What can cause the cervix to become short? Short cervix: minor pathology or death sentence. Video: How and why cervicometry is performed

For many women, pregnancy seems like a magical stage in which they can enjoy a peaceful, calm flow of life. In practice, the pregnancy process is accompanied by risks and complications; the woman regularly visits the doctor, undergoes routine and additional tests to monitor the condition. One of these deviations is a short cervix during pregnancy, which is dangerous for the onset of premature birth.

The natural process is to reduce its size and soften shortly before birth. If this happens much earlier than the planned date, there is a risk of miscarriage, or the baby will be born prematurely.

Diagnosis of a short cervix

The cervix has a cone shape; the special structure of the muscle fibers allows it to hold the fetus together with the placenta until the very moment of birth. Normal values ​​are 35 mm, deviations are 25 mm. Also, the length depends on the period, closer to childbirth it begins to soften and decrease. The norm is considered to be 35-45 mm at 22-28 weeks, after this period - 30-35 mm. If this is a congenital feature of a woman, and she regularly visits a gynecologist, before conception, it is necessary to go through the planning stage.

Diagnosis of the cervix is ​​also carried out when the expectant mother registers, this usually happens in the first trimester, before the 12th week. A routine examination by a doctor is enough to suspect pathology; during palpation, the gynecologist assesses the length, patency and condition of the cervical canal.

Additional studies to confirm the diagnosis:

• inspection using mirrors;
• Ultrasound examination (transvaginal) allows you to further monitor the condition of the cervix.

To determine the pathology of the cervix, an examination by a doctor is sufficient. A comprehensive examination is necessary to make a diagnosis and monitor the impact on the state of pregnancy.

Main reasons

Any deviations of the reproductive system organs pose risks for pregnancy. A short cervix is ​​especially dangerous during multiple pregnancy, polyhydramnios, or the development of a large child.

Causes of pathology:

• heredity factor, abnormal structure or insufficient development of organs due to genetic characteristics;
• hormonal changes that occur after conception;
• uterine dysplasia occurs with the onset of early sexual activity, deficiency of important elements, harmful addictions, and the presence of sexually transmitted infections;
• diseases of the endocrine system, signs are increased greasiness of the scalp, face, acne, changes in the structure of the ovaries;
• violation of the integrity of the uterus during operations, abortions, and childbirth.

If the expectant mother monitors her health indicators, eats right and regularly visits the gynecologist, the risks of pathology are reduced. In addition to genetic reasons, a woman’s lifestyle is of great importance.

Symptoms

The pathology begins to make itself known after the formation of the placenta, from the 16th week of pregnancy. During this period, the size of the fetus increases, which means that the pressure on the os of the uterus increases. A woman cannot detect this on her own; it turns out during a routine examination with a gynecologist.

There is a risk of symptoms of miscarriage. A pregnant woman experiences pain in the lower abdomen, spreading to the lumbar region. Mucous masses interspersed with blood are released from the genital tract. If signs occur, the woman is sent for an ultrasound; this may be a signal of a threat of miscarriage or the onset of premature labor.

The most unfavorable prognosis is for isthmic-cervical insufficiency, which can lead to miscarriage. With a cervical length of less than 25 mm, the uterus cannot support the growing fetus, which leads to the opening of the pharynx. This condition is asymptomatic and can only be detected during a vaginal examination.

Why is a short cervix dangerous?

• onset of premature birth, miscarriage;
• labor proceeds rapidly, often accompanied by ruptures;
• an insufficient barrier can lead to infection of the fetus.

A diagnosis of isthmic-cervical insufficiency is not an obstacle to motherhood. Timely diagnosis and therapeutic therapy allows a woman to maintain pregnancy and give birth to a healthy child.

Treatment and therapy

It is impossible to increase the length of the cervix; the doctor’s actions are aimed at maintaining pregnancy and preventing the onset of premature birth. The pregnancy of women with a history of miscarriages and diagnosed with ICI is carried out under careful observation.

