Short cervix during pregnancy and the risk of preterm birth. Short neck during pregnancy: causes and consequences

The uterus is the main organ necessary for carrying a pregnancy. It consists of the bottom, body and neck. The latter looks like a kind of tube connecting the uterus to the vagina. The successful course of pregnancy and natural childbirth directly depends on her condition. The cervix changes significantly before childbirth, although for the woman herself these changes are practically not noticeable, since this process is not accompanied by any special symptoms. What happens in the prenatal period and why is the neck given special attention?

How is cervical maturity assessed?

Starting at 38 weeks' gestation, at a gynecological examination at the antenatal clinic or at the maternity hospital, the doctor performs a vaginal examination to assess the condition of the cervix. It is also mandatory to examine the cervix before childbirth, as well as during labor. This is necessary to understand how fast the process of its maturation takes place.

There are four main parameters, evaluating which the obstetrician-gynecologist can conclude that the cervix is ​​ready for childbirth. Its maturity is determined by a special Bishop scale, according to which each of the parameters is evaluated on a three-point system (from 0 to 2 points). If this scale is rated 5, then we can talk about readiness for natural childbirth.

What happens to the cervix before childbirth

The cervix begins to prepare for the birth of a child from 32 to 34 weeks of pregnancy. First, its edges soften, leaving a dense patch of tissue along the cervical canal. Closer to childbirth, the uterus often comes into tone, due to which its lower segment softens and becomes thinner. The upper myometrium, on the contrary, becomes denser.

Due to this, the fetus begins to gradually descend and press its weight on the neck, provoking its further opening.

The opening of the cervix before childbirth does not occur equally in women who give birth for the first time, and in multiparous women. In the first, it begins with the opening of the internal pharynx.

In the latter, the process of opening the internal and external pharynx occurs simultaneously, since by the end of pregnancy, their external pharynx usually already passes 1 finger. Opening, the neck thus becomes shorter. A couple of days before the onset of the birth itself, the process of its maturation is significantly accelerated. Gradually, it is completely smoothed out and calmly skips 2 fingers or more.

Based on the Bishop scale above, on the eve of childbirth, the cervix must meet certain parameters.

A soft neck is ideal for childbirth. Her softness is evidenced by the fact that she freely passes 2 or more fingers of the doctor. During this period, a woman may notice the discharge of the mucous plug. This is one of the harbingers of the next birth, indicating the imminent start of labor. As for the length of the neck, during pregnancy, a length of 3 cm is considered normal for it. In this case, both ends of the cervical canal must be closed. Closer to childbirth, it is shortened. The length of the cervix before childbirth should not exceed 1 cm, gradually smoothing out completely.

As for its location, it has been tilted back throughout the pregnancy. This additionally helps to keep the fetus inside. Gradually, due to the softening of the lower segment of the uterus, it begins to turn forward. When the time comes for childbirth, it should be located exactly in the center of the small pelvis.

If the cervix is ​​not ready for childbirth

A soft, shortened cervix, which is located in the center and slightly opened, indicates the approach of childbirth. However, it also happens that the term of childbirth has already come, but the maturity of the cervix has not yet come.

An immature cervix can lead to complications during labor, so if it does not mature by the expected date of birth, the doctor may decide to stimulate.

Pregnancy after 40 weeks is overdue and dangerous for the baby. By this time, the placenta ceases to fully perform its functions. Therefore, if by this time the cervix does not mature, then its stimulation is mandatory.

In addition to prolongation of pregnancy, indications for stimulation are:

• The presence of a disease in the mother, in which further pregnancy threatens her health.
• The development of hypoxia in the fetus.
• Large fetus or multiple pregnancy.
• Termination or weakening of contractions during labor.
• Premature detachment of the placenta.

In all other cases, the question of the need for stimulation is decided individually. There are various methods to prepare the cervix for childbirth.

