The cervix is ​​less than 2 cm. Indications for cervicometry. risk group. long cervix

Attentive attitude to your health during pregnancy is the key to the successful bearing of the little one and his safe birth.

The course of pregnancy is assessed not only by the subjective complaints of the expectant mother, but also on the basis of the results of examinations and tests. An important role in bearing a child is played by the cervix, which precedes the direct entrance to the uterine cavity. The density and length of the cervix during pregnancy is an important diagnostic indicator that indicates the possible risks of preterm labor.

If the acute episode finally disappears, they will be followed in our practice until it is considered that the risk of prematurity has decreased significantly. Also, if you lose amniotic fluid through your genitals during pregnancy, you should go to the emergency room.

Effective measures to prevent the risk of preterm birth

In addition to the treatment and follow-up to be carried out in a high-risk consultation, it is important to follow a number of tips. Of all the lifestyle changes that are in your hand, this is fundamental. Physical rest. If there is a real risk of preterm labor, your doctor may advise you to rest. This is important for pregnancy and you shouldn't feel guilty about doing it. Reduce stress with relaxation techniques. Learn the possible signs of preterm labor.

• Smoking is associated with a two-fold risk of preterm birth.
• Follow the right diet.
• You must follow a balanced diet and avoid saturated fats.
• Take a good amount of food with calcium.

Pregnancy and the cervix

The cervix is ​​not just the vestibule of the uterus. This organ plays an important role both throughout the nine months of bearing the crumbs, and during childbirth. What is the uterine cervix? This is a muscular organ of a dense structure, the vaginal part of which is seen by the doctor during a gynecological examination with a mirror. Normally, the length of the cervix ranges from 3.5-4.5 cm. The part of the uterine cervix facing the vagina is called the external os. In women who have not given birth, it is closed. Already after the first birth, it can be slightly ajar and skip the tip of the finger. In the absence of any violations, the uterine cervix remains dense and long until the onset of labor, since its main task is to keep the baby in the uterus. Then it softens and smoothes out, and the pharynx opens from 2 cm to 10 cm during contractions. After that, when “the path is open”, the baby is born. After childbirth, the cervix returns to its original state. If dilatation occurs before 36-37 weeks, the consequences for the baby may not be very good.

Vaginal length: multivariate analysis. In a one-year prospective study, the aim was to conduct a multivariate analysis to find out which variables affect vaginal length. The patients consisted of three consultations, two from general gynecology and one from menopause. Vaginal length measurements were taken as part of the exploratory activity and before cervical cytology samples were taken. There were 524 nulligests, 131 virgins, 293 hysterectomized and 28 with uterine prolapse.

The median parity was 1.83. 55.5% of the women had some degree of obesity, and 1.51% had morbid obesity. The patients belonged to three different clinics, two from general gynecology and one from menopause. Measurement of vaginal length was performed as part of a routine examination before cervical and vaginal samples were taken. There were 524 nulligrades, 131 virgins, 293 women who had a previous hysterectomy, and 28 uterine prolapses. Some amount of obesity was found in 5% of the women, and 51% were morbidly obese.

Determining the condition and length of the cervix during pregnancy

Checking the condition of the cervix is ​​the key to a successful pregnancy. However, this does not mean that every visit to the gynecologist for 9 months a woman should be examined on a chair. There are two ways to determine the condition of the uterine cervix and its length:

For the first time, the word vagina is written in a Roman green joke, graphite on the wall. Latin vagina means scabbard, swords. It is the sheath of the penis during intercourse, the tube that connects the external genitalia to the uterus. It has great elasticity and great ability to stretch when giving birth.

The vagina is a folded hollow viscus, the anterior and posterior walls are in contact with each other2, and at rest are connected. The vagina is a musculo-membranous canal that connects the cervix and internal genital organs to the vulva3, the external genital organ. The vagina is tilted at a 120° angle by pre-pulling the lifts at the junction of the lower third and upper two thirds. The vagina tilts back more than half of its trajectory.

• Manual examination on a gynecological chair. At the same time, the doctor evaluates the length of the neck, its “consistency” - how soft the organ is, and also checks the condition of the external pharynx. If everything is in order, then the result of the examination should have the following content: data on the length of the cervix - more than 3.5 cm, the structure is dense, the external pharynx is closed (or skips the tip of the finger - for women who have already given birth).
• The second way to assess the condition of the uterine cervix is ​​to conduct an ultrasound using a transvaginal sensor. An ultrasound assessment of the length of the cervix during pregnancy is often more reliable, because. the doctor indicates the length of the neck to the nearest mm. When assessing the state of the length of the cervix before the 20th week of pregnancy, the data obtained should not become fundamental in the course of diagnosis (with the exception of critical indicators), since during this period the cervix is ​​variable. The assessment of the state should be comprehensive and combine the analysis of all factors. For a period of more than 20 weeks, it is possible to estimate the length of the cervix using a transabdominal sensor.

The average length of the vagina is 9 cm, the abdominal wall is 2.5 cm shorter than the dorsal wall. And it is wider at the highest part. In fact, sizes vary from one woman to another and during sexual activity3. However, due to its elasticity, even with penis size disproportion, there is a vaginal adaptation1.

With sexual arousal, there is lengthening and expansion of the upper two-thirds. There are sexual myths that have no scientific evidence5. Like the size of the penis in relation to the size of the nose, arms or legs. Tall men have large penis. Or women with big mouths, big vaginas. In fact, the vagina corresponds to the size of the penis that penetrates it. The human sexual anatomy is similar to that of other primates. The use of frontal copulation due to the adoption of an upright position explains the change that the relative location of the vagina must have taken place in the pelvis as a whole.