If there is a slight deviation of the cervix, an obstetric pessary is used. This device allows you to fix the cervix, rectum and bladder in the correct position. Made from hypoallergenic materials, does not cause reactions in the body. It has different sizes, the ability to choose for both large and small uterine circumference. It is placed after 20 weeks and removed before birth at 38 weeks.

The edges of the pessary are lubricated for painless passage along the vaginal walls. The method allows you to maintain multiple pregnancies and reduces the risks of the onset of labor.

After installing an obstetric pessary, a pregnant woman needs:

• give up intimate life;
• limit physical activity;
• to prevent inflammatory processes, conduct a microflora study every 20 days.

In case of pathological shortening of the cervix, opening of the pharynx, the procedure of suturing the uterus is performed. This mechanical method allows you to restrain dilatation until the moment of birth. The operation is performed starting from the early stages (up to 17 weeks), but not later than 30 weeks. During suturing, the pregnant woman is under short-term local anesthesia; anesthesia that is safe for the development of the baby must be selected.

Stitches are removed by a gynecologist in the following cases:

• after 38 weeks, when the pregnancy is considered full-term;
• with stable labor, regardless of gestational age;
• with leakage or complete discharge of amniotic fluid;
• if there is discharge with blood clots.

Prevention

The basics of sex education will help prevent possible pregnancy pathologies. In addition to the genetic causes of a short cervix, the rest are the result of an irresponsible attitude towards reproductive health.

Prevention measures:

• selection of contraceptives that prevent unwanted pregnancy and sexually transmitted diseases;
• a planned visit to the gynecologist will allow you to identify abnormalities in the early stages and carry out successful treatment;
• the planning stage is mandatory for women who have undergone pelvic surgery, abortion, or ectopic pregnancy in the past;
• A healthy intimate life includes having one partner, no casual relationships, and protected sexual intercourse.

Carrying out therapeutic actions for such a pathology as a shortened cervix will allow you to maintain pregnancy and prevent the onset of premature birth. The expectant mother is also advised to follow a routine, avoid sexual intercourse, and devote more time to rest.

A pathological condition in which the length of the organ is less than the minimum for a certain gestational age. In most cases, it is asymptomatic and is detected by ultrasound screening. The appearance of clinical symptoms in the form of vaginal discharge and pain in the lower abdomen indicates a high risk of miscarriage. To make a diagnosis, the examination data on the chair is supplemented with the results of cervicometry and, if necessary, determination of hormonal levels. Treatment is combined with the use of tocolytics, hormone therapy, installation of an obstetric pessary or suturing of the cervical canal.

General information

A shortened cervix is ​​one of the most common causes of miscarriage. According to experts in the field of obstetrics and gynecology, this pathology causes from 15 to 42% of late spontaneous abortions and premature births. Signs of a short cervix are detected in almost every 10th pregnant woman. The diagnosis is usually made at 15-20 weeks of gestation. An organ length of less than 3 cm at the 20th week of gestation is considered critical for the continuation of pregnancy. A direct indication for surgical correction of the disorder is shortening of the cervix to 2.0 cm or less by the end of the second trimester. Pathology is more often determined in multiparous women, which is associated with possible trauma in previous births.

Causes of a short cervix during pregnancy

Clinically significant shortening of the isthmic-cervical zone occurs in the presence of pathological changes in the tissues of the cervix, its hypersensitivity to the action of regulatory hormones or an increase in their concentration, pressure of the growing fetus and its membranes on the lower uterine segment. The immediate causes of the formation of a shortened neck are:

• Anatomical defects and mechanical damage. Initially, a short cervix occurs with genital infantilism, congenital anomalies of the uterus or cervical canal. Deformation with a decrease in the length of the organ is possible due to trauma received in a previous birth or during invasive manipulations (diagnostic curettage, abortion).
• Hormonal disorders. The condition of the cervix is ​​influenced by hormones produced by the ovaries and placenta during pregnancy. Most often, its shortening is observed with increased secretion of androgens. The occurrence of pathology is also facilitated by connective tissue dysplasia, caused by an increase in relaxin levels as labor approaches.
• Pressure on the isthmic-cervical region. The likelihood of stretching of the lower uterine segment and internal cervical os with its decrease increases from the 2nd trimester of pregnancy, when more rapid growth of the fetus begins. Risk factors include multiple pregnancies and polyhydramnios, in which there is greater pressure on the cervix from inside the uterus.

Pathogenesis

The mechanism of pathological disorders during cervical shortening is associated with changes occurring in its tissues during pregnancy and increased pressure in the uterine cavity. Normally, after conception, the cervical canal closes, its mucous membrane becomes swollen and cyanotic due to accelerated blood supply, and the size of the cervix gradually increases, reaching a maximum value of 3.5-4.5 cm at 28 weeks. Towards the end of pregnancy, the cervix gradually shortens, opens and smoothes. In the presence of congenital or acquired anatomical defects, dishormonal influences, the closure function of the cervical canal is disrupted. As a result, under the pressure of the fetus, the internal and then the external uterine os are stretched, and the cervix becomes shorter. However, it usually does not soften and does not reach the degree of maturity required for childbirth.

Symptoms of a short cervix during pregnancy

In more than 80% of cases, the pathology occurs latently and is diagnosed during routine ultrasound screening in the second trimester of pregnancy. The presence of a short neck may be indicated by the appearance of watery or bloody vaginal discharge, minor nagging pain in the lower abdomen, which becomes cramping as the disorder progresses. However, such disorders are characteristic of severe disorders of the cervical closure function and occur with a high threat of premature termination of pregnancy, which increases the importance of routine examinations.

Complications

The most serious consequence of a short and deformed cervix is ​​increasing isthmic-cervical insufficiency. In the presence of such a pathology, the risk of spontaneous miscarriage and premature onset of labor increases. Incompetence of the cervical canal contributes to the upward spread of genital infections with the development of endometritis, chorioamnionitis, and other inflammatory processes. If a woman with a short neck carries her pregnancy to term, she may experience rapid labor with ruptures of the vagina and perineum, and intrapartum injuries to the child.

Diagnostics

Due to the virtually asymptomatic course of the disorder and the absence of its visible external signs, the leading role in making the correct diagnosis is played by instrumental methods that make it possible to accurately determine the size, condition and shape of the cervix. The most informative diagnostic tests are the following:

• Gynecological examination . The method is more indicative in multiparous patients with expansion of the cervical canal along the entire length. The increase in the diameter of the external pharynx is clearly noticeable when examining the cervix in the mirrors. If it is significantly shortened, it misses the finger of the obstetrician-gynecologist, and the membranes may protrude through it. Palpation provides only approximate data on the possible size of the organ.
• Cervicometry. Transvaginal ultrasound determination of the length of the cervix, the diameter of its internal and external pharynx, and the condition of the cervical canal is the gold standard for diagnosing the disorder. As a screening method, the method is indicated for all pregnant women with a period of 18-22 weeks. In case of a burdened obstetric history, an ultrasound of the cervix is ​​performed in the 1st trimester. Unscheduled sonography is performed if organ shortening is suspected.
• Determination of hormone levels. If the anatomical prerequisites for the development of pathology are not identified, laboratory tests are indicated to assess the concentration of hormones. With functional shortening of the cervix, there may be an increase in the concentration of androgens and a decrease in progesterone content. A small number of pregnant women with a short cervix have increased levels of relaxin, but the data from this analysis are rarely used.

A short cervix is ​​differentiated from other pathological conditions that have characteristic signs of early termination of pregnancy - abruption of a normally located placenta, placenta previa or infarction, leakage of amniotic fluid, etc. In doubtful cases, consultations with related specialists are prescribed - an endocrinologist, an infectious disease specialist, an immunologist.

Treatment of a short cervix during pregnancy

Medical tactics after identifying pathology depend on the gestational age, the degree of organ shortening, the presence or absence of a threat of miscarriage, and whether the obstetric history is burdened with habitual miscarriages or premature birth. All patients are recommended to limit physical and emotional stress, get adequate rest and sleep at night. To achieve the best results, pharmaceutical drugs are usually combined with minimally invasive techniques. Pregnant women with this disorder are advised to:

• Drug therapy. To reduce pressure on the lower segment of the uterus, in addition to wearing a bandage, patients are prescribed antispasmodics and tocolytics that reduce the tone of the uterine muscles. In the presence of hormonal disorders, it is possible to use drugs that regulate the secretion of hormones. To correct emotional disorders, herbal remedies with a sedative effect are used.
• Installation of an obstetric ring (pessary). During the procedure, a special device is placed on the cervix to keep it closed. The method of non-surgical prevention is effective with slight shortening of the organ in the 2-3 trimesters. The pessary allows you to compensate for the pressure of the fetus on the cervical area and prolong pregnancy. The device is selected individually, taking into account the size of the organ.
• Cervical cerclage. Surgical intervention to place sutures on the uterine cervix is ​​performed at 14-25 weeks of pregnancy. During the operation, a circular purse-string or U-shaped suture is placed around the cervical canal to prevent its expansion. Sutures are removed after the rupture of amniotic fluid, the onset of labor, the occurrence of bleeding, or upon reaching 38 weeks of gestation.

Prognosis and prevention

The prognosis of pregnancy with a shortened cervix depends on the time of detection of the pathology and the adequate choice of pregnancy management tactics. With careful implementation of medical recommendations, correction of the motor regime and reduction of loads, the likelihood of carrying a child to 38-40 weeks increases. For preventive purposes, it is recommended to plan pregnancy, avoid abortions and unnecessary invasive interventions on the uterus, early registration at the antenatal clinic and timely ultrasound screening, especially in cases of traumatic birth and a history of uterine pathology.

Sometimes, even during a successful pregnancy, unpleasant surprises happen. Similar diagnoses include shortening of the cervix.

A woman may not be aware of the existing pathology either before pregnancy or during its onset.

The problem will appear only after the 15th week, when active growth of the fetus begins and its pressure on the cervix increases. The diagnosis of “shortening of the cervix” is directly related to isthmic-cervical insufficiency - a dangerous condition that threatens termination of pregnancy.

The cervix is ​​the lower part of the uterus. This is a kind of muscular seal that holds the fetus in the mother’s stomach, protecting it from mechanical damage and infections. The part of the cervix facing the vagina is called the external os, and the inner edge is called the internal os.

As the fetus grows, the cervix stretches from the side of the internal pharynx and, accordingly, becomes shorter. If the external os is also included in the process, the obturator function of the cervix is ​​disrupted, and there is a threat of prolapse of the membranes, infection, and miscarriage.

Even in the absence of symptoms of the disease, it is recommended for a period of 24 weeks. A value of 3.5 cm is considered normal. Shortening of the cervix to 2.2 cm indicates the possibility of miscarriage in 20% of cases, and shortening to 1.5 cm increases the risk of premature birth by 50%.

Diagnosis: what are the symptoms?

The pathology of shortening of the cervix does not have any symptoms as such. The doctor will notice a possible danger during a routine obstetric examination. But to clarify the diagnosis, the woman is sent for an ultrasound.

Examination with a vaginal sensor will allow you to make accurate measurements and assess the threat.

If the diagnosis has already been confirmed and there is a risk of miscarriage, an examination is performed with an external, transabdominal sensor to monitor the condition of the cervix.

At the same time, at a period of 16-20 weeks, a cervix of 4-4.5 cm is considered the norm, at 26-28 weeks the norm will be 3.5-4 cm, but closer to childbirth, the cervix naturally shortens and at 34-36 weeks size 3 .5-3 cm will be an indicator of the preparation of the birth canal by the time the baby is born.

1-2 weeks before birth, the cervix decreases to 1 cm, this indicates the opening and smoothing of the wall from the internal os.

Causes

Some reasons are available for diagnosis even before pregnancy. Among them:

• congenital anatomical features;
• cervical injuries from previous births or abortions;
• scars after a protracted inflammatory process.