Medical methods include the following:

There are other non-medical methods to prepare the body for natural childbirth. Unlike the first ones, they can be used at home, but subject to a full-term pregnancy, a satisfactory state of health of the woman and the baby, and only after consulting a doctor. Otherwise, such stimulation can be dangerous. Non-medical methods of stimulation include:

If the cervix opens prematurely

There is also a reverse situation, when the cervix begins to open and prepare for childbirth ahead of time. This is usually associated with a pathology of the cervical canal, called isthmic-cervical insufficiency. It lies in the failure of the cervix to properly hold the fetus in itself. It shortens and opens at an early stage, which often leads to spontaneous abortion.

The presence of this pathology is evidenced by the length of the cervical canal in the period of 20-30 weeks less than 25 mm.

Isthmic-cervical insufficiency can develop due to trauma to the cervix, hormonal disorders, or excessive stress on the cervix during pregnancy.
In this situation, measures should be taken to maximize the prolongation of pregnancy:

In addition, treatment is carried out that contributes to the rapid maturation of the lungs of the fetus in case the birth begins prematurely. The cervix before childbirth changes so much that it allows the baby to be born unhindered.

The gradual opening of the cervix before childbirth is almost imperceptible to the woman herself.

Therefore, a visit to the gynecologist in the third trimester should be regular and accompanied by a vaginal examination, which allows you to assess the degree of readiness of the body for childbirth. This is especially true for those women who already feel other harbingers. If the term of childbirth has already come up, but the maturity of the cervix has not yet come, then there is no need to be afraid of stimulation. Sometimes delay can cost the life of both the mother and the child.

A short cervix during pregnancy is a pathological condition that poses a threat to the normal course of pregnancy and the bearing of a healthy child. This phenomenon may result from hereditary anomalies or secondarily occur due to other factors. The short cervix cannot cope with the task of holding the fetus in the uterus and opens, leading to early pregnancy loss or childbirth before the time appointed by nature.

Structure

Location of the cervix

The uterus is an organ that is half muscle., in which the embryo and fetus are formed and grow during the period of pregnancy of the body.

The cervix is ​​the lower part of the uterus, having the shape of a cone, in the middle of which the cervical canal stretches.

One end of the canal goes straight into the uterine cavity, where elastic circular muscles form a sphincter that holds the baby. The second goes into the vagina.

The approximate length of the neck ranges from 35 to 45 mm.

During childbirth, a newborn comes out through a greatly expanded cervical canal. In a healthy normal state, the channel is filled with a mucous plug that prevents the penetration of pathogenic microbes.

The outer surface of the neck is smooth, pink, inside - a more saturated color, velvety.

Changes during pregnancy

Pregnancy with a short cervix can be successful

Before conception, the cervix is ​​closed, the cervical tissue is elastic and dense, the cervical canal is closed and filled with mucus. After conception, the structure, size of the neck, the degree of opening of the pharynx change. The surface of the uterus from pink becomes bluish due to the active flow of blood and the growth of the vascular network.

During pregnancy, under the influence of hormones - estrogens, the tissues of the uterus soften, the length of the cervix increases, then gradually decreases. With it, it matures: it becomes shorter, gradually decreasing to 15 mm, and opens a little at the beginning of labor along with the opening of the pharynx.

What threatens the short cervix at the stage of bearing a child?

A short and soft cervix with a length of less than 25 mm for a period of 37 weeks is one of the signs of the development of isthmic-cervical insufficiency in a pregnant woman. This is a symptom of the physical weakness of the uterus to keep the baby inside and not allow it to be born prematurely. The total mass of a growing baby, amniotic fluid and an enlarging placenta is constantly growing. The walls of the uterus are stretched, and the pressure on the tissues of the cervix increases.

As a result, she:

• It ceases to cope with the function of a "barrier" for the introduction of pathogenic microflora;
• Not able to work as a "lock" to hold the fetus
• It becomes shorter, weaker, softer and opens under pressure from within.