As a result of examination of the cervix (visual or using an ultrasound machine), the degree of its maturity is determined. Based on the length of the cervix during pregnancy, as well as other factors, there are 3 degrees of its maturity:

• If the final score ranges from 0 to 2 points, the uterine cervix is ​​immature.
• The result is in the range of 3 - 5 points - maturing (not mature enough) cervix.
• The total score is more than 6 - the cervix is ​​​​mature.

The scores are summarized based on the length, position, and smoothness (consistency) of the cervix.

In the case of the virgin woman, the system has changed. A vaginal cytology sample was taken with a toothpick topped with a cotton ball pulled to the bottom, without gloves, and then the sample was taken from the posterior wall of the vagina. The following data were collected before the examination and in the anamnesis: age, parity as gestation, childbirth and abortion; weight and height; lack of intercourse, hysterectomy and type.

For weight and height, the data were taken orally and accepted as valid when the woman knew them, having the latest measurements. When he did not know or was since the last measure, his decision was made. In consultation with Liria, the dry scale and the weight scale of Parr were used, as well as in the consultations of Bourjassot, the Atlantis altimeter scale.

Depending on the period at which signs of cervical maturity were first detected, as well as the degree of their severity, doctors make a forecast for the further course of pregnancy. It is important to remember that the shortening of the uterine cervix, regardless of the gestational age (up to the 37th week), is an alarm signal that necessarily requires additional attention and control. Ignoring this factor can lead to sad consequences - miscarriage in the early stages of bearing crumbs or premature birth, if we are talking about the third trimester of pregnancy.

On examination, cases of uterine prolapse or cystoreccocele could be observed. They also scored like a prolapse, but that's what we did with no. Being 2 consultations of general gynecology, where all kinds of diseases are present, women are also very diverse, although the series gives a specific profile, as we will see later. Cases of counseling for menopause are more homogeneous.

Other patient variables derived from diagnosis or random study results were also collected. Statistical exploration includes ranges, means, and standard deviation for quantitative data and percentages for qualitative data.

The length of the cervix during pregnancy by week: pregnancy forecast

Despite the peculiarities of the course of pregnancy and individual differences between women, doctors have identified the standards that the cervix must meet at different waiting times for the child. Most often, the measurement of the length of the cervix is ​​​​made after the 20th week of pregnancy, but according to indications, an examination can be carried out earlier. The data are systematized in the form of a table of the length of the cervix during pregnancy.

Based on these data, a first analysis of 577 cases was carried out, looking for groupings. The series consists of 577 cases. Figure 1 shows the distribution of frequencies by age. Pregnancy ranged from 0 to 17 years, with an average of 2, there were 524 shallow women, among whom were virgins, those who had not yet been born by age and were sterile. The ratio is between 0 and 11, with a mean of 1, in 5 cases they had twins; One of them, #641, had 2 twins. Abortion is between 0 and 9, with a median of 0.

Number of cases by age group. The hysterectomies practiced in the abdomen were: total double hysterectomy, adnexectomy, 140 cases; double subtotal hysterectomy, adnexectomy, 4 cases; simple hysterectomy, 96 cases; subtotal hysterectomy, 2 cases; and vaginal hysterectomy, 51 cases.

As can be seen from the table above, during the period:

• From the 10th to the 29th week - normally, the cervical length indicator is in the range of 30–45 mm.
• After the 29th week, the cervix gradually begins to shorten, which is a physiological norm. The length of the cervix at the 32nd week of pregnancy already fluctuates between 30-35 mm.

The most critical are the deviations identified for a period of 14-24 weeks. For a pregnancy of 27 weeks, the length of the neck, for example, 2.5 cm will be less dangerous. So what indicators of the length of the cervix during pregnancy can be a threat? If from the 14th to the 24th week the length of the uterine cervix is:

In 7 cases, women did not know about their pregnancy, which was diagnosed during transvaginal ultrasound. One case, no. 250, was a 21-year-old virgin and was 7 months pregnant. He said he didn't know, he thought he had an abdominal tumor. This was a surprise to her and to her mother, who accompanied her.

In 4 cases they were positive for human immunodeficiency virus. A case was presented for each of the following situations: a paraplegic woman, Down's syndrome, Turner's syndrome, anorexia nervosa, vulvar cancer, and a woman with serious consequences of a traffic accident.

• Less than 1 cm - the baby is most likely to be born before the 32nd week.
• 1-1.5 cm - there are chances to bring the baby to the 33rd week.
• 1.5-2 cm - the term of childbirth is postponed for another week. The chances of having a toddler at the 34th week increase.
• 2-2.5 cm - you have every chance to carry the pregnancy up to 36 weeks.

And this is the graph. Preliminary study of models. By observing the values, we conduct a regression study that will be obtained by eliminating those that do not have a value close to zero; note that their coefficients are close to zero; therefore, even if considered as integral variables of the model, they will be very little descriptive.

After exclusion from the model of a variable whose significance value is far from zero, and provided that the representativeness of the model has not changed significantly. In addition to these variables, it was necessary to exclude the size variable from the model, as it created a condition index significantly greater than 30.