Many of these problems can be corrected surgically, so it is important to see a doctor if you.

But if a woman has undergone a medical examination and no problems were found in the cervix, can she be sure that the problem will not affect her during pregnancy? The doctor cannot give such a guarantee. Some factors that are not normally present and are associated specifically with pregnancy can also affect the condition of the cervix.

• Hormones.

This could be a hormonal imbalance in the woman’s body, or the endocrine system of the growing fetus becoming active. Around 16-18 weeks, when the adrenal glands are formed, androgen production begins. Under the influence of hormones, the tissues of the cervix become softer, more pliable, and open faster under the load of the fetal bladder.

• or .

The “margin of safety” inherent in nature is sufficient for the successful carrying of a normal pregnancy, when one fetus of medium-standard size develops in the mother’s body. But when carrying twins, the pressure on the cervix increases significantly: both because of the additional weight and because of the atypical position of the babies in the womb.

Under pressure, the cervix becomes wider and, accordingly, shorter. The same thing happens if the unborn baby gains weight too quickly. In such a situation, isthmic-cervical insufficiency may even develop.

If near the internal os is not the small head of the child, but the placenta - a larger, wider organ, this leads to excessive stretching of the uterus in the lower part, which will result in a shortening of the cervix.

Shortening of the cervix does not always pose a threat to pregnancy, but it is a condition that requires additional monitoring.

What is dangerous about shortening the cervix?

An important role is played not only by the fact of diagnosing shortening, but also by the period of pregnancy at which this occurred.

Shortening in the 2nd trimester

If the pathology is detected early enough, from 15 to 26 weeks, then there is a high probability of premature birth. This means that additional monitoring of the development of pregnancy is required.

You may need to use special medications to prepare the baby's lungs for birth.

• if at the indicated date the size of the cervix does not exceed 2-2.5 cm, with a high degree of probability the child will be born no later than 36 weeks;
• if the cervix is ​​1.5-2 cm, the baby will appear at 33-34 weeks;
• with a size of less than 1 cm, pregnancy can hardly be carried beyond 32 weeks.

In this case, the birth will take place in a special hospital, where there are conditions for caring for low birth weight premature babies. The newborn will be admitted to the pediatric intensive care unit and will be discharged home after he or she has grown and gained weight.

Shortening in the 3rd trimester

Shortening diagnosed in the third trimester no longer threatens such an early birth, but development can lead to infection of the amniotic fluid or loss of membranes.

Therefore, a woman should pay special attention to hygiene issues and rest regime. Visit your doctor regularly to monitor the condition of your cervix.

How to maintain pregnancy?

Measures to maintain pregnancy depend on the causes of shortening, timing of diagnosis, development (or absence) of symptoms of isthmic-cervical insufficiency:

• If the cause is previous injuries or anatomical features and the uterus is shortened even before pregnancy, surgical plastic surgery is possible.

The elasticity of the muscle and its size are restored. Pregnancy is possible several months after surgery.

• Shortening of the cervix during pregnancy, caused by hormonal imbalance, is corrected with appropriate medications, diet, and vitamin therapy.
• With pronounced ICI and the threat of early disclosure, or.

Both methods are aimed at mechanically holding the walls of the cervix in a closed state. The pessary also plays the additional role of a medical bandage, redistributing pressure on the lower segment of the uterus and preventing premature effacement of the cervix.

Preventive measures

Proper treatment of vaginitis and other inflammatory diseases of the genital organs will preserve the elasticity of the cervix. This applies equally to the period before pregnancy and to pregnant women.

Vitamins or hormone therapy prescribed by doctors can normalize the density of muscle tissue and the conduction of impulses, and will help the cervix in performing its main functions.

Excess weight of the woman herself and non-compliance with the diet during pregnancy put additional stress on the organs. It is important to monitor nutrition and weight dynamics during pregnancy.

If shortening is diagnosed, it is necessary to limit physical activity, heavy lifting, and bending. A woman should be able to lie down 2-3 times during the day and have a good night's rest.

