This record was checked by a gynecologist-endocrinologist, mammologist, ultrasound specialist Sikirina Olga Iosifovna…
The main components of a woman’s uterus are the body and cervix. If the pregnancy is proceeding normally, the fetus is placed in the body of the uterus, and the muscles of the cervix are closed in a tight ring.
But sometimes muscle tissue can weaken prematurely, provoking dire consequences. The danger of isthmic-cervical insufficiency lies in its asymptomaticity: the true cause is often found out after a miscarriage or premature birth.
However, even with such a diagnosis, you can endure and give birth to a baby: the main thing is proper preparation and timely treatment.
The content of the article:
What is the danger of isthmic-cervical insufficiency?
Due to the inability of the muscle ring to cope with the load exerted on it by the weight of the fetus, it begins to gradually open.
All this can lead to the following consequences:
- Lowering the fruit. A fetal membrane enters the uterine cavity, which can be damaged from a sharp movement.
- The infection gets into the amniotic membrane. This pathology occurs against the background of contact of the membrane with the vagina, which contains many different harmful microorganisms.
- Miscarriage in the II trimester of pregnancy.
- Premature birth (after 22 weeks).
PPI often develops after 16 weeks of gestation. Although in some cases, a similar defect can be diagnosed as early as 11 weeks.
Norms of the length of the cervix during pregnancy.
Causes of ICI during pregnancy – who is at risk?
The pathology under consideration can arise against the background of several situations:
- Surgical trauma over the uterus / cervix: curettage for diagnostics; abortion; in vitro fertilization. These procedures lead to the appearance of a scar from the connective tissue, which does not dissolve over time.
- Childbirth. In some cases, the obstetrician may use forceps to rupture the fetal bladder. This can negatively affect the integrity of the uterus. Risk factors also include improper placement of the fetus.
- Crashes in a harmonious background. The second most popular reason for the appearance of the ailment in question is an overabundance of androgens (male hormones) in the blood. With hormonal disorders, PPIs may appear as early as 11 weeks of gestation. It is during this period that the formation of the pancreas in the fetus occurs, which contributes to the entry of an additional portion of androgens into the blood of the expectant mother.
- Increased pressure on the walls of the uterus. It occurs with polyhydramnios, if the fetus is heavy, or with multiple pregnancies.
- Congenital anomalies of the uterus.
Signs and symptoms of cervical insufficiency during pregnancy
Often, pregnant women who have this pathology do not have any complaints. Therefore, it will be possible to identify ICI only through transvaginal ultrasound… Here, the doctor will take into account the length of the cervix (in the third trimester of pregnancy, it should be an average of 35 mm) and the shape of the opening of the internal pharynx. To accurately visualize the shape of the pharynx, a little testing should be done: the pregnant woman is asked to cough or press on the bottom of the uterus.
Regular check-ups with a local gynecologist also help to identify ICI in pregnant women, but they are not as effective as hardware examination. Many doctors limit themselves to examining the abdomen, measuring blood pressure in pregnant women – and that’s all. But to notice a softening of the cervix, a decrease in its parameters is possible only with the help of a gynecological mirror.
In some patients, the ailment in question may manifest itself in the form of the following symptoms:
- Drawing pain in the lower abdomen and in the lumbar region.
- Vaginal discharge. They can be red or transparent with streaks of blood.
- Vaginal discomfort: regular / recurrent tingling, pressure sensation.
Conservative and surgical methods of treating ICI during pregnancy
It is possible to eliminate the indicated pathology only after finding out the reasons that provoked its appearance.
Given the duration of pregnancy, the condition of the fetus and the membranes, the doctor may prescribe the following type of treatment:
- Hormone therapy… It is indicative if ICI has developed against the background of hormonal disruptions in the body. The patient must take hormonal drugs for 10-14 days. After this period, a second inspection is carried out. If the situation has stabilized, hormones are continued: the dosage is determined by the doctor. When the situation worsens, the method of treatment changes.
- Setowka toolice Meyer, or obstetric pessary… Relevant at the initial stage of development of the pathology under consideration. In more advanced stages, Meyer’s ring is used as an adjunct to treatment.
During the procedure, a small plastic piece is placed in the vagina to fix the cervix. This helps relieve pressure and maintain pregnancy. The ring can be used at almost any stage of pregnancy, but it is removed at 37 weeks.
Since this design is by its nature a foreign body, smears are regularly taken from the patient for examination of the vaginal microflora. Additionally, preventive sanitation with antiseptics is prescribed.
This method of surgical treatment of CPI can be used in such cases:
- Early pregnancy (up to 17 weeks). In exceptional situations, the operation is carried out more late, but no later than 28 weeks.
- The fetus develops without anomalies.
- The uterus is not in good shape.
- The fetal bladder is not damaged.
- The vagina is not infected.
- Discharge with blood impurities is absent.
The suture operation takes place in several stages:
- Diagnostics. A few days before the manipulation, smears are taken from the vagina; blood and urine tests are carried out.
- Preparatory stage. Provides for the sanitation of the vagina.
- The actual operation. It is performed under local anesthesia. The operating sutures the internal os of the uterus with silk threads. After that, the manipulation zone is treated with antiseptic drugs.
- Postoperative period.
To minimize complications, the following medications may be prescribed:
- Antispasmodics: drotaverine hydrochloride.
- Antibiotics: as needed.
- Tocolytic therapy: ginipral, magnesia. Required if the uterus is in good shape.
Every 2 weeks, you need to take vaginal swabs, check the condition of the seams.
In the normal course of pregnancy, the stitches are removed in the gynecological chair at 38 weeks. If there are exacerbations in the form of bloody discharge, leakage of amniotic fluid, the sutures are removed. After elimination of negative phenomena, a second suture operation can be performed.
Commentary by a gynecologist-endocrinologist, mammologist, ultrasound specialist Sikirina Olga Iosifovna:
And here is my retrograde adherence to the sutures on the cervix with ICI, which are applied once and removed once at 38 weeks.
Rules for planning and pregnant women with ICI – how to get pregnant and carry a child?
Women who are planning a pregnancy and who have previously had miscarriages / premature births due to PPIs, the following recommendations must be followed:
- After miscarriage / premature birth one should not rush to the next pregnancy. Several months must pass before the body and psyche recover. In addition, it is necessary to undergo a complete examination to establish the cause of the CPI.
- At the stage of planning pregnancy, you need to pass tests for infections, hormones, check the functioning of the thyroid gland. To exclude pathology in the structure of the genital organs, ultrasonography is done.
- To exclude concomitant gynecological pathologies, endometrial biopsy. This procedure will give a complete picture of the state of the uterus.
- Male partners during the planning stage need to go through examination by a urologist-andrologist.
Pregnant women diagnosed with PPI should be aware of the following important points:
- Physical activity should be minimized, or even restrict yourself to bed rest. Here everything will depend on the specific case and past experience. But even if the CPI responds positively to treatment measures, it is still better to shift household chores to loved ones.
- Sexual contact must be excluded.
- Scheduled visits to the local gynecologist are required. Often, patients diagnosed with CPI have sutures fixed at 12 weeks of gestation. Those with Meyer’s ring should have a swab every 14 days to prevent infection.
- The correct mental attitude is also important. Pregnant women should protect themselves from stressful situations as much as possible and think about the good. In such cases, motivating videos, meditations help well.
All information in this article is provided for educational purposes only, it may not correspond to the specific circumstances of your health, and is not a medical recommendation. The сolady.ru website reminds you that you should never delay or ignore your visit to a doctor!
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