Cervical length during twin pregnancy

The presence of two peanuts in the mother's womb is characterized by an increased load on the entire body of a woman. That is why the risk of early labor in this case occurs more often. What are the norms for the length of the neck during twin pregnancy and do these indicators differ from a singleton pregnancy? The standards are the same, regardless of the number of babies a woman is carrying.

The model as a whole is also expected to be significant. First, it must be emphasized that the variability of the data does not present a problem of interpretation of extreme values, and certainly does not present one with respect to maximum values. The model should be able to predict these cases.

Studying the adequacy of the model. Regression variance analysis. The data is divided into two groups: even and odd. Regression is calculated for each of the groups separately. Model summary. Contrast coefficients and statistics. Very less than the value of 0, 1. Analyzing the model from the receipt of waste, we find.

• If the cervix is ​​more than 3.5 cm long, it is considered to be long. This indicator gives reason to believe that childbirth will occur later than at the 34th week of pregnancy and without additional help (support).
• If the cervix is ​​less than 3.5 cm long, it is said to be short.
• If the neck is less than 2 cm long, this is an ICI.
• A neck length of 2.5 cm or less in the period from the 24th to the 28th week of waiting for babies is a dangerous signal.

Below we give the ratio of the length of the cervix at different stages of pregnancy with twins and the probability of the onset of labor in these periods.

Where there are no excessive differences between them, their means are zero and that their typical deviations are close to everything. This shows stability in the model as it indicates that the errors made in the prediction are small and similar.

Inflation dispersion coefficient. You can see that everything between 1 and 1. 4; whereas an indicator of collinearity problems would put these values ​​higher. Research has been done on the possible presence of an interaction between two or two variables. With regard to the explanatory variables included in the proposed model, it is interesting to comment on the following.

Normal cervical length during pregnancy and on the eve of childbirth

How should the cervix “behave” in the process of bearing a toddler, we figured it out, but what happens to this organ on the eve of childbirth? 1-2 weeks before the birth of a child, the cervix rapidly matures. It becomes soft, its length is reduced to 1 cm, the internal pharynx begins to open. This means that the beginning of the birth process is very soon. However, there is another, opposite, problem. In some cases, the PDR is getting closer, and the body is not physiologically ready for the birth of a baby. One of the indirect factors indicating the biological unpreparedness of the body is the preservation of the length of the cervix more than 3 cm at the term of full-term pregnancy (after the 37th week). If at the same time a closed pharynx and a dense muscular structure of the organ are noted, we are talking about the immaturity of the uterine cervix. Most often, this pathology is caused by hormonal disorders. If the gestational age is 40-41 weeks, and the cervix is ​​still not ready, it is prepared by medication. A woman is given prostaglandins. In cases where the body does not respond to such an intervention, a caesarean section is performed.

There are variables in the model with very low correlation values ​​with the dependent variable. But while these results may make these variables underestimated in the proposed model, it has already been seen that the results of the proposed model support the opposite.

On the other hand, as stated above, the size variable was also excluded from the model after analyzing its collinearity with the rest of the variables and checking that its condition index is close to 80. Masters and Johnson6 in Human Sexual Response said that the unstimulated vagina is a virtual space, rather than real, the walls are in contact, except for menstruation. Vaginal collapse is not a measure of vaginal expansive potential. With excitement comes expansion.

Early shortening of the cervix: isthmic-cervical insufficiency

Premature shortening of the uterine cervix, as well as its smoothing (softening) or opening of the internal os, are unpleasant symptoms that can pose a danger to the normal course of pregnancy. If these symptoms appeared before the 37th week (the period when the pregnancy is considered full-term), we are talking about ICI - isthmic-cervical insufficiency.

The vagina is more dilated with more anterior dilation. Obstetric injured vaginas present placement problems, loss of muscle tone, instead of supporting and compressing the penis, they only surround it. With a large vagina and a small penis, there is housing. With a small vagina and a large penis, pain occurs. Prolonged abstinence and menopause behave in the same way as in the latter case. In any case, the size of the penis plays a minimal role in the sexual stimulation of women.

Correlating all the data, they draw the following conclusions: there is less vaginal atrophy in a sexually active woman. The sexually inactive woman had an overweight of 8 kg, which is significant in relation to the active one. The importance of androgens lies in reducing atrophy and maintaining sexual interest. The interaction maintains vaginal elasticity. Sexual abstinence causes progressive vaginal atrophy. It's "use it or lose it". Masturbation helps maintain vaginal transudability and elasticity.

Causes of ICI

Based on all the factors affecting the earlier shortening of the neck, isthmic-cervical insufficiency can be divided into 2 types:

• Congenital. In this case, there are deviations in the development of the genital organs. Most often, pathologies in this group are corrected surgically.
• Acquired. Unfortunately, some gynecological manipulations do not go unnoticed. As a result, the cervix is ​​injured (during instrumental abortions, childbirth or operations), there may be unsewn tears. In addition, hormonal disorders (especially elevated levels of male hormones) also affect the appearance of CI.

Factors that increase the risk of developing CI include:

• Large fruit.
• Insufficient production of progesterone.
• Polyhydramnios.
• Pregnancy with more than one baby.
• Difficult childbirth, frequent abortions and miscarriages in history.
• Previous invasive therapies (eg, cervical conization).
• Connective tissue dysplasia.
• Psycho-emotional factors - fears, stresses.

The presence of these factors is not a "guarantee" of the formation of pathology, but requires a more careful attitude of a woman to her health during the bearing of crumbs.