It wraps around:

• loss of pregnancy;
• Birth before term;
• Rapid labor activity;
• Ruptures of the muscles of the cervix, walls of the vagina, tissues of the uterus;
• The threat of infection entering the uterus and infecting the baby.

Why is the cervix short?

This anatomical feature is congenital, but, more often, it is an acquired pathology.

In some patients, a short, soft cervix is ​​found during re-pregnancy, although its length at the first gestation was normal. But if the cervix is ​​short, what does that mean?

The reasons that lead to a decrease in length are:

• Congenital anomalies due to heredity uterine structures: infantile uterus; insufficient development of the cervical canal; defects in the development of the uterus.
• Mechanical injury received: in severe traumatic childbirth, accompanied by tissue ruptures; rough cleanings of the uterine cavity; abortion; surgical interventions with forced opening of the cervical canal; unprofessional application of forceps.

In this case, the muscles of the uterus are injured and scarring occurs at the sites of damage. Rigid and dense scar tissue does not allow the muscles to stretch elastically, which leads to deformation of the cervix and its shortening.

• A sharp change in hormonal balance in the period 12 -. At this stage, the adrenal glands of the fetus actively produce androgens. Under their influence, the neck loses elasticity, density, becomes shorter and opens a little. In this case, the pregnant woman may not feel threatened, since there is no excitation of uterine tone.
• Cervical trauma during previous births. Under such circumstances, the risk of deformation increases if there are complicating factors, which include: pregnancy with multiple fetuses; a large baby (more than 4 kg) or a large head (more than 36 cm in circumference); polyhydramnios.
• A pathological increase in the amount of relaxin - a hormone that causes premature softening, a decrease in length and opening of the neck.

Symptoms of premature opening or softening of the cervix are detected by ultrasound at 15 -. At this stage, the fetus is growing rapidly, and tension in the lower muscular sphincter increases. Sometimes there is a weak discharge, light, slightly bloody.

Treatment

The scheme and methods of therapy are developed in direct connection with what is the cause of this condition.

• Surgical;
• medication;
• Preventive.

It depends:

• From the gestational age;
• neck length;
• States of excitability of the uterus;
• Placenta location;
• The degree of opening of the cervical canal;
• The degree of probability of miscarriage or termination of pregnancy;
• Possible infection.

Conservative treatment

The possibilities of conservative therapy have certain advantages in comparison with surgical methods:

• They take little time and are easy to use;
• Easily carried out on an outpatient basis;
• They have a low degree of pain and are bloodless.

If isthmic-cervical insufficiency with CBS pathology occurs due to a large amount of androgens, which is detected when passing a special blood test for hormones, then corrective treatment with glucocorticosteroids (dexamethasone) and progesterone, which has a positive effect on gestation, is prescribed.

An increase in uterine tone, together with an increased content of androgens, provokes premature maturation of the cervix, its softening, shortening and early opening.

If the shortening of the cervix is ​​insignificant, medications are prescribed that reduce the excitability of the uterus. This gradually brings the length and density of the neck to normal.

Use a group of antispasmodics - no-shpa, papaverine, metacin, apply magnesia, Ginipral, Turinal, Partusisten.

Tablets Utrozhestan with a short cervix

During pregnancy, the drug with this diagnosis is used as an analogue of progesterone .

The medicine is produced in the form of suppositories, tablets and capsules. Only a doctor prescribes, taking into account all the criteria: the gestational age, the length of the cervix and the degree of its disclosure, the amount of progesterone, the state of the body, contraindications.

Utrozhestan:

Side effects: dizziness, distraction, thrombophlebitis, varicose veins;

Contraindications: diseases of the liver, central nervous system, heart and blood vessels, diabetes mellitus.

Surgical treatment of CI and short neck length

If at week 20 the neck length decreases to 20 mm, surgical correction or surgical cervical cerclage is prescribed - suturing. The procedure takes place under anesthesia and serves the task of keeping the fetus in the uterine cavity. After the correction, the pregnant woman spends in the hospital from 5 to 20 days.

