Sutures on the cervix, suturing the cases in which it is necessary
Failure of the cervix represents a real danger for a pregnant woman. The search for an effective method to eliminate this pathology is particularly relevant with increasing gestational age. Suturing the cervix during pregnancy is one of the methods of elimination of isthmic-cervical insufficiency on the up to 21 weeks. A set of diagnostic procedures prior to surgery will allow the doctor to determine the kind of surgery and further therapy.
In some cases, surgical plastic?
Suturing of the cervix during pregnancy is a fairly common procedure in obstetric practice. This technique has established itself as the most effective way to prevent probable complications in the insolvency of the cervical canal.
Cervical plastic used when prior hormonal therapy and symptomatic treatment (use of diaphragm) did not give the expected result. In addition, there are also factors that indicate the need for surgical intervention is mandatory.
Indications for suturing is the following:
- a high degree of disclosure of the throat of the cervix (less than 2.5 cm);
- V, Y shape pathological condition of the cervix;
- previous pregnancy ended prematurely;
- the constant nagging pain in the abdomen and in the lumbar;
- the appearance of watery, mucous and bloody discharge from the genital tract;
- the soft feeling of a foreign body in the region of the cervical canal and vagina;
- increase in urination;
- the presence of scarring due to injuries during surgical manipulation in the past;
- physiological features of development of the reproductive organs.
Before surgery, the doctor examines the data of the anamnesis of the patient, collected through a comprehensive survey.
The complex of diagnostic measures before the procedure consists of the following procedure.
- Cervical examination on the gynecological chair with the use of mirrors.
- Smear on the pathogenic flora. Microbiological examination of secretions of the vagina and cervical canal to determine the presence of infection.
- Ultrasound diagnosis of the cervix and other pelvic organs. Preference is given intravaginal method of diagnostics because of the greater efficiency. The doctor will determine the length of the cervix, its structure.
- Colposcopy (the detection of pathological processes in the cervix).
- General and biochemical blood tests determine the presence of inflammatory processes in the body.
- The General analysis of urine. The result of the analysis will determine the presence of systemic diseases that may preclude plastics.
The use of surgical methods of treatment may be limited. Contraindications to the appointment of surgical intervention are the following circumstances:
- the presence of infectious-inflammatory process in the vagina and cervical canal;
- recurrent bleeding;
- serious violations in the work of the heart, liver, kidneys;
- increased tone of the uterus, which can not be eliminated with medication;
- intrauterine fetal death;
- damage to the fetal bladder;
- anomalies of fetal development.
The surgery technique
The correct choice of a specific surgical intervention is the key to successful treatment.
How exactly stitches, the doctor decides, after studying the data of the anamnesis of the patient, her age, overall health, individual characteristics. And the gynecologist determines type of anesthesia: epidural anesthesia or intravenous anesthesia. The surgery usually lasts no longer than 15 – 20 minutes.
There are several ways to eliminate the insolvency of the cervix:
- Complete stitching the external OS (the author’s method B. Szende). Cathalogue seams impose after a preliminary truncation of the epithelial layer of the cervix in a circle (5 mm). As a result of the intervention, scar formation, which can only be remove with a scalpel at the time of the onset of labour. This technique is most dangerous because of the likelihood of development of sepsis in case of inadequate readjustment of the vagina and cervical canal. Is not appointed in the presence of erosion, dysplasia, and other pathological conditions.
- Closure (constriction) of the internal OS (the technique of Mac Donald). The seams on the cervix impose a purse-string method during pregnancy. In this method, produce stitching the front and back walls of the cervix, without resection of mucosa.
- Correction of the internal OS. Modern gynecologists who practice the technique of A. I. Lyubimova and N. M. Mamedalieva (which includes double U-shaped suture on the cervix). The effectiveness of this methodology see more than 90% of cases. Stitch removed at 37 weeks of pregnancy or in early labor.
The stitching of the cervix should only trust experienced during pregnancy.
To eliminate postoperative complications prescribed the following treatment:
- intravenous administration of tocolytic (Ginipral) to relieve hypertonicity of the uterus;
- the use of antispasmodics to eliminate the muscle tone of the pelvic organs (Nospanum, Urinal);
- symptomatic use of painkillers (Nurofen, Paracetamol);
- antibiotic therapy to prevent secondary infection pathogenic flora (mainly cephalosporins and macrolides);
- use vitamin complexes for pregnant women with the aim of increasing resistance of the organism (Pregnavit, Magne B6);
- sanitization of the vagina with antiseptic solutions (Furatsilin, Miramistin, solution margantsovokislyj or hydrogen peroxide);
- use of sedatives in violation psycho-emotional state (tincture of Valerian, motherwort, Sedavit).
Prevention of complications
Any surgical intervention in the body does not exclude the likelihood of complications. They appear not only in the absence of adequate therapy, but also due to the individual characteristics of the functioning of the reproductive system, immune system and other precipitating factors.
The most common complications include:
- the rupture of the amniotic SAC;
- inflammation of amnion (interim authority that provide aquatic environment for the development of the fetus);
- ripping the seams;
- bleeding of varying intensity;
- infectious diseases of the vagina;
- pain in the pelvis and lumbar spine.
If you experience any of the symptom of the pathological state is required to consult a gynecologist. In most cases, the patient hospitalitynet. The period of stay in Department of a hospital depends on many factors.
To prevent the above complications, you must follow a gentle routine and diet.
Prevention measures include the following procedures:
- Limitation of physical activity. Lifting heavy weights (>1 kg).
- Pelvic rest. Contraindication to vaginal sex due to the injury of the cervical canal and provoking tone of the uterus.
- Regular consultations of the gynecologist. Continuous monitoring of the area of the manipulation and compliance with the recommendations of a physician.
- Treatment of systemic diseases. Treatment the doctor develops individually.
- Eliminate stressful situations. The psycho-emotional disturbance is the trigger for the development of various complications.
- A balanced diet. The diet must include large amount of fiber that promotes normal bowel function, preventing the development of constipation.
- Full genital hygiene. Maintaining cleanliness of the vagina prevents the chance of infection by pathogenic microorganisms.
Plastic surgical cervix of the uterus to prevent possible complications caused by the failure of the muscles of the body in relation to polyhydramnios, a large fetus, multiple pregnancy. Regular consultation with the attending physician and strict adherence to its recommendations will allow you to pass this period as comfortable as possible.