Maintenance of pregnancy in ICI

A woman must understand that it is impossible to get rid of the ICI, so to speak, to be cured, while carrying the crumbs. The main task is to bring the baby to the safest time for his birth. The main requirement for premature shortening of the uterine cervix is ​​maximum rest (including sexual rest until childbirth). In addition, wearing a bandage will not be superfluous. These actions will not replace corrective actions, but will help to simplify the situation. The doctor will analyze the causes of such a pathological condition as isthmic-cervical insufficiency and prescribe appropriate therapy. It could be:

• If the pathology manifests itself in a mild form, a pregnant woman can be prescribed conservative treatment. The action of the drugs is aimed at normalizing the condition of the uterus, as well as its cervix. During therapy, both tablet medicines and injections (for drip administration) are used.
• If hormonal disorders have become the cause of ICI, the appropriate correction with hormones is designed to restore the physiological state of the organs of the reproductive system (uterus and its cervix). The problem of premature shortening of the uterine cervix often occurs when the balance of male hormones is disturbed. It is on the elimination of this kind of deviation that therapy is most often directed in the first place.
• If drug treatment fails or there is mechanical damage to the uterine cervix, more cardinal therapy is required - the application of an obstetric pessary (a special ring made of plastic or silicone that will keep the cervix from possible opening) or suturing the cervix. If the installation of the ring is a relatively painless (tolerable) procedure, then suturing the uterus occurs under anesthesia. Artificially created barriers help to carry the pregnancy to the due date. They are removed most often at the 38th week, when both the baby and the mother are physiologically ready to meet each other. When applying a pessary ring or sutures, a woman is additionally prescribed therapy for the rehabilitation of the genital organs.

In the event of a threat to the course of pregnancy, the following will also not be superfluous:

• Reception of sedatives on a natural basis (tincture of valerian, motherwort).
• If the doctor deems it necessary, antispasmodics (No-Shpa, Papaverine) may be prescribed.

The cervix is ​​​​an organ that connects the uterine cavity with the vagina and performs certain functions. The normal length of the cervix during pregnancy should be at least 3 cm. It is on this reproductive organ that the main task is assigned: it must hold the fetus in the uterus.

Women who have been diagnosed with a short neck are at risk during pregnancy. There is a high chance that they will not be able to carry a child. In addition, the whole process of giving birth to a child depends on her condition.

Very rarely there are cases when the cervix is ​​short - this is an individual anatomical feature of the female body. In most cases, it is shortened due to a variety of deliberately inflicted damage. Abortions and other gynecological interventions cause this sexual organ to expand and shorten. In addition, scarring occurs, deforming it. They also cause shortening.

If the cervix is ​​medium in size or long, then this does not pose any threat to pregnancy.

Therefore, before you start planning a pregnancy, you need to consult a gynecologist. He will examine and identify the presence or absence of this pathology. You also need to regularly visit a antenatal clinic during pregnancy in order to diagnose the appearance of various ailments in time.

Normal size of the cervix

The cervix is ​​a tight ring of muscles that sits at the end of the uterus and connects it to the vagina. It consists of the cervical canal, internal and external os.

After the conception of a child, changes begin to occur in the length of the neck, its consistency and the degree of opening of the pharynx. There is also an increase in the blood flow of this organ, and the neck acquires a cyanotic (cyanotic) hue. Thus, the manifestation of fullness occurs. Significantly increase the size of the endocervical epithelium, producing thick mucus. Its main function is to prevent the occurrence of pathogenic microflora.

Changes in estrogen levels during pregnancy greatly affect the condition of the epithelium. It is these female hormones that affect the formation of hypertrophy of the muscular layer of the uterus. This helps to increase the volume and length of the neck. As a result of this process, the endocervical epithelium turns into the vaginal cavity. An everted cervix during pregnancy is an ectopia, which is one of the variants of the norm.

Throughout the entire period of pregnancy, careful monitoring of the length of the neck by the attending physician is carried out. He periodically measures this indicator using ultrasound. Thus, timely diagnosis of pathology is ensured and the threat of miscarriage is prevented.

In the early stages of pregnancy, this organ of the female body is characterized by density and inelasticity. From 12 to 37 weeks, the length of the neck should be 3.5 - 4.5 cm. Only with the advent of 38 weeks of pregnancy does the process begin. And immediately before childbirth, its size decreases to 10-15 mm. At this time, it is already located in the center of the small pelvis.

This is due to the fact that the woman's body begins to prepare for the upcoming birth. If this process is absent, labor is stimulated or surgery is used for delivery. There are cases of premature, occurring at a very early date. In this case, it becomes necessary to install a pessary.

In this case, the closed state of the cervical canal, which prevents the penetration of various infections to the fetus, is considered the norm. Throughout the entire period of pregnancy, the length of the cervix should be maintained within 40 mm, as well. Only in women who give birth again, some deviations in the density and length of this organ by week are allowed.

Mucus Plug Functions

The mucous plug that clogs the cervix performs a protective function. It prevents infections from entering the fetus from the outside. Its formation ends by the end of 1 month. The course of this process is influenced by hormones, which, after entering the uterine cavity, cause swelling and filling of the cervical mucus of the uterine cervix. With an increase in the duration of pregnancy, the density of the mucous plug also increases.

Immediately before the onset of labor or some time before, under the influence of estrogen, the density of the cork decreases, it softens and is removed from the body. Regardless of color and size, its departure indicates the onset of an early delivery.