Indications:

• Cases of premature birth and miscarriages in past pregnancies;
• The cervix becomes softer and shorter (progression);
• The deformity in the form of a shortened neck appeared as a result of an injury.

Contraindications:

Most often, stitches are applied between 13 and. To prevent infection of the uterus, surgical correction is also allowed from the seventh to the thirteenth week.

The earlier the suturing is done, the better the result. This procedure helps even if the cervical canal is ajar.

After the operation, the woman remains in the hospital for additional treatment for increased uterine excitability. After discharge at 37-38 weeks, the stitches are removed and hospitalization is carried out to prepare for childbirth.

In case of discharge of amniotic fluid, the occurrence of contractions, bleeding, the sutures are removed immediately upon detection of these conditions. During a planned caesarean section, the stitches are not removed.

Short cervix during childbirth

The condition of the shortened and soft neck is reflected in the passage of childbirth. There are two options:

The first rapid birth takes place in less than 4 hours, fast - in 6. The second and third births take even less time - 2 and 4 hours, respectively.

Important! If surgical suturing of the neck was performed, and the amniotic fluid has departed, or contractions have begun, then the sutures are removed urgently - at any time. Otherwise, during contractions, the stretched threads cut and damage the tissues of the cervix.

A short neck between 12 and is the main sign of a high probability of preterm birth.

Feedback on childbirth with a short cervix:

Zhanna, 24 years old

I was very nervous until I gave birth. The cervix was soft and short. It started like this at 21 weeks. Our doctor told me, I myself did not feel anything at first, only the lower abdomen ached unpleasantly. But the doctor said that the uterus could open and miscarry. They put a ring on me that “hugged” my neck tightly and did not allow it to open, and I also drank Utrozhestan capsules until the very birth. At the thirty-seventh week I was admitted to the hospital, everything was fine, and at 38 the pessary was quietly removed from the neck. And it started five days later. I had my first childbirth, and everything went very quickly. The doctor warned me that this happens, who has a short and soft neck. And obstetricians, when my baby wanted to jump out like a cork, held him by the crown. Therefore, I had perineal tears, but not strong ones. In general, everything is fine. It's good that they spotted this short neck in time and did everything right.

Prevention

Prenatal prevention includes:

Prevention of preterm birth

If the length of the neck has become less than 30 mm before, special observation is necessary. Women with this diagnosis, made before or during pregnancy, run the risk of not carrying the child to a normal term.

With all the dangers, a short cervix is ​​not an insurmountable obstacle to the normal completion of pregnancy and the bearing of a baby. But this requires a serious attitude to prevention.

After conception, you need:

Sex with a short cervix

Intimate relationships during the period of bearing a child is a complex issue and requires special attention. This is physical activity with prolonged contact with the cervix and sharp jolts into the pregnant uterus.

Even with the ideal condition of a woman's genitals during this period, sexual games should be careful and not frequent.

When suturing and installing a pessary with a diagnosis of CBS, vaginal sex is prohibited without fail. Adults can always agree.

With a short soft neck, sex becomes an aggravating factor that can provoke the opening of the cervix of the uterus - miscarriage or premature birth, because:

Therefore, with any suspicion of a shortening of the neck, opening of the pharynx - sexual rest is necessary until a complete examination by a gynecologist.

The cervix is ​​a structure that is a continuation of the body of the uterus - its lower part. The normal length is 4-5 centimeters outside of pregnancy. In the middle of the neck there is a hole - the cervical canal. It connects the uterine cavity to the vagina. When carrying a child, it must remain closed, this prevents the fetus from being born prematurely.

Short cervix during pregnancy- a pathology in which a given anatomical structure softens and decreases in length. These processes contribute to the opening of the cervical canal. Due to the described changes, there is a threat of miscarriage or premature onset of labor.

Norms of the length of the cervix

From the 25th to the 30th week of pregnancy, the normal length of the cervix lies between 3.5 and 4 centimeters. It can be shortened up to 2.5-3 centimeters. From 30 to 32 weeks of gestation, the optimal length of the cervix is ​​3.5 centimeters, within the normal range, its size is up to 2.5 centimeters.

