Short cervix in pregnancy: treatment and prevention of disease
The female body is so arranged that the period of gestation of the fetus tries to create all the necessary conditions. Changing hormone levels that take an active part in the process of adaptation to new conditions. During pregnancy a woman undergoes a thorough comprehensive examination of the body. Short cervix in pregnancy is a frequent occurrence, diagnosed by the gynecologist at a scheduled inspection. Anomaly provokes the development of isthmic-cervical insufficiency – a pathological condition that causes premature birth.
A woman can go for years without suspecting the presence of pathology in the cervix. Its anomalous structure is often diagnosed at the time of confirmation of pregnancy in the process of pelvic examination.
The normal length of the cervix varies from 3 to 4.5, see If in the period before 20 weeks of gestation, its length is less than 3 cm, the patient automatically gets to group of risk. With increasing period the cervix becomes thinner, its size decreases until the birth. Therefore, strict control over the course of pregnancy of patients with this anomaly is of great importance.
Timely diagnosed pathology increases the chances of a favorable course of pregnancy.
Diagnosis using laboratory and instrumental methods of research of an organism is a prerequisite for the pregnant patient.
The complex of diagnostic measures includes the following procedures:
- inspection on the gynecological chair using mirrors;
- smear on pathogenic flora;
- ultrasound examination of the cervix and other reproductive organs;
- General blood test (to assess the state of the organism, the presence of inflammatory processes);
- biochemical analysis of blood;
- a blood test for hormone levels (progesterone, human chorionic gonadotropin and others);
- data collection medical history, including information about previous pregnancies, childbirth, trauma and genetic predisposition to disease
Suspected short cervix can be yourself, if the characteristic symptoms are:
- pain of varying intensity in the abdomen and in the lumbar region;
- watery, mucous and bloody discharge from the genital tract;
- discomfort during sexual intercourse;
- uterine tone (tension of muscles);
- the change in overall health (nausea, headache, lethargy).
These symptoms of the abnormal condition may be missing, so regular examination by a gynecologist; in the presence of isthmic-cervical insufficiency (ICN) requires strict control during the whole period of pregnancy (before 20 weeks and later). Examining the data of the anamnesis, the doctor decides on the method of warning of probable complications.
The reasons for emergence of anomalies
Among the main precipitating factors are the following:
- Abnormal structure of the reproductive organs that occurred in utero. The underdevelopment of the cervical canal can be genetically determined or the result of a failure during the laying of the bodies (bicornuate uterus).
- Violation of a hormone imbalance. Elevated levels of androgens, and relaxin affects the density of the neck, contribute to its softening and shortening, disruption of the composition of the mucous secretion. The lack of the female hormone progesterone also triggers the rejection of the ovum.
- Mechanical injury of the cervix and cervical canal. A structural discontinuity in the form of scarring caused by the injury to the body, with abortion, heavy labor, curettage, surgical treatment of erosion, dysplasia of the uterus, polyps in the cervical canal.
- Increased load on the cervix. It develops with increasing gestational age. Stretching and shortening of the body provokes polyhydramnios, a large fetus, multiple pregnancy.
- A stress factor. Violation of psycho-emotional condition of the woman affects your overall health, is the trigger for the development of complications.
The potential danger remains throughout the pregnancy, but the most difficult period watching from about the twentieth week, when significantly increased fruit weight and volume of amniotic fluid.
The rationality of the use of certain treatment due to the anamnesis data, which indicated the following facts:
- the age of the patient;
- the degree of isthmic-cervical insufficiency;
- the General condition of the body;
- the presence of systemic diseases;
- the causes of the pathological state;
- information about previous pregnancies, childbirth injuries.
If clinical manifestations are mild, limited to drug therapy. It involves the application of the following drugs:
- Hormonal agents. If blood tests confirm that blood not enough progesterone, then assign its synthetic analog in the form of tablets or candles (cough medicine). It can be combined with glucocorticosteroid preparations (Dexamethasone). Control the level of androgens, and relaxin (especially before 20 weeks).
- Antibiotics systemic or local action. They are shown in the case of infection with pathogenic flora. In most cases, prescribe cephalosporins and macrolides. For the sanitation of the vagina using the means of local action in the form of candles (Micogynax, Hexicon, Viburkol). Treatment determined by the attending physician depending on the scale of the infection and other factors. Requires special attention to the period up to 14 weeks, when there is a bookmark of bodies.
- Antispasmodic drugs. Prescribers with the tone of the uterus, with painful sensations (But-shpa, Tuinal, Metacin, etc.).
These tools combined with the use of the discharge of the pessary (ring of Meyer), made of silicone or plastic. These devices are noninvasive technique for the prevention of possible complications, which can be performed on an outpatient basis. Worn on the neck of the pessary works as a bandage, relieving the muscles from the weight of the growing uterus. The doctor will select the right size of the discharge device based on the size of the cervix and other individual characteristics.
A prerequisite for the use of the pessary is to limit sexual activity, refusal of vaginal sex.
What method of treatment is preferable, prompt ultrasound examination of the reproductive organs. Intravaginal study gives more accurate results. The total duration of the procedure does not exceed 20 minutes. If the cervix is narrow or small, then this poses a risk in the period of labor.
Surgical treatment method in the kind of surgery cervical tissue are shown when expressed signs of isthmic-cervical insufficiency, as well as in cases of ineffectiveness of drug therapy up to 20 weeks.
Indication for prescription of plastic are the following:
- failure of the cervix diagnosed in a previous pregnancy;
- previous miscarriages;
- the progression of the process ICN (V, Y-shaped cervix);
- injuries due to surgical intervention.
Surgical procedures the most secure up to 20 weeks of pregnancy. The sooner the correction is made, the less likely complications.
Contraindications to suturing is the following:
- diseases of the nervous system, the endocrine system (nervous disorders, heart, kidney and liver failure, severe);
- increased tone of the uterus;
- excessive bleeding;
- infectious-inflammatory processes in the genital area.
If, after suturing the patient’s bleeding, water broke or contractions started, the stitches will be removed. The patient was under the strict control of the attending physician in the hospital. Duration of hospitalization in each individual case. The woman is kept under observation until complete disappearance of characteristic symptoms. If the assigned planned caesarean section, the sutures are left. In any case the final decision the doctor takes, assessing data history and overall health of the patient.
Shortening of the cervix with marked clinical manifestations at the onset of pregnancy requires a woman to follow certain guidelines.
Prevention measures are the following:
- limit physical and sexual activity;
- a ban on lifting weights (about 1 kg);
- regular physician visits and the compliance with its recommendations;
- prompt treatment of systemic diseases;
- the prevention of unwanted pregnancy, minimizing the likelihood of its artificial interruption;
- using the discharge of pessary and brace for pregnant women on the advice of a gynecologist;
- eliminate stressful situations.
Failure to comply with these recommendations may cause the appearance of complications of abortion, rupture of the reproductive organs, bleeding, infection and injury to the fetus.
Short cervix in pregnancy — pathology, requiring constant monitoring by a specialist. Timely diagnosis, full range of inspection and compliance with the pregnant woman the recommendations of a physician at times reducing the likelihood of complications.