Cicatricial deformity of the cervix treatment. Cicatricial deformity of the cervix: causes and treatment. The cervix after childbirth. What it is

Cicatricial deformity of the cervix is a dangerous pathology. In modern medical practice, such a disease is diagnosed relatively rarely. The deformation covers the cervical and vaginal canals: the structure changes and, as a result, the organs of the reproductive system are displaced. Against the background of pathology, the risk of developing malignant diseases increases, so in no case should you ignore the problem.

How does cicatricial deformity of the cervix develop?

The so-called cervical canal passes through the cervix. Its walls are covered with a cylindrical epithelium. It is here that specific mucous secretions are produced, a plug is formed that protects the uterine cavity from the penetration of pathogenic microorganisms.

Sometimes, as a result of injuries and inflammatory processes, damage to the tissues of the genital organs occurs, followed by scarring. The structure and length of the cervix changes, and the cervical canal turns out and shifts into the vaginal cavity. As you know, the environment here is acidic, and an alkaline reaction is necessary for the normal functioning of the endocervix.

Changes in the acidity of the environment provoke the development of inflammatory processes, as a result of which the nutrition of the epithelial cells of the cervical canal is disturbed. The chemical composition of the mucus produced is disrupted, making tissues more susceptible to infection.

The main causes of pathology

If large children are born, then this is very good. At least that's what people think. But doctors do not agree with this. The birth of a child weighing more than 3.5 kg is already considered potentially dangerous, because in such cases the likelihood of injury is high. Tears and other damage to the tissues of the internal genital organs require suturing.

Quite often, the cervix after childbirth is not fully restored, scars form on it. Scar tissue is different from healthy structures - it is rough and inelastic. A large number of scar formations deform the neck, which is fraught with dangerous consequences.

Risk factors include not only difficult births. Scarring is possible after abortions and diagnostic procedures if the tissues of the cervix were damaged in the process. In some cases, deformities are congenital. Serious hormonal disruptions can also be attributed to the list of reasons.

What are the symptoms to look out for?

Cicatricial deformity of the cervix often occurs without any symptoms. In most cases, the pathology is accidentally discovered during a routine gynecological examination. Nevertheless, the appearance of some violations is still possible. Their signs include:

Menstrual irregularities.
An increase in the volume of menstrual flow, sometimes up to bleeding.
The appearance of thick, stretching white vaginal discharge.
Aching pains in the lower back and pelvic region (sometimes they become quite intense).
Some patients report pain during intercourse.

These symptoms cannot be called specific, because the same clinical picture can be observed in various diseases of the pelvic organs. However, in the presence of violations, you should consult a doctor.

Possible Complications

Changing the acidity of the environment increases the susceptibility of the tissues of the internal genital organs to infections. Cicatricial deformity of the cervix increases the likelihood of developing endometritis, cervicitis and endocervicitis.

In turn, these inflammatory diseases can lead to keratinization and atrophy of the epithelial tissues of the endocervix. Against the background of such a pathology, the presence of deformations often develops negatively affects the reproductive functions of the body. Violation of tissue trophism leads to improper development of cells - there is a possibility of malignant degeneration and the development of cancer.

Effective diagnostic methods

Diagnosis of such a pathology is rarely associated with difficulties. Cicatricial deformity of the cervix is detected during an examination with the help of a doctor. The doctor may notice a displacement of the cervical canal, inversion of the mucous membranes, and the presence of scar formations.

Additionally, a colposcopy is prescribed. During the procedure, the gynecologist can assess the degree of change in the folds of the cervical canal. As a rule, a biopsy is performed - taking tissue samples for further laboratory analysis. The study makes it possible to detect cancer cells. Additionally, smears are taken to determine the composition of the bacterial microflora.

In some cases, an ultrasound examination of the pelvic organs is performed. With congenital deformities, patients are tested to determine the level of hormones.

Treatment of cicatricial deformity of the cervix

The treatment regimen is compiled individually, because it is necessary to take into account the patient's age, her hormonal status, the amount of scar tissue, the presence of concomitant diseases. The goal of treatment is to restore the structure of the uterus, normalize the reproductive and protective functions of the reproductive system.

Drug therapy is advisable only if the disease is associated with hormonal disruptions or inflammatory processes.

Next, the doctor decides on the method of tissue. If the lesions are small, then sparing destructive methods are used. Scars are removed by cryodestruction (freezing with liquid nitrogen) and diathermocoagulation (high-frequency currents are applied to the affected tissues). A beam is also considered effective.

Surgical intervention: features of the procedure

In some cases, full surgical intervention is necessary. If the patient is a woman beyond her reproductive age, the doctor may recommend a trachelectomy. During the procedure, the cervix is completely excised, and the uterus itself is sutured to prevent it from descending into the vagina.

Young patients are prescribed an operation, during which only scar tissue is removed. Excision with a laser beam is considered safer, since the risk of complications (infection, the appearance of new scars) in this case is much lower.

When removing a large number of affected tissues, patients need another operation - cervical plastic surgery. The procedure is aimed at restoring the normal shape of the organs.

Scar deformity and pregnancy

What to do if the cervix was deformed after childbirth? The presence of changes in the structure of the genital organs does not mean that a woman cannot conceive. But on subsequent pregnancy, cicatricial deformity of the cervix affects negatively, as the likelihood of spontaneous interruption increases. In addition, there is a risk of infection of the fetus, since pathogenic microorganisms against the background of this pathology easily penetrate from the vagina into the uterine cavity.

However, pregnancy is possible. The decision on the need for treatment in this case is made by the doctor. Expectant mothers are also advised to carefully monitor their health, eat right, avoid physical exertion, adhere to personal hygiene rules and refrain from sexual intercourse.

Often, women with cicatricial deformities even give birth naturally, although they sometimes need a caesarean section.

Deformation of the cervix - a change in the natural state of the cervix, as well as its vaginal part. Most often, the deformation of the cervix occurs after abortion, during childbirth, since during the passage of the fetus through the cervix, small cracks and tears form, after surgical interventions, as well as after gynecological operations, which lead to its changes.

Deformation of the cervix after childbirth

During labor, the cervix becomes much shorter and smoother, which allows it to open 8-10 cm and allow the baby's head to pass easily. Quite often, during the passage of the fetus through the birth canal, ruptures of the cervix occur. The reasons for these adverse events may be: previous ruptures during childbirth, the large weight of the child, gynecological operations, abortions, weak labor activity followed by rapid labor, improperly selected obstetric forceps, untimely strong attempts. As a result, ruptures of the cervix are formed. Tears and cracks can be of different depths and even touch the vagina and the uterus itself. Therefore, at the end of childbirth, the doctor must carefully examine the cervix and the uterus itself for ruptures. If any are found, they are sutured with special threads, which will resolve themselves over time.

If not all breaks were detected and sewn up, the cervix is deformed, its shape and pharynx change. The woman in labor herself may not feel any changes. Most often, an incorrect cervix does not cause any concern in a woman and does not affect the patient's well-being in any way. But this factor can play a decisive role in planning a future pregnancy, since an incorrect cervix can lead to miscarriages, bleeding, amniotic fluid leakage and, as a result, to premature birth. Therefore, it is very important to undergo an examination of the cervix after childbirth for changes, then the doctor will be able to prescribe the correct treatment and remove all the consequences of a difficult birth.

Cicatricial deformity of the cervix

As a result of surgical interventions or difficult childbirth, ruptures and cracks that are not sewn up at all or not sewn up at all are healed. After that, the woman develops cicatricial deformity of the cervix. In this case, the cervix is deformed and everted into the vaginal part. Cicatricial deformity of the cervix can lead to many diseases: infectious, severe inflammatory processes, which can be aggravated by purulent rashes, roughening of the endometrium, erosion of the cervix, and even the formation of cancer cells. For women who are trying to conceive or carry a child, cervical scarring can be a major cause for concern.

Very often, cicatricial deformity of the cervix does not manifest itself in any way, although obvious signs of this pathology can be: disruptions in the menstrual cycle, as well as abundant discharge during the cycle itself, unpleasant pain in the lower abdomen, painful sexual contacts, white discharge, which may have an unpleasant odor. If you find any of these symptoms in yourself, immediately go to a doctor who can confirm or refute the presumptive diagnosis. To do this, you will be examined on a chair with the help of mirrors, a colposcopy, a cytology of smears will be prescribed, and you will also need to pass some tests. If, nevertheless, you have been diagnosed with a cicatricial deformity of the cervix, do not panic, the doctor will prescribe you a course of treatment that will be aimed at restoring the natural initial state of the cervix and its integrity. In most cases, this treatment is quite successful, although it will take some time.

Cervical deformity: consequences

As mentioned above, many women may not even notice that their cervix is deformed and they do not observe any negative consequences. