The norm of the length of the neck by week. What to do with a short cervix. How does the cervix change?

The cervix plays an important role in pregnancy. With a long cervix, pregnancy proceeds safely. Women with a short cervix during pregnancy are at risk for miscarriage.

Rarely there is a short cervix, as an anatomical feature of the structure, more often the cervix becomes shorter after mechanical damage. Abortions and any gynecological interventions contribute to the expansion of the cervix and lead to its shortening. In addition, scars are formed that deform the neck, as a result of which it is shortened.

Therefore, at the stage of pregnancy planning, it is necessary to have an examination by a gynecologist to identify this pathology, as well as regular visits to the doctor throughout the pregnancy.

The cervix is ​​a tight muscular ring that is located at the end of the uterus and connects it to the vagina. The cervix of a non-pregnant woman has a length of about 30 mm and a closed pharynx. Throughout pregnancy, the length of the cervix, its consistency and the size of the opening of the pharynx changes.

How does the cervix change during pregnancy?

Changes in the cervix occur during pregnancy. During pregnancy, uterine blood flow increases, and plethora is manifested by the appearance of a cyanotic (bluish) hue of the cervix. The endocervical epithelium grows and produces thick mucus, which prevents the penetration of pathogenic microflora.

The epithelium of the cervix is ​​sensitive to changes in estrogen levels during pregnancy. Estrogens cause hypertrophy of the muscular layer of the uterus, so the volume and length of the cervix increases during pregnancy.
An increase in the diameter of the cervix entails eversion of the endocervical epithelium into the vaginal cavity. Cervical inversion during pregnancy is called ectopia, but during pregnancy it is considered a variant of the norm.

What is the change in the length of the cervix during pregnancy

The length of the cervix during pregnancy is controlled by the doctor throughout the entire period, since the success of bearing the fetus depends on this indicator. The length of the cervix during pregnancy is periodically measured by ultrasound in order to prevent the threat of miscarriage during pregnancy.

If we take the early stages of pregnancy, then the cervix is ​​​​still dense and inelastic, and between 12-37 weeks, its length should be 35 - 45 mm. The cervix shortens only by 38 weeks of pregnancy. And just before the birth itself, the length of the cervix is ​​reduced to 15-10 mm, by this time it is located in the center of the small pelvis.

A short cervix during pregnancy indicates a threat premature birth. If the cervix is ​​shortened to 30 mm, special monitoring of the pregnant woman is required.

A small (short) cervix during pregnancy is observed against the background of hormonal disorders, and most often this occurs for a period of 16 weeks. In the presence of a short (20 mm) cervix during pregnancy, a diagnosis is made - isthmic-cervical insufficiency, which is subject to surgical correction.

The risk of preterm birth is evidenced not only by the length, but also by the diameter of the cervical os. If the diameter is over 6 mm, then this indicates the beginning of disclosure and premature birth. In early pregnancy, the expansion of the internal cervical os is a threat of miscarriage.

The cervix changes its consistency during pregnancy - it softens, even in the early stages of pregnancy, when examining the cervix, a significant softening of the isthmus is determined. Therefore, its slight displacement in any direction and a posterior inflection are observed.

Toward the end of pregnancy, there is a complete "ripening" of the cervix - this means readiness for childbirth.

The opening of the cervical canal by 5 - 10 mm and cramping pains mean the beginning labor activity. The opening of the cervix during the birth itself reaches 10 cm in diameter - this allows the fetus to pass through the birth canal.

Thus, the maturity of the cervix and readiness for childbirth is determined by its length, consistency and opening of the cervical canal.

The tactics of doctors in the diagnosis of "short cervix" in a woman during pregnancy

Women with a small cervix during pregnancy should be constantly under the supervision of a doctor. You need complete rest, respect for yourself and monitoring changes in well-being.

If isthmic - cervical insufficiency is caused by hormonal disorders, then it is corrected with medications. In some cases, with a short cervix, surgery is suggested during pregnancy.

Cervical cerclage surgery is performed - sutures are applied to the cervix, which keep it closed, which prevents premature opening, rupture of the membranes and premature birth.

A promising way to correct cervical insufficiency, which is used when it progresses, is non-surgical cerclage - this is the use of supporting obstetric pessaries of various designs that are worn on the cervix. All these methods of treatment help a woman endure pregnancy and give birth to a full-term baby.

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The uterus is the main reproductive organ of a woman. Its outer epithelial layer reliably protects the developing fetus from the adverse effects of the natural environment. To communicate with the outside world, there is a so-called cervical canal, located in the cervix. It is filled with a special mucus that prevents the penetration of various infections.

Some features of this part of the uterus have perhaps the most important influence on the healthy course of pregnancy in a woman. Thus, the length of the cervix by weeks of pregnancy allows medical specialists who monitor the gestation of the fetus to judge the possibility of certain pathologies or other disorders that can even provoke a miscarriage.

The length of the cervical canal and childbirth

Each representative of the weaker sex has a different length of the cervix. The norm is determined based on the individual characteristics of the organism of an individual patient.

However, it is not the normal length of the cervix, but the shortened cervical canal that is of particular danger to the body as a whole and during pregnancy in particular.