From 32 to the optimal length of the cervix is ​​3 centimeters, but it can be shortened to 2 centimeters. After this period, hormonal changes occur in the female body, which prepares the woman for the upcoming birth.

Starting from the 38th week of pregnancy, the cervix begins to actively shorten. This process contributes to the disclosure of the uterine pharynx and the onset of labor. In the last days of gestation, the normal length of the cervix is ​​less than 2 centimeters, with the onset of contractions, the anatomical structure is completely smoothed out.

Causes of shortening of the cervix

• increased production of androgens - testosterone and its derivatives;
• reduced synthesis of progesterone, which supports pregnancy;
• reduced synthesis of estrogens - female sex hormones;
• trauma in past births;
• more than 3 births;
• sexually transmitted infections;
• uterine bleeding;
• cervical trauma during abortion;
• large size of the unborn child;
• multiple pregnancy;
• change in the amount of amniotic fluid (polyhydramnios or oligohydramnios).

Danger of a short cervix

Isthmic-cervical insufficiency is accompanied by a softening of the neck, due to which the opening of the internal and external pharynx can occur at any time. The consequence of these events is the activation of contractions and the premature birth of a child.

Childbirth with a short cervix often does not proceed physiologically. Normally, the duration of contractions in a primiparous is about 12 hours, in a multiparous - about 9 hours. The long and gradual course of labor protects the uterus and its neck from ruptures and other injuries.

With isthmic-cervical insufficiency, childbirth often takes on a rapid character and lasts from 2 to 6 hours. Excessively violent contractions can cause fetal hypoxia (its oxygen starvation) and trauma to the internal genital organs.

The most dangerous complication of rapid labor is uterine rupture. It can lead to pain shock, severe bleeding and death of the fetus. With complete rupture of the uterus, it may be necessary to remove it. At the present stage of medicine, this complication is a rarity.

A very short and soft neck during pregnancy can be a factor in intrauterine infection of the fetus. Normally, the vagina is not a sterile environment, it constantly contains a variety of microorganisms. With severe ICI, the amniotic bladder "shines through" and even protrudes from the external uterine os, which contributes to the transition of bacteria to the fetal membranes.

Intrauterine infection of the fetus is an extremely dangerous complication. In the early stages, it often causes the death of the unborn child and. Sometimes a miscarriage does not occur, the dead fetus remains in the uterine cavity and leads to its infection. At a later date, infection of the unborn child leads to the development of severe anomalies, often incompatible with life.

How long should the cervix be during pregnancy? Gynecologist Lyudmila Shupenyuk answers:

Symptoms of a short cervix

• discomfort in the lower abdomen, lower back, sometimes reaching cramping pains;
• feeling of heaviness in the vagina;
• transparent abundant uterine discharge;
• vaginal discharge with red streaks;
• red or brown uterine discharge.

Diagnostics

Next, the doctor conducts a digital examination of the vagina. With the help of it, the obstetrician-gynecologist reveals the patency of the cervical canal. Then the specialist conducts a visual examination of the vagina using mirrors. This procedure helps to see the condition of the external uterine os and the presence of protrusion of the membranes.

The "gold standard" for diagnosing CI is ultrasound. The doctor can consider the first signs of shortening with abdominal ultrasound (through the anterior abdominal wall) at the first and second screenings (according to the screening calendar, these studies are carried out at 11-12 and 21-22 weeks of pregnancy).

If there is any doubt, the obstetrician-gynecologist should perform a vaginal ultrasound examination, it allows you to make a final diagnosis. After shortening is detected, the expectant mother needs to be closely monitored throughout the subsequent pregnancy. Your doctor will usually order a follow-up vaginal ultrasound every 2 to 4 weeks.