When installing a pessary or applying sutures, the doctor will tell you about additional features of the regimen. Hospitalization will be required on the eve of the planned birth.

The diagnosis of “shortening of the cervix” made during pregnancy means a deviation of the diagnosed size from the norm. But it doesn't always talk about. It is possible to preserve the obturator function of the cervix if you follow the regimen and follow the doctor’s prescriptions.

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

Why is a short cervix dangerous?

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

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

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

Causes

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

Examination and diagnosis

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

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

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

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

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

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

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

Short cervix during pregnancy

Causes, prevention and treatment of short cervix during pregnancy

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

Why the cervix opens prematurely and diagnosis of pathology

This pathology is medically called isthmic-cervical insufficiency (ICI). Its signs: premature shortening, softening and dilatation of the cervix. These signs are most often diagnosed at 15-20 weeks, when rapid weight gain in the fetus begins and the cervix experiences heavy loads during pregnancy. A doctor can notice abnormalities during a gynecological examination, as well as during an ultrasound. 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.

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

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

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Shortening of the cervix during pregnancy

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

Read also Dilatation of the cervix

Why does the cervix shorten during pregnancy?

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

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

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

Why is a short cervix dangerous during childbirth?

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

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

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 beremennost.net Elena TOLOCHIK

Short cervix: causes of pathology and its elimination

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

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

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

Short neck. Physiological side of the issue

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

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

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

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Short cervix: causes of pathology

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

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

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

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

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

How to maintain pregnancy with a short cervix?

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

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

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

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

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

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

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Diagnosis and treatment of a short cervix

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

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

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

A little anatomy

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

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

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

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

Why is a shortened cervix dangerous?

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

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

Symptoms

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

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

Causes

Why is such a pathology suddenly discovered during pregnancy?

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

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

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

• multiple pregnancy,
• polyhydramnios.

Diagnostics

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

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

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

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

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

Prevention

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

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

Treatment

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

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

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

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

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

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

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

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

The birth of a child can truly be called the greatest miracle of miracles. Unfortunately, sometimes nature fails at the genetic level. And sometimes even mechanical human intervention in certain processes can lead to terrifying consequences. Thus, a long-awaited pregnancy may not occur at all or may occur but end in miscarriage or premature birth. And it can lead to the birth of a person with congenital pathologies and defects.

A short cervix is ​​one of the causes of miscarriages and premature births. Why does this happen and is it possible to carry and give birth to an absolutely healthy baby with such a diagnosis?

What does a short cervix mean during pregnancy?

The uterus is located in the pelvic area. Its shape resembles a pear, its main function is to bear a child. In the picture below you can see the structure of the uterus:

• neck,
• isthmus,
• fundus of the uterus,
• body of the uterus.

On average, a normal cervix in women is about 3-5 cm, usually 4. If its length is 2 cm or less, then they speak of a short cervix.

Causes of a short cervix during pregnancy

A short cervix during pregnancy can be a congenital phenomenon or acquired after certain surgical interventions (for example, mechanical abortion). It also happens that the cervix can shorten due to a hormonal surge during pregnancy. The most dangerous period in this regard is considered to be from the 1st to the 27th week, the peak falls on the 16th.

How to recognize a short cervix during pregnancy

If the cervix is ​​shortened from birth, then when a woman is required to regularly visit a gynecologist from the moment of puberty, it will be possible to establish this long before the onset of pregnancy, and to take this point into account at the planning stage.

If a woman is already pregnant, then a simple examination on a gynecological chair will help establish this fact. If the doctor suspects something wrong, he will refer the patient for a transvaginal ultrasound, which will confirm or refute his assumptions.

Short cervix during pregnancy: consequences

• A short cervix during pregnancy is one of the main signs of ICI (isthvicocervical insufficiency). This is a certain condition when pregnancy is at an increasing risk due to the physical impossibility of holding the constantly growing and gaining weight in the uterine area. Possible miscarriage or premature birth.
• The cervix, under pressure, gradually opens and softens ahead of schedule, which means there is a high risk of all kinds of infections reaching the baby.
• Plus, such an early opening means a rapid birth, which is fraught with ruptures, which then take quite a long time to heal under the condition of complete rest and minimal physical activity. And after the birth of the baby, complete rest is unlikely to be ensured.