This feature of the structure of the main reproductive organ can sometimes be congenital. But in most cases, this pathology occurs as a result of various medical interventions in the female reproductive system. For example:

• artificial abortions;
• diagnostic scrapings and so on.

In addition, the length of the cervix in a girl can be affected by scar tissue resulting from surgical interventions or when cauterizing foci of erosion with electric current.

The need for medical supervision

Due to the fact that the length of the cervix before childbirth affects the process of the birth of a baby, it is advisable to contact a gynecologist before planning a conception for an examination to identify the pathology in question.

In addition, it is important to be under the control of a medical specialist during the entire period of pregnancy. This allows the doctor to observe the length and condition of the cervical canal and the fundus of the uterus. They must correspond to the norm and depend on the degree of development of the fetus.

Naturally, the described violation, like many others, will not prevent the expectant mother from bearing and giving birth to offspring, but observation by a specialist will make it possible to identify possible pathologies in a very timely manner and take measures to eliminate them.

Features of the internal structure of the cervix

The considered internal organ, with which the uterus ends, outwardly represents a circular muscle attached to the lower extremity of the main genital node of a woman.

With the help of the cervix, its internal cavity is in contact with the vagina, and through the latter - with the external environment. For this, the so-called cervical canal is used, filled with mucus that performs protective functions.

In a woman who is not pregnant, the channel is in a closed position. The length of the closed part of the cervix is ​​about 3 or 4 centimeters.

But as soon as in fallopian tubes ah, fertilization will occur and the egg is implanted on the prepared endometrial layer in the uterine cavity, metamorphoses occur with the cervical canal, preparing the cervix for the future appearance of the baby.

Changes accompanying gestation

The transformations that the cervical canal undergoes during pregnancy are due to hormonal effects and an increase in blood circulation in the muscular layer of the uterus. This is indicated by the bluish tint of the outer walls, which is diagnosed by a gynecologist during an internal examination using special tools. He also establishes whether the length of the cervix by weeks corresponds to the accepted standards.

In addition, when a woman is in this physiological state, there is an increase in the amount of cervical mucus that fills the canal. This allows you to successfully deal with pathogenic microflora that can develop in the vagina of a pregnant woman.

Changes also occur with the epithelial layer, which is affected by an increased concentration of the hormone estrogen in the body. As a result, the size and volume of the female genital organ increase significantly.

Controlled parameters

During pregnancy, during a routine examination by a gynecologist, he determines several indicators that have the most significant impact on the process of bearing a child:

• length of the cervix by week of pregnancy;
• metric dimensions of the main reproductive organ at certain stages of gestation;
• the state of the uterine fundus, or rather, its height in the first, second and (or) third trimester of pregnancy.

If all controlled variables are normal, we can talk about the correct development of the fetus. When one of the indicators deviates from the generally accepted parameters, there may be a pathology that has an adverse effect on the unborn baby.

It is especially important to know how long a woman's cervix is ​​at a certain time in the development of the fetus. Indeed, for example, deviations in the height of the location of the fundus of the uterus depend on the individual structural features of the female body and may vary for each individual patient. And the discrepancy in the length of the cervical canal almost always indicates a particular violation.

The influence of the size of the cervix

The success of its completion and healthy childbirth directly depend on how long the cervix is ​​by weeks of pregnancy. Therefore, as already mentioned above, the monitoring of this parameter is given Special attention during the examination with the help of ultrasound diagnostic devices.

This, among other things, allows you to diagnose the threat of miscarriage in time and take the necessary measures to prevent it.

Channel length depending on the term

Consider what is the length of the cervical canal during the entire period of bearing a baby:

• the length of the cervix at the beginning of pregnancy is 30 mm, the muscle tissue is inelastic, the skin is cyanotic;
• the length of the cervix at 20 weeks of gestation is 36-46 mm;
• the length of the cervix of 32 weeks or more becomes somewhat smaller (up to 10 mm), preparing for the passage of the baby.

generic process

Before the baby is born into the world, the normal length of the cervix should not exceed 10 mm. In addition, the outer section of the cervical canal moves to the center of the small pelvis. The degree of readiness of the reproductive system for contractions is determined by the following parameters:

1. The length of the cervix. The rate is listed above.
2. The consistency of mucus that fills the cervical canal.
3. degree of neck opening.

In order for the head of the child to be born to pass freely, the diameter of the outlet increases.

However, excessive disclosure should not be considered normal either. Such a condition can lead to the emergence of the so-called ectopia, that is, the entry of the inner epithelium of the uterus into the vaginal cavity. In the future, this may provoke erosion.

Pathologies

The small cervical canal, as has been mentioned more than once, poses a considerable threat to the process of carrying a baby. In this case, it is imperative to control the entire process with a gynecologist, and in some cases only surgical intervention can help.

The length of the cervix a woman will have during pregnancy is influenced by the concentration of hormones in the body.

In addition, it is important to know that not only a too small length of the canal, but also its excessive opening can lead to a miscarriage. The diameter of the hole, exceeding the accepted 6 mm, indicates the onset of the process of childbirth (usually premature), and at an earlier date - the threat of miscarriage.

Too short cervical canal (no more than 20 mm) indicates that the patient has isthmic-cervical (IC) insufficiency. Such a condition should be treated appropriately at the stage of offspring planning.

Diagnosis is made using an ultrasound diagnostic apparatus. In this case, various sensors are used:

• vaginal;
• transabdominal.

These procedures make it possible to establish not only the external dimensions of the organ, but also the closeness of the external cut of the cervical opening.

Treatment

Measures aimed at correcting the established violation are assigned depending on the reasons that caused it.

So, if isthmic-cervical insufficiency is provoked by malfunctions in the endocrine system of the body, which is responsible for the production of hormones in the body, treatment is carried out with the help of medicines containing the necessary components.

When the cause of the pathology was a bicornuate uterus, the patient is recommended to have a cerclage. It is especially important to do this in the case when, before pregnancy, an operation was performed to remove the rudimentary horn, and the remaining one does not allow the embryo to fully grow in the womb. At the same time, a strong effect on the cervix can lead to a miscarriage, so you should not hesitate with treatment.

For this, a so-called cervical cerclage is performed. During this procedure, special circular sutures are applied to the cervix and, accordingly, the cervical canal, preventing it from opening.

This procedure allows you to warn:

• gap amniotic sac;
• premature birth in a woman.

Sometimes cerclage is performed without surgical opening of the skin. For this, a variety of obstetric pessaries are used, located on the neck through the vagina, which also do not allow the cervical canal to open.

In any case, when this pathology is diagnosed in a pregnant woman, she must constantly be under the constant supervision of a gynecologist. In addition, it is important to ensure:

• the absence of any stressful conditions;
• careful and attentive attitude to the state of one's health;
• timely provision of medical care if necessary.

Conclusion

All systems in the body are interconnected. The functioning of all systems and processes, including the course of pregnancy, depends on the proper functioning of each organ.

Of great importance during the bearing of the baby is the length of the cervical canal in the cervix, as well as its changes at each stage of pregnancy.

Various pathologies can affect the length of the cervix, and therefore it is necessary to constantly monitor this parameter using ultrasound diagnostics. Such a procedure will make it possible to begin timely treatment if pathologies are detected.

Otherwise, the pregnancy may end in miscarriage.

Normal size of the cervix

Cervix- a muscular organ that closes the entrance to the body of the uterus. The opening in the cervix is ​​called the cervical canal and serves as a passage for spermatozoa into the uterine cavity and an outlet for menstruation and the fetus.

Cervix dimensions: norm 4 cm, 2.6 cm, 3.5 cm (length, thickness, width). Deviations of about 0.5 -1 centimeter are allowed. After the first birth, the sizes change upwards by 0.5 - 1 centimeter. After the second, another 0.3 centimeters. Postponed abortions affect the size in almost the same way as childbirth, because the uterus is artificially opened. Because of this, it also increases, but only by 0.1-0.2 cm.

Cervical size during pregnancy:

An important parameter for determining the possibility of bearing a child is the length of the cervix, the norm is 3.5 cm - 4 cm. If the cervix is ​​less than 25 millimeters, it is called shortened, and less than 20 - short. In the case of a shortened cervix, pregnancy will pass without complications, just under the strict supervision of a doctor. With a cervix shorter than 20 mm, pregnancy is more risky. It is she who holds the fetus in the uterus and the short neck is weaker. The bearing of a child will proceed with a constant threat. This is not a contraindication, but a signal for more careful examinations and frequent visits to the doctor.

When a woman is in position, the length of the neck is constantly monitored. This is necessary, as it should not be shortened before 38 weeks. If the neck has reached a size of 20 mm, a woman needs to go through a simple surgical procedure for correction. In this case, sutures are placed on the cervical canal, which help to keep the baby in the uterus.

Before childbirth, the length is already 10-15 mm, and the body of the cervix becomes soft.

Normal length of the cervix during pregnancy by week. Her deviations

The cervix is ​​a small organ that connects the body of the uterus to the vagina and has an internal and external os. Its main function during pregnancy is to keep the fetus in the uterus and block any infection that can reach the baby. Usually, the doctor examines the length of the cervix during pregnancy by weeks, as well as its consistency, which allows you to timely determine the likelihood of premature birth.

Such a risk, according to gynecologists, can best be determined at 24 weeks of gestation by performing a transvaginal ultrasound. Of course, at this time, such an examination is prescribed to women very rarely.

But, if the doctor during the examination found any inaccuracies in the state of the cervix (density, length, condition of the external pharynx), then he will definitely send the pregnant woman for ultrasound with a transvaginal sensor.

The normal length of the cervix during pregnancy at week 24 averages 3.5 cm (it may be somewhat shorter in multiparous women). As the due date approaches, this small organ will gradually shorten.

Deviations from the norm and pathology

The most common pathology of the cervix is ​​its insufficient length, which in medicine is called isthmic-cervical insufficiency (ICN for short). Such a diagnosis is made if the length of the neck is less than 2.5 cm, and the internal pharynx has a funnel-shaped extension (normally it should be closed).