Treatment of a short cervix

In case of non-hormonal etiology of isthmic-cervical insufficiency, non-surgical and surgical methods of treatment are used. The first type includes - a ring that is inserted into the cervix and protects it from further disclosure. This method of treatment is indicated from the 28th week of the gestational age. A contraindication for its use is prolapse of the amniotic membranes and a severe degree of the disease.

Before installing the obstetric ring on the cervix, you must make sure that there is no inflammation. If present, antibiotic treatment should be mandatory. A woman who has a pessary on her neck should come to the doctor every 14 days to disinfect the ring, which prevents the development of inflammation. Before childbirth, this device is removed.

Attention! Often, a short cervix does not manifest itself during gestation, so expectant mothers should never miss scheduled examinations by an obstetrician-gynecologist.

Suturing is carried out under general anesthesia up to 28 weeks of gestational age. In the postoperative period, it is necessary to take antibacterial agents to prevent infection. Stitches should be removed at 38 weeks of gestation.

Expectant mothers with a short uterine cervix are advised to follow the regimen. Women are prohibited from exercising excessive physical activity, engaging in active sports. It is desirable to exclude sexual life and emotional stress.

Prevention

During childbirth, the expectant mother should carefully listen to the doctor and midwife, do not push ahead of time, so as not to provoke cervical ruptures. Organ injuries contribute to the development of isthmic-cervical insufficiency during subsequent pregnancies. A woman is advised to be selective in sexual relations, to protect herself with non-permanent partners. Inflammatory diseases of the urogenital system can cause structural changes in the cervix.

For every pregnant woman, the greatest danger is associated with premature birth or miscarriage.

Undoubtedly, such a problem is very difficult to survive, both from a psychological point of view and physiological.

The essence of pathology and possible consequences

According to gynecologists, a short cervix becomes a serious stumbling block on the way to carrying a pregnancy. In some cases, the pregnancy can be saved, but the woman cannot give birth on her own.

From a physiological point of view, the isthmus and cervix are the first section of the birth canal.

The shape of the cervix resembles a truncated cone or cylinder, which is formed by muscles (30%) and connective tissue (70%). It is the muscular part of the cervix that is located near the uterus and is a muscular ring or sphincter. The main function of this ring is to prevent the uterus from opening before childbirth.

In the process of labor activity, the muscle ring opens, which becomes a signal for the beginning of the last stage of childbirth.

Cervix without pathologies has a length of 40 mm. During pregnancy, this indicator decreases somewhat, the internal os expands - this is how the body prepares for childbirth.

Due to various circumstances, the process of shortening the cervix can begin in the first half of pregnancy. In this case, doctors diagnose isthmic-cervical insufficiency(ICN).

As a result of premature reduction of the cervix, the muscle ring softens, which can lead to the opening of the first part of the birth canal and end in premature birth. The diagnosis of "isthmic-cervical insufficiency" made in the first and second trimesters significantly increases the risk of miscarriage.

It is important to note that the cervix, the length of which does not meet the standards, is not able to perform one of the main tasks - to protect the fetus from infection. Thus, the child is defenseless against microorganisms.

Causes of isthmic-cervical insufficiency and diagnosis

Pathology is both congenital and acquired.

congenital pathology, as a rule, is associated with the physiological characteristics of the structure of the organism or genetic heredity.

Such a pathology can be detected by a gynecologist during an examination, during which a specialist will assess the size of the cervix and its condition. You can also use an ultrasound examination of the pelvic organs.

Ultrasound is performed in two ways:

1. transabdominal- through the abdominal cavity;
2. transvaginal- through the vagina using a special sensor.

The diagnosis of "isthmic-cervical insufficiency" can be made if the diameter of the internal os is less than 1 cm, and the length of the cervix is ​​less than 2 cm.

In this situation, pregnancy will not be easy and under the constant supervision of a specialist. The expectant mother needs to regularly monitor her own well-being, exclude any physical activity and, if possible, remain calm for nine months.

However, the pathology may be acquired. In this case, the process of shortening the cervix may begin before pregnancy. What can provoke pathology?