The risks increase significantly if a woman has polyhydramnios, a large fetus, or is carrying several babies at once.

What to do with a short cervix?

If you regularly go to the doctor and undergo all the examinations prescribed by him, then such a factor as a short cervix will not go unnoticed. And forewarned is forearmed!

Fortunately, medicine today has made great progress, so depending on the specific situation, doctors will offer several options for solving this problem.

If ICI is a consequence of hormonal changes in the body, then a treatment regimen with medications will be prescribed.

In case of urgent need, temporary sutures will be placed on the cervix to prevent its early dilatation. The stitches will be removed just before delivery. This procedure can be roughly compared to an inflated balloon, which is tied with a rope so that the air does not escape from the balloon. This procedure is called cervical cervical cording and is performed under general anesthesia, the composition of which is carefully controlled by an anesthesiologist, taking into account the characteristics of the woman’s position and the duration of her pregnancy.

In some cases, a special gynecological ring or pessary is placed on the cervix, which keeps it in a stable state without the slightest risk of dilatation and the onset of premature labor.

Of course, it happens that even with the diagnosis of ICI, the pregnancy itself proceeded safely and ended in childbirth on time. But the chances of losing a child are great, is it worth the risk? If the doctor insists that certain measures are necessary, then it is better to take them.

Much depends on the expectant mothers themselves. We must try to organize our daily life in peace and quiet, without unnecessary stress, quarrels and disputes. No excessive physical activity, and special gymnastics and swimming in the pool only after the official permission of a gynecologist!

Short cervix during pregnancy 20 weeks

The 20th week is a kind of equator, approximately the middle of pregnancy. Most women can already feel the kicks of their baby in their tummy. Now the active growth of the uterus has begun, it is moving towards the navel and can put pressure on the abdominal wall, causing the navel to protrude outward. Active growth of the uterus is accompanied by the risk of miscarriage in the presence of a short cervix. Close supervision by a doctor is necessary during this period; a routine ultrasound is performed at 20-21 weeks, so you don’t have to go to the consultation again.

Short cervix during pregnancy 30 weeks

It’s not for nothing that in Russia people go on maternity leave at the 30th week. The belly is already quite large, women are quite clumsy at such a long time.

For women with a short cervix, the risk of premature birth has increased by an order of magnitude, especially if the pregnancy is multiple! The good news is that babies born at this stage are already viable with appropriate medical care. But it’s better that it doesn’t come to that. Therefore, it’s time to relax, now without work it’s much easier to surround yourself with only pleasant emotions, sleep more, and be less nervous. If you have a short neck, you should not overexert yourself with physical activity and excessive activity. Only peace and harmony!

Short cervix during pregnancy 32 weeks

32 weeks is the time to have your last ultrasound. If you have a short cervix, a specialist will definitely assess its condition at this time. There is less and less time before birth, which means that the baby has an increasingly greater chance of survival and normal development after birth. But it’s better that he’s born on time. The recommendations remain the same - more sleep and rest. Perhaps, at such a long time, the doctor will prescribe bed rest or even suggest hospitalization, so that the pregnant woman is under the supervision of doctors and certainly observes bed rest, which is not so easy to organize at home.

Increased uterine tone

A short cervix during pregnancy is directly related to the threat of miscarriage, and, therefore, is often accompanied by increased uterine tone.

Signs of uterine tone:

1. Pain in the lower abdomen.
2. Discharge with blood.
3. Feeling of a stone, hard, tense abdomen.
4. Dizziness, nausea.

A gynecologist will be able to determine the increased tone of the uterus during an examination, and it can be confirmed using an ultrasound machine. In some cases, the expectant mother will be able to guess for herself based on the signs described above. If, with increased tone, a woman has a short cervix, the risks of miscarriage or premature birth increase significantly. Even hospitalization is possible.