ICI occurs as a result of trauma to the cervix during previous births, after its treatment, and also after abortions. AT this case this body is not able to perform its direct functions, provoking the risk of premature birth.

A short cervix between 14 and 24 weeks of gestation is the main indicator of an untimely onset of the birth process:

• length less than 1 cm - childbirth at 32 weeks;
• length less than 1.5 cm - delivery at 33 weeks;
• length less than 2 cm - delivery at 34 weeks;
• length less than 2.5 cm - delivery at 36 weeks.

When diagnosing CI, doctors immediately take action. Depending on the severity of such insufficiency, the gynecologist may prescribe:

• drug therapy;
• use of a silicone pessary;
• cerclage of the cervix (suture).

The opposite is the problem, which is the immaturity of the cervix, provided that the pregnancy is full-term. This phenomenon is explained by a violation in the formation of the generic dominant (for example, when a woman experiences a strong fear of childbirth), anatomical features, as well as the state of the neck after medical interventions, as a result of which it becomes less extensible.

If, after 37 weeks of pregnancy, the cervix does not move from immature to mature, then this causes difficulties in the first stage of labor - it either opens too slowly or does not open at all.

As a result, there is a need for a caesarean section or special preparation for natural delivery. The last measure depends on the maternity hospital and can be carried out through the introduction of kelp, the use of prostaglandins, etc.

Normal "behavior" of the cervix before childbirth

After 37 weeks, when the pregnancy is already considered full-term, the structure of the cervix begins to change - it shortens, softens, takes a position in the center and begins to open slightly.

Such a process is necessary to combine the cervix with the body of the uterus into a single channel. So, the first stage of labor ends with its opening up to 10-12 cm. In the postpartum period, the cervix gradually returns to almost the same state in which it was before pregnancy.

So, from all of the above, we can conclude that the length of the cervix and its other indicators are very important for the timely diagnosis and correction of CI, which is one of the causes of preterm birth.

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The cervix performs an important function of holding the fetus in the uterus. Until 37 weeks, it is normally closed, and after this period it begins to prepare for childbirth. In addition, a closed cervical () canal to some extent prevents the infection from entering the fetus.

Cervical length and consistency Normally, throughout pregnancy, the neck is dense in consistency, its average length is 3-4 cm (it may be somewhat shorter in multiparous women).

It is these characteristics that allow it to perform its main function? holding the fetus. After 37 weeks (the period from which the pregnancy is considered full-term), structural changes begin to occur with the cervix: it softens, shortens, occupies a central position, begins to open slightly. These changes are necessary in order to form a single channel with the body of the uterus. During childbirth (during the I period), it gradually opens up to 10-12 cm. And then (in the postpartum period) it gradually returns to a practically pre-pregnant state (the external pharynx of the cervix becomes slit-like, and in nulliparous it is pinpoint).

Measurement of the cervix can be done in two ways:

1. When an obstetrician-gynecologist determines all the main characteristics (length, density, position relative to the axis of the pelvis, the state of the external pharynx). It is carried out at each examination on a gynecological chair to assess the dynamics of changes.
2. Ultrasound examination (ultrasound): you can determine the length, condition of the internal and external pharynx, as well as the cervical canal itself (which is very important when there is a threat of preterm birth).

Pathologies and deviations from the norm

Information The most common pathology is a short cervix during pregnancy - isthmic-cervical insufficiency (ICI).

In an ultrasound examination, a neck length of less than 25 mm is taken as an ICI. Another criterion is the funnel-shaped expansion of the internal os (which is normally closed).

The causes of ICI are trauma to the cervix in previous births, after abortions, and also after treatment of the cervix (). In this case, the cervix cannot perform its functions, there is a threat of premature birth. It can also lead to habitual miscarriage. Diagnosis is based on ultrasound data (cervicometry is performed - measuring the neck and assessing the condition of the internal pharynx). When shortened to 25 mm or less, either a suture is applied to the neck, or an unloading obstetric pessary is placed.

Additionally The opposite problem is immaturity of the cervix during full-term pregnancy. It is caused by a violation of the formation of the generic dominant (for example, with fear of childbirth), as well as anatomical features, or after interventions on the neck (it becomes poorly extensible).

The degree of maturity of the cervix is ​​estimated in points for a number of signs, which is presented in the table

Infertility and the cervix: a direct link

The last 2 decades in the countries of the post-Soviet space have been marked by one unpleasant fact. Low birth rate is still one of the main problems of public health and the state as a whole. But, if at the end of the last century, the bulk of the reasons for the deterioration of demographics related to the socio-economic side of life, now the low birth rate is a consequence of the widespread infertility. Here, various pathological conditions reproductive system. Last but not least is the length of the cervix.

The female reproductive system is located in the pelvic cavity. And represented by the following bodies.