Cervical length according to weeks of pregnancy

The length of the cervix is ​​measured in millimeters. Some minor fluctuations in its indicators are allowed. For the 1st trimester (10-12 weeks of pregnancy), the size of its length is normally 35-36 mm. For the second trimester, the neck is considered the norm, the size of which is 38 - 39 mm. In the third trimester, this figure increases to 39 - 41 mm.

But at the end of pregnancy, after 29 weeks, there is a gradual reduction in the size of this organ. This is due to the beginning of the preparation of the female body for childbirth.

When the 37th week comes, the pregnancy is already considered full-term. In this regard, significant structural changes occur with the cervix. It shortens, smoothes and softens. In some cases, this process lasts about 2 weeks, and sometimes everything happens 2 days before the baby appears.

In addition, the uterus is placed in a central position and gradually or rapidly begins to open. It depends on the individual characteristics of the organism of each pregnant woman. Someone can walk with an opening of 2 fingers for several weeks without waiting for the onset of labor, while for someone it takes just a few minutes.

Labor activity is characterized by the presence of pains of a cramping type that occur at certain time intervals, and not by the maturation of the cervix. During childbirth, it opens by 10 - 12 cm. After the birth of a child, it shrinks to its original size.

The threat of abortion and its causes

To exclude the threat of miscarriage, gynecologists examine the parameters of the length and condition of the cervix during examinations and ultrasound examinations. Usually this pathology occurs at 18-20 weeks of gestation and is called isthmic-cervical insufficiency. To eliminate it, urgent intervention of doctors is necessary. The essence of this condition lies in the fact that an imperceptible shortening of the cervix occurs, which provokes the lowering of the fetus in the direction of the birth canal. To prevent a late miscarriage, you need to prevent the opening.

When diagnosing isthmic-cervical insufficiency, the pregnant woman is urgently hospitalized. In the hospital, appropriate therapy is carried out, which relaxes the smooth muscles of the uterus. If injections and droppers are not enough, sutures are placed on the cervix, a cerclage or a silicone pessary is installed. These surgical techniques prevent premature dilatation of the uterus. There is also hormone therapy.

Throughout pregnancy, a woman will have more than one trip to the gynecologist. During this period, a lot of inspections, measurements, analyzes and surveys are carried out. At each trip to the antenatal clinic, the doctor will without fail make examination of the cervix, which is already undergoing changes from the first weeks of pregnancy. Not only whether the baby will be born on time, but also how the birth process itself will go, largely depends on her condition.

it tubular muscle that connects the vagina to the uterus. Inside the organ there is a cervical canal: menstrual secretions are brought out through it, and spermatozoa move through it after intercourse.

In turn, the cervical canal is connected to the uterine cavity by the internal os, and to the vagina by the external os. With no developing life inside a woman the cervix has an average length of 3.5 cm. The color of its outer part is pale pink, and inside it is bright pink with a loose texture.

What should be the cervix during pregnancy? When a few days have passed after the fertilization of the egg, the cervix changes shape and size.

• Her color goes from pale pink to bluish.. This is due to the fact that the load on the organ increases sharply, as a result of which blood circulation in this area increases, and the circulatory network grows.
• With the onset of pregnancy, the body becomes much softer to the touch, while in its normal state it is always solid.
• Under the influence of the hormone, the amount of which increases from the moment of conception, the cervix drops below the usual level. Then rises with every week of pregnancy.
• The shape of the cervix takes on a conical shape., while in a non-pregnant woman, the organ is a cylindrical shape.

The size of the cervix during pregnancy by week: the norm

The need for cervical control

The condition of the cervix is ​​of great importance to determine whether the pregnancy is developing correctly. Gynecologists pay special attention to her condition after: it is from this moment that the active growth of the child in the womb begins, which means that the cervix is ​​under serious stress.

During pregnancy, almost throughout its entire length, the cervix should remain tight, and the entrance to the uterus should be tightly closed with a mucous plug: this helps to avoid the penetration of infections to the fetus.

A key indicator of the condition of the cervix is ​​its length. It depends on whether she copes with her main task - keeping the fetus in the uterus. It is very important to identify a possible pathology in time in order to preserve the pregnancy and the health of the child.

It is assumed that the length of the cervix corresponds to the following values:

• 16-22 weeks - 4-4.5 cm;

• 24-30 weeks - 35-40 mm;

• 32-38 weeks - 30-35 mm.

How is the length of the cervix measured?

If the appearance of the cervix is ​​assessed by the gynecologist visually by examination in the chair, then length measurement can be done using ultrasound. Just in the 2nd trimester, e passes, which will show what the length is at the moment.

If there is a suspicion that the cervix is ​​short for the current gestational age, the doctor will perform the procedure transvaginally. This is the most accurate way to determine the length.

If a short cervix during pregnancy

If a shortened cervix was found in a woman during pregnancy, then this indicates a high risk of premature birth. Among the reasons for this pathology, we note:

• existing diseases of the genital organs with inflammatory processes;
• hormonal disruptions;
• transferred infectious diseases.

From the moment when a pathology is detected in a woman (the length of the neck does not exceed 25 mm), she needs constant medical supervision. In most cases, it is necessary to be predominantly in a horizontal position, and even hospital treatment is recommended.

To eliminate the risk of premature birth, the patient is prescribed hormonal therapy course. In especially severe cases, an obstetric pessary can be installed, which will support the pregnancy until the end of the term.

Long cervix during pregnancy

An increase in the normal values ​​​​of the length of the cervix is ​​\u200b\u200b in such cases:

• psychological factor (fear of childbirth);
• consequences of surgery before pregnancy;
• non-standard anatomy of the genital organs.

It does not affect the development of pregnancy and the fetus. However in the birth itself, this can cause certain difficulties, since the neck may simply not open. In such cases, a caesarean section is performed. In order to avoid this, a competent doctor, who properly monitors the condition of the woman throughout the pregnancy, will prescribe a special therapy shortly before the birth, which will soften the cervix.

In the period after the cervix prepares for childbirth. Its length becomes smaller by 1-1.5 cm and softer, and also tends to take a central position relative to the pelvis.

For each woman, the process takes place on an individual basis: for someone, such preparation for the process of having a baby takes weeks, and for someone, everything can happen in a matter of days or even hours before giving birth.

Video about checking the length of the cervix

At the end of the article, we suggest watching a short video clip, where the gynecologist will talk about the need to control the length of the cervix throughout the interesting position and about what can provoke premature birth.

The most important female organ during pregnancy is the uterus, in which the fetus grows. At the same time, during gynecological examinations, close attention is paid to her neck, which holds the fetus and, being tightly closed until the end of the term, prevents the penetration of infections. But sometimes the cervix during pregnancy, for various reasons, does not perform its functions, and in such cases there is a threat of miscarriage.

During pregnancy, the cervix holds the fetus and prevents the penetration of infections.

The cervix is ​​a kind of tube connecting the uterus and vagina, with a diameter of about 2.5 centimeters and a length of 3-4 cm. Its lower section is the vaginal part, the upper one is supravaginal. Inside the neck is the cervical canal; outside it is normally pink and smooth, inside - loose, velvety to the touch.

During pregnancy, the cervix changes. The criteria for its normal state, determined at , are as follows:

• dense to the touch;
• bluish tint due to proliferation of blood vessels;
• increased in length and volume compared to the state before pregnancy;
• slightly deviated relative to the pelvic axis;
• with overgrown epithelium producing thick mucus;
• closed, the finger does not pass into the canal.

The doctor can determine the threat of miscarriage by the loose structure and open cervical canal. If there are suspicions of deviations from the norm, the doctor will prescribe an ultrasound, which determines the structure and condition of the cervical canal.

Length per week

One of the main criteria that the doctor pays attention to during the patient's pregnancy is the length of the cervix. If it is less than the values ​​\u200b\u200bnecessary to hold the fetus until childbirth, there is a risk of miscarriage. The shortening of the neck can be detected in two ways:

1. During a gynecological examination.
2. When conducting a vaginal ultrasound, which is recommended to be done in several positions - standing, lying down, coughing.

At the same time, before pregnancy, it is possible to estimate the length of the cervix only if it decreases as a result of injuries and is accompanied by gross, visible anatomical disorders. reasons, along which the cervix can be shortened, several:

1. Congenital anatomical changes, deficiency of connective fibers, which is rare.
2. Hormonal changes, especially characteristic for a period of 15-28 weeks, when the adrenal glands are activated in the fetus, synthesizing androgens.
3. Consequences of injuries of the muscle ring, operations, abortions, difficult births (for example, with a large fetus or in breech presentation). In damaged areas, scars form during healing, which disrupt the ability of muscles to contract and stretch.

Normally, the length should change as the fetus grows and shorten before childbirth. Dimensions (in millimeters) and other criteria considered normal are shown in the table (in mm).

If an ultrasound scan reveals a shortened cervix in combination with an expansion of the pharynx, the diagnosis is " isthmic-cervical insufficiency". However, it should be borne in mind that during the first pregnancy it is very difficult to catch a shortening in the early stages (up to twenty weeks), therefore, an additional examination with a vaginal ultrasound is usually prescribed for a period of 20-22 weeks.

Short cervix: what to do

First of all, a short neck is a reason for constant monitoring, so the number of visits to the gynecologist in women with this pathology is much greater.

According to statistics, it is this pathology that becomes the most common cause of miscarriages that occur in the 2nd trimester, and with habitual interruptions, it is found in about 20% of cases.

The degree of development of isthmic-cervical insufficiency and, accordingly, the threat to the bearing of the fetus is determined by the sum of various criteria.

The scores obtained from the survey results are summarized. If their sum is 5 or more, a correction is shown.

The patient may be prescribed the following treatments:

• Tocolytic therapy.

Drug treatment aimed at reducing the tone of the uterus and relaxing the muscles. To achieve this goal, the following drugs can be prescribed:

1. Droppers with magnesium sulfate.
2. Magne B6 up to six times a day.
3. Beta-agonists, for example, Partusisten.

• hormone therapy.

Functional shortening of the uterus can occur with changes in the hormonal background, primarily with an increase in the level of androgens and a lack of progesterone. The following drugs may be prescribed:

1. Progesterone up to 25 mg per day.
2. Utrozhestan orally or intravaginally twice a day until 27 weeks.
3. Dufaston tablet up to 3 times a day.

Important conditions for hormone therapy are constant monitoring of the level of hormones in the blood and the gradual withdrawal of drugs, since a sharp cessation of their intake can provoke a miscarriage.

The suture is applied at the point where the anterior fornix of the vagina passes into the cervix. This operation can be performed in several ways:

1. The external os is sutured (posterior and anterior lips of the neck). The disadvantage of the method is that the sutured cervix creates conditions for the development of infections in a confined space.
2. The narrowing of the internal pharynx by applying a circular seam. In this case, a drainage hole remains, so this method is considered more favorable.