You can name other factors that result in a shortening of the cervix. All of them are associated with its injury or expansion.

Any mechanical impact on the cervix can provoke its deformation, the appearance of scars on its walls. The consequences are quite serious: the cervix loses its elasticity and becomes shorter.

In addition, experts identify another reason for the shortening of the cervix, which is easily explained from a physiological point of view.

From about the tenth week of pregnancy, the child begins to independently synthesize the hormone androgen, which is necessary for successful labor activity. If the amount of androgen in the body of the expectant mother exceeds the permissible norm, a natural process of preparation for childbirth occurs: the cervix shortens, the internal os opens and the risk of premature birth increases.

How to avoid the occurrence of pathology?

When a pathology is detected, the doctor must prescribe a series of studies to understand the cause of its development.

First of all, it is important to donate blood for hormones. If the cause of the shortening of the neck was a hormonal failure, then it is quite possible that the danger can be eliminated with the help of hormone therapy.

If studies have shown a slight degree of changes in the cervix, the doctor may use a conservative method of therapy: intravenous drip of Magnesia or Ginipral, which eliminates the tone of the uterus.

A woman with such a diagnosis needs complete rest and bed rest, a bandage is mandatory. If, following these recommendations, the pathology progresses, a special device is installed on the cervix - an obstetric pessary, which maintains the uterus in its natural position and reduces the pressure of the fetus on the cervix.

In critical situations, when the length of the neck less than 20 mm, and the internal os has opened more than 10 mm, the cervix is ​​corrected surgical method- A cervical cerclage is applied. The procedure is possible for up to 27 weeks, under ultrasound control, in a hospital, using anesthesia.

The cervical cerclage is removed during contractions, when the water breaks or with the onset of labor bleeding. If the delivery has not taken place before 38 weeks, the sutures are removed as planned.

It is important to understand that a shortened cervix is ​​not a sentence for motherhood. It is possible and necessary to fight the problem and follow all the recommendations of the doctor.

Every woman draws in her dreams an ideal pregnancy that proceeds calmly, without complications associated with the threat of miscarriage and premature birth. But no one is immune from failures, sometimes everything does not end the way you want. If the cervix is ​​short during pregnancy, the risk of premature birth of the baby increases significantly.

Shortly before childbirth, the body begins to prepare for the upcoming event. Changes do not bypass the cervix - it becomes softer and shorter, so that at the crucial moment it is easier to open up and release the baby from the birth canal. Sometimes this process, conceived by nature, begins much earlier, and then the woman is faced with the threat of miscarriage or premature birth.

Normally, the length of the cervix is ​​3.5 cm, but if we are talking about its pathological condition, then this figure drops to 2.5 cm or less. It is shaped like a cone. Its structure is one third represented by strong muscle fibers that securely fix the fetus in the reproductive organ during pregnancy.

If a shortened cervix in a woman is due to heredity, then this fact can be recognized long before pregnancy. Girls who regularly visit a gynecologist from the onset of puberty are usually aware of their diagnosis. It, in order to avoid complications, must be taken into account by the doctor at the stage of planning the conception by the patient.

If a woman came to the gynecologist already in position, then the doctor will be able to establish the fact of a short cervix during a routine examination on the gynecological chair. As a rule, in these cases, the specialist additionally directs the patient to a transvaginal ultrasound examination, which can confirm his assumption.

Why is a short neck dangerous during pregnancy?

The greatest danger of a short cervix during pregnancy is (ICN), leading to the threat of miscarriage. If its length is less than 2.5 cm, then it will not be able to hold the fetus for a long time and premature opening of the uterus will begin. A pathology not detected in time leads to pregnancy loss.

During the birth itself, there is a high probability of their rapid course and complications associated with this: injuries, ruptures, etc. In addition, the shortened neck of the reproductive organ does not reliably protect the fetus from infection, since in this case there is no full barrier from pathogenic microflora penetrating from the outside.

Fortunately, this condition is not a barrier to motherhood. Even in the presence of isthmic-cervical insufficiency, it is possible to endure and give birth to a child if the necessary therapeutic and preventive measures are taken in time.

The reasons

A short cervix during pregnancy can adversely affect the entire process of bearing a child. This pathology is aggravated by such concomitant factors as a large fetus, polyhydramnios and multiple pregnancies.

Causes of shortening of the cervix:

• congenital pathologies due to genetics: incomplete development of the cervical canal, abnormal structure of the uterus, sexual infantilism;
• hormonal abnormalities that have arisen during pregnancy;
• hyperandrogenism;
• acquired injuries of the neck of the reproductive organ, received during childbirth, abortion or curettage;
• organ dysplasia.

Symptoms

For the first time, the symptoms of a shortened cervix make themselves felt from the 16th week of pregnancy. The fact is that from this moment the fetus begins to gain body weight faster, putting more pressure on the uterine pharynx. The doctor can detect this during the next examination on the gynecological chair. Any complaints from the expectant mother are usually absent.

In rare cases, the symptoms of a short cervix during pregnancy are manifested by minor discharge mixed with blood or abundant mucous discharge from the genital tract, pain in the lower abdomen. If a woman has these signs, then the doctor must send her to an ultrasound examination. The first symptom of a miscarriage or the onset of premature birth is bleeding at any time.

Diagnostics

Diagnosis of the condition of the cervix is ​​usually carried out before the 12th week of pregnancy, at the moment when a woman comes to the antenatal clinic to register for the fact of pregnancy.

A comprehensive examination includes the following steps:

1. Finger examination of the vagina, during which the doctor evaluates the length of the cervix, its patency and the condition of the cervical canal.
2. Inspection in the mirrors, which allows you to clarify the condition of the external pharynx of the cervix.
3. An ultrasound study, which not only confirms the presence of pathology, but also further allows you to track its development.

The fact that the cervix is ​​shortened, the doctor will see after the first vaginal examination of the patient. But he will be able to make the diagnosis himself only on the basis of the results of an ultrasound examination performed by the transvaginal method.

Treatment

If a woman has a history of spontaneous miscarriages and premature births, or during a real pregnancy she is diagnosed with isthmic-cervical insufficiency, then throughout the entire gestation period she will have to be under close medical supervision.

If a short cervix is ​​found during pregnancy - what to do? Unfortunately, the length of a shortened organ cannot be increased. Therefore, treatment should be aimed at maintaining pregnancy and preventing premature onset of labor.

Doctors use two tactics in the treatment of such patients. With a therapeutic and prophylactic purpose, if the cervix has shortened slightly during pregnancy, a pessary is installed on its sphincter, which reduces the pressure of the amniotic bladder, fixes the uterus in a certain projection and prevents the opening of the uterine os ahead of time.

With a serious shortening of the cervix or opening of the external os, it becomes necessary to apply sutures that will mechanically prevent the subsequent opening of the cervix until the moment of delivery. This procedure cannot be postponed: a short cervix can be sutured during pregnancy of 30 weeks or less.

If the shortening of the organ is caused by a hormonal imbalance, the condition is corrected by prescribing hormone therapy to the woman. Also, the doctor should give the patient a number of recommendations, such as wearing a prenatal bandage, limiting physical activity, and sexual abstinence.

Prevention

Prevention of premature opening of the cervix during pregnancy should begin long before conception, even from the moment of sexual activity. It includes the following aspects:

• reliable contraception aimed at preventing unwanted pregnancy and subsequent abortions;
• regular monitoring by a gynecologist in order to timely identify health problems and eliminate them;
• adequate pregnancy planning, especially in women who have experienced abortions, miscarriages and premature onset of labor in the past;
• maintaining a healthy intimate life (absence of promiscuity, protected sexual intercourse, etc.).

A short cervix leads to serious problems during pregnancy. The health of the mother and child, namely, the outcome of pregnancy, depends on her condition.