1. Ovaries. paired organs. They are small bean-shaped formations. Their length is about 3 centimeters. The ovaries are located on the upper border of the small pelvis on both sides. And they are held in place by ligaments.
2. Fallopian tubes. Paired tubular formations. They are located above the ovaries and, as it were, surround them from above. Normal length is 11-12 cm. One end opens into the pelvic cavity in the immediate vicinity of the lateral pole of the ovary. The other end of the tube opens into the uterine cavity. Their main role is to ensure the processes of fertilization and the promotion of the egg to the uterus.
3. Uterus. Unpaired hollow organ. Up to 2/3 of its volume is occupied by the muscle layer. The organ is located in the central part of the small pelvis. Outwardly, it resembles an inverted pear. In its upper part it connects to the fallopian tubes. Here, its width reaches 4 cm. With its lower end, the uterus passes into the vagina. The structure of the uterus is as follows.
4. The fundus of the uterus is the upper part of the organ. It consists entirely of muscle layer.
5. The body of the uterus is the largest middle part of the organ.
6. The cervix is ​​the lower, less wide part of the organ. She is directly connected with the vagina. Most of the neck is occupied by the muscle layer. In its center is a canal called the cervical canal. One end of it opens into the uterine cavity (it is called the internal os), the other - into the vagina (external os). Thus, a thick muscular tube is obtained. Also called the muscular ring. The normal length of the cervix is ​​3 to 4 cm.
7. Vagina. It is also an unpaired hollow muscular organ. But the proportion of the muscle layer is less than in the cervix - less than 1/5. One end of the vagina opens outward. Its other end is attached to the cervix. The normal length of the vagina ranges from 7 to 11-12 cm.

Cervix: role in pregnancy

Immediately after the attachment of a fertilized egg (now called a zygote) to the endometrium, transformations begin in the cervix. Under the action of progesterone, the mucous secretion of the cervical canal acquires a thicker consistency. An increase in the blood supply to the uterus (including the cervix) leads to an increase in mucus secretion. Thus, the formation of a "cork" begins. Estrogens, which begin to be produced from the first half of pregnancy, increase the number of myosin and actin fibers in muscle cells. This leads to an increase in their volume. As a result of all these processes, the cervix hypertrophies - increases. The cervical canal remains closed with a dense "plug".

All these mechanisms are necessary for the preservation of pregnancy and its normal course. Hypertrophy of the cervix gives it the ability to withstand the ever-increasing pressure in the uterine cavity. What keeps the fetal bladder intact. The presence of a dense "cork" reliably closes the uterine cavity from the ingress of various microorganisms from the vagina.

How does the length of the cervix change during pregnancy

Changes in the cervix depending on the duration of pregnancy

But the size of the cervix is ​​not always the same. Everything changes depending on the state of the female body. Otherwise, she would not be able to perform her functions.

A length indicator of 3-4 cm is an average. Even outside of pregnancy, it can fluctuate. What to say about the period between conception and childbirth. Here, the length of the cervix varies by weeks and months.

In the first two weeks of pregnancy, the size of the cervical canal is almost 4 cm, although it is already starting to increase. The maximum length of the cervix is ​​at the 16th week. This is about 4.5-5 cm. Then, on for 22-23 weeks, its size does not change.

In the last weeks before childbirth, the reverse process begins in the cervix. Its size begins to decrease. Approximately at 38-39 weeks of pregnancy, the cervix becomes 3 cm. A few days before childbirth, it does not exceed 1.5-1.7 cm. On the day of the onset of labor, the internal cervical os begins to open, which reduces the longitudinal size to 1 cm. The further process affects the cervical canal throughout at the same time. Therefore, the shortening of the cervix is ​​no longer mentioned. All this is called its disclosure.

The above picture is an average and in no case can be applied to one woman individually. Any indicators, such as cervical length, by week of pregnancy should only be interpreted by a doctor.

Pathologies of the cervix: causes and consequences

The number of cervical pathologies is determined by a rather impressive number of diseases. All of them can be divided into two large groups

• Inflammatory.

Both those and other pathologies are detected thanks to three main methods.

• Bimanual examination on a gynecological chair.
• Visual examination of the vagina and outer part of the cervix using mirrors.
• Ultrasound examination of the pelvic organs.

All other methods (hysteroscopy, biopsy, puncture, etc.) are more specialized. Since with their help, the identified pathologies are clarified and / or the suspected violations are excluded.

The three groups of studies described above, one way or another, relate to the cervix. All of them can identify or suspect a certain pathology. In the first case, the doctor relies only on tactile sensations. In the second, one can draw a conclusion about the state of the outer end of the cervix and the external pharynx. That allows you to indirectly judge the cervical canal. And, as you know, his condition is essential for the course of pregnancy. Therefore, a bimanual examination and examination in the mirrors must be carried out at the initial examination at the beginning of pregnancy. And if no pathologies are found, only an ultrasound examination is carried out in the future.

The fact is that only ultrasound makes it possible to monitor how the length of the cervix changes by weeks of pregnancy, and the development of the fetus as a whole. With a normal pregnancy, an ultrasound examination is carried out in the following terms.

• The first registration in the antenatal clinic. The term varies greatly over time. Usually, ultrasound is done in the period from 5-6 to 10-12 weeks.
• The second ultrasound is performed at 20 weeks.
• The third time - 32 weeks.

All other cases of the study are unscheduled. They are carried out according to indications.

In ultrasound examination, special attention is paid to three indicators.