The operation is considered simple, but it is carried out only in a hospital. The optimal time for the operation is 14-20 weeks, but in any case not later than 27 weeks, since later, with a noticeable growth of the fetus, there is a high risk of postoperative complications. Anesthesia, as a rule, is administered epidurally and does not harm the health of the fetus. Stitches from the closed neck are usually removed at 37 weeks to prepare for childbirth.

• Placement of a pessary.

A pessary is a silicone or plastic ring that is placed to unload the cervix and ease the pressure on it from the uterus. There are several types of obstetric pessaries; the choice is made depending on the number of births, the diameter of the cervix and the size of the upper part of the vagina.

Installation of the ring is usually painless: the doctor lubricates it with silicone, inserts it into the vagina and places it on the uterus. The optimal time for the procedure is after 20 weeks, and the pessary is removed at 37-38 weeks. When the ring is displaced, inflammation can develop, so testing is scheduled every two weeks to prevent complications.

How does an obstetric pessary work?

Maturity indicators

At about 37 weeks, the cervix begins to change and prepare for childbirth. These changes are manifested by shortening, softening and smoothing, as well as the fact that the neck moves into a central position and begins to open. In gynecology, the term "degree of maturity" is used, which refers to the level of readiness for childbirth. The degree of maturity is expressed in points, which are determined according to the following criteria:

The points obtained are summed up and the result is evaluated:

1. Up to 3 points - the neck is immature.
2. 4-6 points - the neck is ripening, not mature enough.
3. 7-10 points - maturity.

If after 37 weeks the cervix does not become mature, it is a pathology opposite to isthmic-cervical insufficiency. It also requires correction, and in some cases, the choice of caesarean section as a method of delivery.

If, during early pregnancy, the doctor suspects a shortening of the uterus, a sparing regimen is recommended, which involves the rejection of physical exertion, heavy lifting, and caution during sexual intercourse. At the same time, doctors advise avoiding strict bed rest, since it does not contribute to the preservation of pregnancy, but can lead to the formation of blood clots.

Sources:

1. Baskakov P. N., Torsuev A. N., Tarkhan M. O., Tatarinov L. A. Correction of isthmic-cervical insufficiency with an obstetric unloading pessary // Protection of motherhood and childhood. - 2013. - No. 1
2. Obstetrics - National Guidelines. Ed. E.K. Ailamazyan, V.I. Kulakova, V.E. Radzinsky, G.M. Savelyeva. Moscow, 2009.

The cervix is ​​the entrance directly into the body of the uterus. During pregnancy, the cervix changes its shape. Depending on how this process will take place, the likelihood of premature birth or post-term pregnancy decreases or increases. Usually, this small organ is closed and blocked by a mucous plug that comes out shortly before or during labor. The cervix consists of the cervical canal, which connects the body of the uterus and the vagina, as well as the internal and external os.

Around the 24th week of pregnancy, it is very important to determine how long the cervix is. This is an excellent indicator (gynecologists believe that it is generally the best) for diagnosing the risk of preterm birth. The length is most accurately measured using transvaginal ultrasound, which is rarely prescribed for women at this time. But if the doctor saw during the examination that the cervix is ​​short, then for reliability it is worth making an ultrasound with a transvaginal sensor.

Studies show that the average length of the cervix at 24 weeks is 3.5 cm. When the indicator is less than 2.2 cm, the risk of preterm birth reaches 20%. Another practical study proves that with a cervical length of less than 1.5 cm, preterm delivery occurs in 50% of cases.

It is worth knowing that as the expected date of birth approaches, the cervix will naturally shorten. You can find approximate data by week from the table below.

A planned ultrasound in the second trimester suggests that it will be carried out in a transabdominal way (the sensor will be driven along the woman's stomach). Ask a specialist to calculate the length of the cervix. If the indicator is below 4 cm, it is worth doing a transvaginal ultrasound to measure it more accurately.

If the indicator is at this limit of the norm, but at the same time you observe some in yourself, ask the gynecologist to refer you to an ultrasound again. The clinical picture in this case will be quite accurate in order to determine the risks and prescribe treatment if necessary.

A short cervix between 14 and 24 weeks is the main indicator of early labor:

• Length less than 1 cm - children are usually born on.
• The length is less than 1.5 cm - the average gestational age of the newborn is .
• Less than 2cm - .
• Less than 2.5 - 36.5 weeks.

(Research Source: American Journal of Obstetrics and Gynecology, 2000)

Cervix before childbirth

7-14 days before delivery, the cervix begins to mature rapidly. At the same time, its length is shortened to 1 cm. The gynecologist, after examination on the chair, indicates that the internal pharynx has already begun to open. This means that the beginning of the birth process is already close ().

What causes premature shortening of the cervix?

• Individual characteristics of a woman.
• Inflammation of the pelvic organs.
• Infections.
• Complications caused.

What to do?

If the doctor diagnoses a rapid shortening of the cervix, urgent action must be taken. Depending on the situation, the gynecologist will suggest drug therapy, cervical cerclage (a suture is applied that will prevent the development of premature labor), the use of a silicone pessary or hormone therapy.

The length of the cervix is ​​a very important indicator. In the early stages, its shortening indicates possible complications. But even when the cervix retains its original length and structure immediately before childbirth, this is also not good. Everything has its time. This statement is especially relevant for characterizing the process of bearing and giving birth to a child.

A couple of days ago, the gynecologist told me that I have a short cervix. Since then, I have been afraid. I found an article by a well-deserved obstetrician-gynecologist, she says that there are times when a pessary is placed for no reason due to illiteracy. Below are some of her quotes.

Reminder:

In the hospital, women can be observed whose cervical length is less than 1.5-2 cm. A length of up to 2.5 cm is considered the norm.

Question: 2 0 weeks pregnant and bad cervix. 38mm open. Tests for torch infection are negative. A smear on a ureaplasma and a mycoplasma is good. The level of leukocytes is slightly increased (in connection with this I drink an antibiotic). The ring is not put, again, because of the increased level of leukocytes. There are no more symptoms of the inflammatory process in the body. What could be the reasons (of the above)? And how to be?

Answer:It is necessary to clarify whether you mixed up anything, like your doctors too. Perhaps 38 mm is the length, not the diameter. You need to clarify the following:

1. What is the length of the cervix according to ultrasound
2. What is the condition of the INTERNAL pharynx.

Rings, like pessaries, do not preserve pregnancy, so they are not used in obstetrics. Also, the suture on the cervix is ​​placed depending on the length of the cervix. With such an opening, they usually do not bet. Leukocytes in secretions during pregnancy are the norm. After clarifying the questions, if you have a really short and open cervix, you should be in the hospital. Bed rest does not preserve such pregnancies, so it is useless to lie constantly. Various drugs are not shown to you, since tocolytic therapy at this time and with an open cervix is ​​​​also contraindicated. It remains only to wait.

Question: They pose a threat of pregnancy, a period of 24 weeks. No ICI, but recently treated for infections. From 12 weeks, doctors say that I have a short cervix (at 12 weeks it was 28 mm), at 20 weeks they performed an intravaginal examination - 23 mm and opening of the internal os 3.8 mm. Since 20 weeks I have been drinking Utrozhestan 200 in the morning and 200 in the evening. In my city of Ilyichevsk, doctors insist on putting a pessary, but Odessa ones are against it. Whom to listen to? What should be done in such a situation? How to increase the chances of maintaining a pregnancy?

Answer: If this is the first pregnancy, it is very often difficult to catch the moment of shortening of the cervix for up to 20 weeks, because usually the second ultrasound is performed at 19-20 weeks. Risk factors for the occurrence of isthmic-cervical insufficiency are taken into account. 28 mm is considered the norm, so additional cervical control was not prescribed. 23 mm and the expansion of the internal os suggests that there is a 50% chance of giving birth within 2 weeks. Tocolytic therapy is not prescribed, especially since there is no labor activity. Utrozhestan in the form of tablet preparations is NOT effective in this case (and this has been proven). Some doctors recommend vaginal progesterone suppositories from 24 to 32 weeks of pregnancy, but most still do not prescribe, because the effectiveness of such therapy is very low. A pessary is not recommended, since this is a foreign body, it has no effectiveness, on the contrary, it can speed up childbirth. Bed rest also does not save such pregnancies. So, the only possible option might be to use progesterone vaginally, rather than in the form of tablets by mouth.

Question: On a planned ultrasound scan at 32 weeks, a short cervix of 1.5 cm was established. Prior to that, she led a normal life: hiking, aqua aerobics, light exercises in the morning, pleasant household chores. I felt and feel fine. After the ultrasound, she was admitted to the hospital for a week to observe, CTG was performed, her stomach was examined, no drugs were prescribed. After a week of hospitalization, from 32 to 33 weeks, she was discharged with a recommendation of the most relaxed regimen: to lie down, not to be nervous, not to lift weights, saying that so far there were no indications for hospitalization. You just need to take care of yourself. At discharge, the length of the cervix was 1.36 cm. The LCD also made similar recommendations. Now I am at the beginning of 36 weeks, since 33 weeks I have not been examined either in the gynecologist's office or for ultrasound. Do I need to sign up for an intermediate ultrasound on my own or visit an additional gynecologist and insist on an examination in order to understand the situation? Or is extra intervention not very desirable? What actions should I take and behave in this situation? Planned inspection in the LCD at the end of next week. Daily routine: I lie a lot, I walk a little, I do light housework.

Answer: This is an extremely correct, progressive approach in the management of a woman with a short cervix, especially at this time. Bed rest does not preserve these pregnancies and is therefore not recommended, although limitation of physical activity and exercise is necessary. On the contrary, bed rest significantly increases the risk of thrombosis and thromboembolism, and this is worse than premature birth. There is not much left before delivery, so ultrasound at 36 weeks to clarify the length of the cervix is ​​no longer so important. A short cervix means that a woman has a 50% risk of having a birth within the next two weeks. You have passed this milestone, i.e. you fell into the other 50% and didn't give birth prematurely. Therefore, calmly endure pregnancy. Your baby is almost 98% born alive and healthy. Above this percentage practically will not rise. So, everything is fine.

Question: Pregnancy 23-24 weeks. Three weeks ago, they put a ring (pessary), because. the cervix was 29 mm. Now I put candles "Utrozhestan" 200 mg 2p / day up to 30 weeks.
Is it necessary to control the ring and do they look at the neck? And was the ring placed correctly at all?

Answer: Your doctors are sabotaging. The real wrecking. You have a NORMAL length of the cervix, so the pessary is NOT shown to you, just as Utrozhestan is NOT shown.