The causes of uterine tone can be malignant tumors, kidney diseases, liver diseases, cardiovascular and hypertension diseases. A woman’s psychological mood also plays an important role. In a family where the expectant mother is emotionally stable, receives all possible support and care from family and friends, the phenomenon of uterine tone is much less common than in families where quarrels, scandals and showdowns are the daily norm of life.

If you have uterine tone, you should immediately consult a doctor, but you can help yourself a little before your appointment. It’s enough to lie down, relax as much as possible, and rest. Try not to be nervous. You can stroke your belly, chat with your baby while listening to classical soft music, or meditate.

Doctors, as a rule, prescribe hormonal treatment for women with uterine tone to compensate for the deficiency of the hormone progesterone in order to avoid miscarriage or premature birth.

What is important to know about progesterone

This is a hormone necessary to maintain pregnancy, which is initially produced by the ovaries, and later by the placenta (as it is finally formed). Progesterone is needed at every stage of pregnancy, from conception to labor. Without it, the woman’s body simply will not accept foreign DNA and will reject the fetus. But this is not all that the hormone progesterone contributes to a successful pregnancy. It controls the growth of the uterus, preparing it for a strong increase in size. It prepares the mammary glands to produce colostrum and then breast milk. It stimulates the growth of the endometrium (the inner layer of the uterus), thereby creating fertile soil for the successful attachment of the embryo, and then its successful growth and active development. Ultimately, it relaxes the walls of the uterus to avoid hypertonicity.

Progesterone deficiency with a short cervix necessarily requires additional measures to maintain pregnancy. Suturing or installing a pessary is no longer enough; hormonal therapy is also necessary.

Utrozhestan for a short cervix during pregnancy

Utrozhestan is a synthetic analogue of the hormone progesterone. The hormone molecules are surrounded by peanut butter, since in this form the body is able to accept it and absorb it as much as possible.

Composition of the drug:

• progesterone;
• peanut butter;
• soy lecithin;
• gelatin;
• glycerol

The medicine may interact with other drugs because it does not contain substances that could react negatively to such an interaction.

Progesterone deficiency can occur at any stage of pregnancy planning. But in the 1-2 trimesters, uterine activity is not so great. The danger of a lack of progesterone lies in the fact that the egg (or the fetus subsequently) will be rejected by the mother's body. And against the background of redistribution of progesterone production between the ovaries and placenta, any violation is fraught. Therefore, at these times there is no danger in taking Utrozhestan. As for the 3rd trimester, excess progesterone is more dangerous here than its deficiency. Therefore, taking the medicine is no longer advisable.

When taken orally, the drug replenishes the deficiency of progesterone, while it does not affect the weight of the pregnant woman and does not contribute to the manifestation of swelling. Under its influence, the uterus relaxes, the maternal body calmly accepts the fetus, creating conditions for its further development.

Like any other drug, Utrozhestan contains a number of contraindications (liver failure, diabetes, bronchial asthma, and so on). Side effects may include dizziness, lethargy, and drowsiness, so after taking it it is better to stay at home for some time.

There are two ways to take the medicine - capsules or suppositories. Typically taken 3 times a day for 2-3 weeks, but this schedule may vary depending on the specific situation.

Never engage in self-diagnosis, much less self-medication! Only a doctor can recommend Utrozhestan and calculate the individual dosage! Therefore, at the first signs of uterine tone, knowing at the same time that you have a short cervix, and, therefore, there is already a high risk of miscarriage/premature birth, you should urgently run to the doctor. And before taking it, be sure to try to relax and calm down.

Let's sum it up

A short cervix can have dire consequences. You should know about yourself and your condition in advance, ideally, even at the stage of pregnancy planning. If it turned out as it turned out, do not delay your visit to the consultation at the first signs of pregnancy. It is in the early stages that a woman faces all sorts of dangers, which is why it is important to see a specialist as early as possible! You can give birth to a healthy baby at the right time if you really want it and do everything you can on your part! Be reasonable!

Video " Cervical length during pregnancy"