1. The size of the baby and its parts in relation to the gestational age
2. condition of the placenta.
3. The size and condition of the cervix.

Cervix and isthmic-cervical insufficiency: ways to overcome

Cases of miscarriage due to cervical incompetence are quite common. Therefore, the obstetrician-gynecologist monitors changes in its length throughout the entire period from the first appearance of a woman until the end of the term. Since the normal state of the cervix is ​​the key to successful gestation.

If in the early stages of pregnancy the result of an ultrasound examination reveals a length of the cervix of 2-2.5 cm, the woman immediately begins to be at risk for spontaneous abortion. Such women recommended physical and emotional rest and re-appearance to the obstetrician-gynecologist in two weeks. Be sure to conduct a bimanual examination and control ultrasound. With a neck length of more than 2.7-3 cm, a pregnant woman can safely go home, but with mandatory ultrasound monitoring every 8 weeks until the 7th month.

The situation when the length of the neck is 2 cm, and its pharynx is ajar, the pregnant woman is diagnosed with isthmic-cervical insufficiency. Antispasmodics, vitamins and rest are prescribed. The same applies to women from the category described in the first case, if the length did not increase during the second visit and ultrasound. For both cases, control after 2 weeks is mandatory. In case of unsatisfactory results, the woman should be hospitalized in the department of pathology of pregnant women.

According to indications in the first and second cases, in addition to antispasmodics, vitamins, rest, hormonal preparations can be prescribed. But for this, the connection between the shortening of the cervix and the activity of fetal hormones must be proven. Usually, their level rises in a period of 16 to 18 weeks.

When all the measures taken are insufficient and the length of the cervix continues to decrease, they resort to surgical intervention. Stitches are placed on the neck, which are removed only at 27 weeks.

If the length of the cervix began to decrease after 28 weeks, and treatment with vitamins and antispasmodics did not work, doctors resort to a pessary - a special device made of inert materials inserted into the vagina. The pessary reduces stress on the neck. It is removed only after reaching 38 weeks of pregnancy.

In any case, the correct observance of all the doctor's recommendations increase the chance of bearing a child!

Pregnancy- a special period in the life of every girl. The body of women has an interesting and complex structure. During gestation, many organs begin to change. There are quite a lot of changes going on in the body.

The size of the organ changes during gestation, as well as after childbirth. This is due to the process of muscle hypertrophy that occurs during the period of bearing a child.

This organ is one of the mobile organs, capable of occupying a different position in the environment. In shape, this organ resembles a pear.

There are women with different forms of the uterus and are not always pear-shaped. This does not always indicate the presence of pathology. This is just an individual feature.

The walls of the body consist of three types of tissues:

• myometrium;
• perimetry.

In general, the organ itself consists of three parts:

• body;
• neck.

Each part of the uterus plays an important role in the life of women and in the bearing of the fetus.

What is the cervix?

Now it became clear what constitutes such an organ. As mentioned earlier, this organ consists of three parts, one of which is the neck.

The whole organ is unable to hold the fetus. Under the weight of the baby, it happens and this entails premature birth, ending in the death of the child.

The survival rate in this case is low.

As a rule, CCI occurs without symptoms, and the problem can be noticed during examination by a doctor. Sometimes pregnant women suffer from bursting pains in the vaginal area. Pain can spread not only through the vagina, but also into the lumbar region and even into the groin area.

Treatment

In the case of diagnosing a problem such as ICI, doctors offer several solutions:

• courses of therapy with hormonal drugs;
• installation of a pessary;
• installation and suturing of the cervix to avoid problems.

Which path of treatment to choose is determined, of course, only by the doctor.

It all depends on how high the probability of termination of pregnancy is, and what threat it can be for the child and mother.

These measures help prevent uterine dilatation. The sutures applied to hold the cervix, as well as the installed pessary, are removed during the 38th week. It is at this stage that the baby is already full-term and nothing threatens his life.

long cervix

It can be not only, but also the length of the cervix exceeding the norm. Is it dangerous? This will not affect the course of pregnancy in any way. If the length of the cervix does not change by the time the baby is born, then this can complicate the process of childbirth.

In this case, disclosure in the prenatal period is very difficult and causes difficulties in the process of giving birth to a child. As a rule, in such cases, the doctor decides on an emergency caesarean section.

The reasons:

The consequences of childbirth

The consequences may not be as dire as with a short cervix.

In the case of a large length, the hardness of the organ increases, it becomes oak and it becomes necessary to soften it.

Moreover, for these reasons, poor disclosure occurs and interferes with the birth process.

If during the prenatal period it was not possible to smooth the cervix and eliminate the problem of structuring the cervix, then in this case, a caesarean section is promptly performed.

Changing the cervix before childbirth

The structure of the cervix during the period of gestation before childbirth undergoes changes.

As you know, the cervix is ​​smoothed out. However, it happens that it is still oak. This is what can interfere with the normal birth process.

Normally, shortening in size should occur within the normal range. The reduction is approximately one centimeter. The softening of the cervix promotes the passage of the fetus without various injuries to the fetus.

As you can see, the cervix goes through many changes before the baby is born. However, when diagnosing a pathology, the necessary treatment is prescribed to prepare the cervix for the birth process.

Alas, not always treatment helps to achieve the desired result. In the process of giving birth to a baby, cardinal measures are applied - a caesarean section.

If diagnosed with premature shortening of the cervix?

Diagnosis of a shortened cervix happens quite often. This is quite a common occurrence. First of all, I must say that this is a big threat to the fetus.

If the length reaches less than 25 mm, then in this case the threat of miscarriage is really high. This can be explained by the fact that the weight of the fetus increases and puts pressure on the uterus, as well as on the cervix. In this case, the fetus is not retained and, when the cervix opens, it goes beyond.

Such a process is called premature birth, which in most cases ends sadly due to the fact that children in such a period are not yet full-term and the likelihood of survival is very small.

Of course, with the early diagnosis of such a problem, doctors take all measures and constantly monitor changes in the length of the cervix.

What to do?

First of all, one must be very attentive to the symptoms that disturb or cause discomfort.

I must say that the condition of a shortened cervix can cause discomfort:

• in the vaginal area
• give characteristic pain in the groin area
• to the lumbar region.

If such symptoms have been noticed, it is necessary to inform the doctor about it.

In most cases, a woman does not feel any discomfort and such a problem is detected only with ultrasound diagnostics. If the diagnosis showed the presence of such a problem as a short size that does not meet the norm, then doctors offer several solutions.

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How to achieve the state of the norm?

To achieve the desired size of the cervix, you must:

1. Visit a doctor regularly.
2. Moreover, additional ultrasound examinations are required., allowing you to most reliably determine the length of the cervix.
3. In the case of a diagnosis of a reduced or enlarged size, it is necessary to take all measures to restore the size so that the birth is successful and without complications.
4. Very often, the formation of such a pathology is affected by infectious diseases or diseases of the pelvic organs. To prevent and exclude problems, before planning a pregnancy, it is necessary to undergo a full examination.
5. In addition, before planning pregnancy, it is necessary to conduct an ultrasound examination of the uterus. The doctor will be able to determine the anatomical changes that cannot be influenced. This will help to respond and diagnose the pathology in a timely manner.

The screening of the first trimester of pregnancy is over, time passes, the tummy grows, and new worries appear.
Have you heard or read somewhere about isthmic-cervical insufficiency (ICI), premature birth, ultrasound of the cervix and now you don’t know if this threatens you and whether you need such a study, and if necessary, when?
In this article I will try to talk about such a pathology as ICI, about modern methods of its diagnosis, the formation of a high risk group for preterm birth and methods of treatment.

Premature births are called those that occur between 22 and 37 weeks (259 days) of pregnancy, starting from the first day of the last normal menstruation with a regular menstrual cycle, while the body weight of the fetus is from 500 to 2500 g.

The frequency of preterm birth in the world in recent years is 5-10% and, despite the emergence of new technologies, is not decreasing. And in developed countries, it increases, first of all, as a result of the use of new reproductive technologies.

Approximately 15% of pregnant women fall into the high risk group for preterm birth even at the stage of anamnesis. These are women who have a history of late miscarriages or spontaneous preterm births. In the population of such pregnant women, about 3%. In these women, the risk of recurrence is inversely related to the gestational age of the previous preterm birth, i.e. the earlier a preterm birth occurred in a previous pregnancy, the higher the risk of recurrence. In addition, this group includes women with uterine anomalies, such as a unicornuate uterus, a septum in the uterine cavity, or trauma, surgical treatment of the cervix.

The problem is that 85% of preterm births occur in 97% of women in the population who have this first pregnancy or previous pregnancies ended in full-term birth. Therefore, any strategy to reduce the number of preterm births that targets only a group of women with a history of preterm birth will have very little effect on the overall rate of preterm birth.

The cervix plays a very important role in maintaining pregnancy and the normal course of childbirth. Its main task is to serve as a barrier that prevents the fetus from being pushed out of the uterine cavity. In addition, the glands of the endocervix secrete special mucus, which, when accumulated, forms a mucous plug - a reliable biochemical barrier for microorganisms.

"Maturation of the cervix" is a term that is used to describe the rather complex changes that occur in the cervix, related to the properties of the extracellular matrix and the amount of collagen. The result of these changes is the softening of the cervix, its shortening up to smoothing and expansion of the cervical canal. All these processes are the norm at full-term pregnancy and are necessary for the normal course of childbirth.

In some pregnant women, for various reasons, the “ripening of the cervix” occurs ahead of time. The barrier function of the cervix is ​​sharply reduced, which can lead to premature birth. It should be noted that this process has no clinical manifestations, is not accompanied painful sensations or bloody discharge from the genital tract.

What is an ICN?

Various authors have proposed a number of definitions for this condition. The most common is this: ICI is an insufficiency of the isthmus and cervix, leading to premature birth in the II or III trimester of pregnancy.
or such : CCI is a painless dilatation of the cervix in the absence of
uterine contractions leading to spontaneous interruption
pregnancy.

But after all, the diagnosis should be made even before the termination of pregnancy occurred, and we don’t know whether it will happen. Moreover, most pregnant women diagnosed with CI will deliver at term.
In my opinion, ICI is a condition of the cervix, in which the risk of preterm birth in this pregnant woman is higher than the general population.

