Pessary, as a method of maintaining pregnancy – types, installation of a pessary, the course of pregnancy

Pregnancy is an important event in the life of every female. But sometimes happiness can be overshadowed by a disappointing diagnosis: “The threat of premature birth.” Today, expectant mothers can protect themselves with several methods of treatment, one of which is the installation of a pessary.

This procedure is safe and painless, although it has its drawbacks.

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The content of the article:

What is an obstetric pessary – types of pessaries

Not so long ago, the problem of the threat of miscarriage, premature birth could be solved only through surgical intervention. On the one hand, it helps to preserve the fetus, however, the use of anesthesia, suture has its negative sides.

Nowadays, it is possible to save the fetus with the help obstetric pessary (Meyer’s rings)…

The structure in question is made of silicone or plastic. Although such materials are considered safe for health, the body does not always respond positively to a given foreign body. Sometimes allergic reactions may occur that require immediate removal of the construct and treatment.

Commentary by a gynecologist-endocrinologist, mammologist, ultrasound specialist Sikirina Olga Iosifovna:

Personally, I have a negative attitude towards pessaries, it is a foreign body in the vagina, irritating, capable of causing a pressure sore on the cervix, and infecting it.

Only a doctor can correctly install it. So how long can this foreign object stay vaginally? It’s my personal opinion.

In no case should a pregnant woman drink pain medications either before or after the procedure, since all NSAIDs (conventional pain relievers) are contraindicated in pregnant women!

Doctors often refer to the pessary as an ordinary ring – but it is not. This device is a mixture of circles and semicircles connected to each other. The largest hole is for fixing the cervix, the rest are needed for the outflow of secretions.

In some cases, a donut-shaped pessary with many small holes along the edges is used.

Depending on the parameters of the cervix and vagina, there are several types of pessaries:

• Type I. Use if the size of the upper third of the vagina does not exceed 65 mm, and the diameter of the cervix is ​​limited to 30 mm. Norms of the length of the cervix during pregnancy. Often, the design is installed for those who have a history of their first pregnancy.
• II type. Relevant for those who have a 2nd or 3rd pregnancy, and who have different anatomical parameters: the upper third of the vagina reaches 75 mm, and the diameter of the cervix is ​​up to 30 mm.
• III type. Set for pregnant women with the size of the upper third of the vagina from 76 mm, and the diameter of the cervix up to 37 mm. Experts turn to similar designs for multiple pregnancies.

Indications and contraindications for the installation of a pessary during pregnancy

The considered design can be installed in the following cases:

• Diagnosis of isthmic-cervical insufficiency in pregnant women. With this pathology, the cervix softens, and under the pressure of the fetus / amniotic fluid begins to open.
• If present in the medical history miscarriages, premature birth.
• If there are malfunctions of the ovaries, errors in the structure of internal genital organs.

It is optional, but it is recommended to install the uterine ring in such situations:

• If there was a place to be C-section.
• Pregnant exposed regular physical activity.
• If the expectant mother wishes. Sometimes partners try to conceive a child for a long time, and it takes them several months or years. In some cases, a couple is treated for infertility for a long time. When, finally, the long-awaited event comes, the woman, in order to minimize the risk of miscarriage, may insist on installing a pessary.
• If the ultrasound shows more than one fetus.

Meyer’s ring alone is not always enough to maintain pregnancy. They often use it, as an aid, in combination with drugs, suturing.

Sometimes an obstetric pessary is generally contraindicated:

• If the patient is allergic to a foreign body, or there is regular discomfort.
• The fetus has been diagnosed with abnormalities that require an abortion.
• The diameter of the vaginal opening is less than 50 mm.
• The integrity of the amniotic fluid is impaired.
• If an infection of the mucous membrane of the uterus, vagina is found.
• With profuse discharge, or with discharge with impurities of blood.

How and when to put an obstetric pessary, are there any risks?

The specified device is most often installed in the interval between 28 and 33 weeks… But according to indications, it can be used as early as the 13th week.

Before installing the pessary, a smear should be taken from 3 points of the vagina, the cervical canal and the urethra (urethra), and PCR tests for latent infections from the cervical canal.

When pathologies are identified, it is necessary to take measures to eliminate them, and only then carry out various manipulations with the pessary.

The technology for installing the structure is as follows:

• A few days before the procedure, you should use vaginal suppositories with chlorhexidine (“Hexicon”)… This will cleanse the vagina of various harmful bacteria.
• Anesthesia is not performed before manipulation.
• The gynecologist pre-selects the designthat will fit. As mentioned above, there are several types of pessaries: choosing the right device is very important.
• The pessary is lubricated with cream / gel before insertion. The introduction begins with the lower half-ring of a wide base. In the vagina, the product must be deployed so that the wide base is located in the posterior fornix of the vagina, and the small base is under the pubic articulation. The cervix is ​​placed in the central opening.
• After installing the structure, the patient is allowed to go home. The first 3-4 days there is an addiction to a foreign body: frequent urge to urinate, cramps in the lower abdomen, discharge may disturb. If, after the specified period, the pain persists, and the secreted secretion has a greenish tint, or contains impurities of blood, you should immediately consult a doctor. In the presence of abundant liquid transparent secretions that are odorless, you should immediately contact your gynecologist: this can leak amniotic fluid. In such a situation, the ring is removed and treated. The urge to urinate can be troublesome throughout the entire period of wearing the ring when the pessary is placed low.

The very process of installing the Meyer ring is painless and safe. This design rarely causes negative reactions from the body.

However, a lot here depends on the professionalism of the doctor: an incorrectly installed design will not correct the situation, but only cause discomfort. Therefore, it is better to contact trusted specialists in reliable clinics.

After the introduction of the pessary, pregnant women must adhere to certain recommendations:

• Vaginal sex should be ruled out. In general, if there is a threat of termination of pregnancy, any kind of sex should be forgotten until the baby is born.
• Bed rest should be observed: any physical activity is unacceptable.
• Visits to the local gynecologist should be at least once every 2 weeks after the installation of the product. The doctor in the gynecological chair will make an examination to make sure that the structure has not budged.
• In order to prevent the development of vaginal dysbiosis in pregnant women, smears are taken every 14-21 days to determine the microflora. For prevention, vaginal suppositories, capsules can be prescribed.
• It is prohibited to remove / correct the pessary on your own. This can only be done by a doctor!

How is the pessary removed – how is childbirth going after the pessary?

Closer to the 38th week of pregnancy, Meyer’s ring is removed. The procedure takes place quickly on a gynecological chair, and does not require the use of painkillers.

The structure can be removed earlier with the following complications:

• The amniotic fluid is inflamed or leaking. It is possible to determine this phenomenon by means of a test that is sold in pharmacies in the city.
• Infection of the genitals.
• The beginning of labor activity.

After removing the pessary, a profuse discharge may be observed. You should not worry about this: sometimes the ichor accumulates under the rings, and comes out only when a foreign body is removed.

To ensure the sanitation of the vagina, the gynecologist prescribes candles or special capsulesthat are inserted into the vagina. Such prophylaxis is carried out within 5-7 days.

Many people associate the removal of the vaginal ring with the onset of labor. But this is not the case. Childbirth occurs differently for each patient.

In some cases, a happy event can happen in a few days… Others are safe cared for 40 weeks…

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The Сolady.ru website reminds that all the information in the article is given solely for educational purposes, it may not correspond to the specific circumstances of your health, and is not a medical recommendation.