeds normally, but under the additional supervision of a medical specialist who complements the midwife due to the rapidity of the process itself. Caesarean section can be prescribed only in exceptional cases if there are appropriate indications.

Drug therapy:

• Glucocorticosteroid drugs. Designed to normalize hormonal levels in cases where the main pathological factor that increases the risk of premature softening of the cervix and its dilatation is a corresponding imbalance of biologically active substances that regulate the metabolic and physiological functions of the body of the fair sex. Typical drugs in this group are Dexamethasone, Prednisolone, Turinal, human chorionic gonadotropin;
• Inhibitors of uterine tone. Tocolytics are used as an addition to hormonal therapy to eliminate the tone of the organ, which has an inducing effect on the start of labor, the formation of uterine contractions and dilation of the cervix. Typical representatives are Ginipral (intravenously or orally in tablet form), other beta-adrenergic agonists and Magnesia (intramuscular magnesium sulfate);
• Non-steroidal anti-inflammatory drugs. To reduce the level of potential inflammatory processes and as an analgesic, Indomethacin and Diclofenac in tablet forms are used;
• Preventative drugs. Used to prevent placental insufficiency. Typical groups are vasoactive and vasodilating drugs, low molecular weight dextrans;
• Antispasmodics. Designed to relieve spasms and tone smooth muscles. Typical representatives are Drotaverine and Spazmalgon;
• Sedatives and vitamins. As an addition to the main therapy, the use of valerian with motherwort, as well as specialized ones, may be prescribed.

Physiotherapeutic procedures:

• Acupuncture;
• Electroanalgesia;
• Endonasal galvanization;
• Electro-relaxation.

Surgery

In the absence of the required effect from conservative therapy and additional instrumental procedures, a specialized specialist may decide to suture the cervix. The radical technique is prescribed from 13 to 27 weeks of actual pregnancy in the absence of direct contraindications such as the presence of systemic chronic diseases of the kidneys, liver, cardiovascular system, infectious lesions, as well as mental and genetic syndromes.

The procedure itself (called cervical cerclage) is performed using a needle and surgical sutures directly through the vagina or using laparoscopy. Basic approaches to suturing:

• Suturing the external pharynx with kengut threads to create a complete closed space in the uterus. Not effective in the presence of erosion on the cervix;
• Narrowing of the internal pharynx with the formation of a hole for drainage.

After the operation, the woman must follow a special regime (antiseptic treatment of the vagina, maximum rest without physical activity, limiting the consumption of liquids, prevention of viral and bacterial infections, etc.), and the sutures applied are removed by the 37th week, after which the pregnant woman will be able to give birth physiologically or through cesarean section section.

Preventive measures for a short vaginal neck are relevant only in cases where the pathology was identified in advance and did not have time to manifest itself. If the organ is regularly in good shape, characteristic vaginal discharge is observed, other symptoms appear that precede isthmic-cervical insufficiency, then classical preventive measures will not work to protect the fetus from premature exit - complex therapy is necessary.

Basic principles of prevention include:

• A special set of exercises;
• Special regime;
• Installation of an obstetric pessary.

Special regime

It is prescribed when there is a high probability of developing isthmic-cervical insufficiency, when there are no visible symptoms of the pathology yet, but data from laboratory tests, ultrasound and other diagnostic methods clearly indicate the presence and potential development of the problem described above.

First of all, physical activity is limited - this is carrying heavy objects, running, exhausting and long work. In the early and middle stages of pregnancy with a short cervix, the gynecologist recommends refraining from sexual intercourse. In especially severe cases, bed rest is prescribed.

Exercises for a short cervix during pregnancy

In the absence of uterine tone in the active phase, varicose veins, low blood pressure and a direct threat of miscarriage, a specialized specialist may prescribe a set of Kegel exercises. It is quite simple to perform even at home. However, it is worth considering the potential dangers of physical activity and not prescribing it yourself - this is the prerogative exclusively of a gynecologist, who will be able to professionally assess the potential benefits and risks, if necessary, replacing Kegel exercises with classical breathing exercises or elements of light yoga.

Before performing the basic complex, it is necessary to empty the bladder and intestines as much as possible. During gymnastic actions, it is undesirable to strain muscle groups other than those indicated, and the procedures themselves are carried out sitting, lying or standing - in a position comfortable for the pregnant woman from 2 to 4 times a day for 3-4 weeks or longer (on the special recommendation of a doctor).

• Voltage. Smoothly tense the pelvic floor muscles (PFM) and hold them in this state for about 10 seconds, then smoothly relax and after 2-3 seconds repeat the action again - a total of 2-4 sets of 10 cycles;
• Relaxation. Smoothly contract the MTD for 3-5 seconds, then quickly relax and repeat the procedure after 5 seconds. A total of 3-4 approaches of 10-12 times;
• Moving. Imagine that your body is in an elevator that moves quickly down and up the shaft of a multi-story building. Start with a potential lift, tightening the MTD accordingly and gradually increasing the holding force over 10-12 seconds. After completing the first stage of the trip (the elevator has arrived at the top floor), begin to relax slowly, again for about 10-13 seconds (the elevator goes down all the way to the basement), reaching the peak of relaxation on the last lower “floors”. Repeat the event 5–10 times;
• Ripple. Contract the vaginal muscles first in waves, and then the anal area, and then relax in the reverse order. 1 cycle of such a “wave” is 10 seconds. The total number of repetitions per lesson is from 5 to 20;
• Fixation. From a state of complete relaxation, imitate pushing in the same way as you strain during bowel movements. Hold the contraction at its peak for about 3-5 seconds, then relax by breathing deeply. A total of 10–15 repetitions per lesson.

Pessary for short cervix

An obstetric pessary is a special mechanical product, which is a structure of several rings and is designed to constantly support the uterus during pregnancy. It is made from elastic, hypoallergenic material and is a modern alternative to surgical suturing of the cervix.

The main functional task of the pessary is to redistribute the load on the uterus in the direction of reducing the pressure of the growing fetus. Typically, device installation is prescribed in the presence of ICI, multiple pregnancies, as well as preventive measures to reduce the risks of miscarriage and premature birth.

The procedure for introducing the structure itself is not painful, although somewhat unpleasant, it is carried out by a gynecologist and takes about 5 minutes. Important factors:

• Selecting a quality product. The purchased products must be certified and made from the highest quality materials that do not have sharp corners, burrs, and so on;
• Right size. A qualified specialist will help you choose the most suitable pessary size so that the ring “falls” in the exact physiological place allotted to it. This parameter correlates with linear indicators of cervical diameter, the volume of the upper third of the vagina and the number of previous births;
• No local infections. The product can be installed only if the pregnant woman does not have local or systemic sexually transmitted infections, for example, candidiasis.

Before installing the pessary, the patient is moved to the gynecological chair. The structure is lubricated with glycerin and inserted into the vagina, after which it is correctly positioned by an experienced gynecologist. The device is removed from the 36th week of pregnancy, when the period of physiological labor is approaching. While wearing, there is no discomfort or unpleasant sensations, no specific maintenance of the structure is required - you just need to avoid vaginal sex, regularly perform general hygiene of the intimate areas, and also undergo a routine examination by a gynecologist every month with a smear test for bacterial infections.

A short cervix during pregnancy should not be taken as a death sentence for the unborn child. Under a certain set of circumstances with a combination of various negative factors, there is a risk of miscarriage or premature birth, but modern medicine, with timely access to specialized specialists, will reduce them to a minimum.

• Be sure to visit a gynecologist. Any representative of the fair sex in an interesting position is obliged to take care of the health and life of the unborn baby, especially if she has been diagnosed with a pathology of a short cervix. Regular visits to a specialized specialist with the necessary tests and ultrasound will allow you to quickly monitor potentially dangerous situations and respond to them in a timely manner;
• Do not self-medicate. Any medications, instrumental techniques, gymnastics and other activities must be prescribed or, as a last resort, agreed upon with the attending physician, who takes into account the individual characteristics of the body of the future woman in labor, the presence of negative factors, the current state of the woman’s health and other nuances;
• Follow the regime. If you have a short cervix during pregnancy, limiting physical activity becomes mandatory for every woman.

Sex with a short cervix during pregnancy

As modern gynecological practice shows, in the vast majority of cases, pregnancy provokes an increase in sexual desire - this is due to complex biochemical processes of radical restructuring of the entire body and changes in hormonal levels. That is why, in the presence of pathology of a short cervix, special attention must be paid to sex.

Gynecologists here recommend limiting or completely stopping any contact in the first trimester of pregnancy, when the potential risk of miscarriage is high. Starting from the second trimester and in the absence of obvious signs of isthmic-cervical insufficiency, as well as other complications, sex is possible with restrictions on the intensity of sexual intercourse. Starting from the third trimester, restrictions on sexual intercourse are lifted.

It is worth understanding that each case is individual and the recommendations presented above must be agreed upon with the specialized gynecologist who is managing the woman’s pregnancy.