In modern medicine, the most reliable way to evaluate the cervix is transvaginal ultrasound with cervicometry - measurement of the length of the closed part of the cervix.

Who is shown an ultrasound of the cervix and how many times?

Here are the recommendations from https://www.fetalmedicine.org/ The Fetal Medicine Foundation:
If a pregnant woman belongs to those 15% with a high risk of preterm birth, then such women are shown an ultrasound of the cervix every 2 weeks from the 14th to the 24th week of pregnancy.
For all other pregnant women, a single ultrasound of the cervix is ​​recommended for a period of 20-24 weeks of pregnancy.

Cervicometry technique

The woman empties her bladder and lies on her back with her knees bent (lithotomy position).
The ultrasound transducer is carefully inserted into the vagina towards the anterior fornix so as not to exert excessive pressure on the cervix, which can artificially increase the length.
Obtain a sagittal view of the cervix. The mucosa of the endocervix (which may or may not be echogenic compared to the cervix) provides a good guide to the true position of the internal os and helps avoid confusion with the lower uterine segment.
The closed part of the cervix is ​​measured from the external os to the V-shaped notch of the internal os.
The cervix is ​​often curved and in these cases the length of the cervix, considered as a straight line between the internal and external os, is inevitably shorter than the measurement taken along the cervical canal. From a clinical point of view, the measurement method is not important, because when the cervix is ​​short, it is always straight.

Each study should be completed within 2-3 minutes. In about 1% of cases, the length of the cervix can change depending on the contractions of the uterus. In such cases, the lowest values ​​should be recorded. In addition, the length of the cervix in the II trimester may vary depending on the position of the fetus - closer to the bottom of the uterus or in the lower segment, in a transverse position.

You can evaluate the cervix and transabdominally (through the abdomen), but this is a visual assessment, not cervicometry. The length of the cervix with transabdominal and transvaginal access significantly differs by more than 0.5 cm, both up and down.

Interpretation of research results

If the length of the cervix is ​​more than 30 mm, then the risk of preterm birth is less than 1% and does not exceed the general population. Hospitalization is not indicated for such women, even in the presence of subjective clinical data: pain in the uterine region and minor changes in the cervix, abundant vaginal discharge.

• If a shortening of the cervix less than 15 mm in a singleton pregnancy or 25 mm in a multiple pregnancy is detected, urgent hospitalization and further management of the pregnancy in a hospital with the possibility of intensive care for newborns is indicated. The probability of delivery within 7 days in this case is 30%, and the probability of preterm birth before 32 weeks of pregnancy is 50%.

• Shortening of the cervix to 30-25 mm in a singleton pregnancy is an indication for consultation with an obstetrician-gynecologist and weekly ultrasound monitoring.

• If the length of the cervix is ​​less than 25 mm, the conclusion is made: “ECHO-signs of CI” in the 2nd trimester, or: “Considering the length of the closed part of the cervix, the risk of preterm birth is high” in the 3rd trimester, and it is recommended to consult an obstetrician gynecologist with the aim deciding whether to prescribe micronized progesterone, perform a cervical cerclage, or install an obstetric pessary.

A few words about the opening and shape of the internal os. When conducting an ultrasound of the cervix, you can find various forms of the internal os: T, U, V, Y - figurative, moreover, it changes in the same woman during pregnancy.
With ICI, along with shortening and softening of the cervix, it dilates, i.e. expansion of the cervical canal, opening and changing the shape of the internal pharynx is one process.
A large multicenter study conducted by FMF showed that the shape of the internal os, without shortening the cervix, does not increase the statistical likelihood of preterm birth.

Methods of treatment

The effectiveness of two methods of preventing preterm birth has been proven:

• Cervical cerclage (suturing the cervix) reduces the risk of delivery before the 34th week by about 25% in women with a history of preterm birth. There are two approaches in the treatment of patients with previous preterm births. The first is to cerclage all such women shortly after 11-13 weeks. The second is to measure the length of the cervix every two weeks from weeks 14 to 24, and suturing only if the length of the cervix becomes less than 25 mm. The overall preterm birth rate is similar for both approaches, but the second approach is preferred as it reduces the need for cerclage by about 50%.

• Prescribing Progesterone from 20 to 34 weeks reduces the risk of delivery before 34 weeks by about 25% in women with a history of preterm birth, and by 45% in women with an uncomplicated anamnesis, but a shortening of the cervix up to 15 mm is detected. Recently, a study was completed that showed that the only progesterone that can be used for a short cervix is ​​micronized vaginal progesterone at a dose of 200 mg per day.

• Currently, multicenter studies of the effectiveness of the use of a vaginal pessary are ongoing. A pessary, which is made of flexible silicone, is used to support the cervix and change its direction towards the sacrum. This reduces the load on the cervix due to pressure reduction. gestational sac. You can read more about the obstetric pessary, as well as the results of recent research in this area.

After suturing the cervix or with an obstetric pessary installed, ultrasound of the cervix is ​​impractical.

See you in two weeks!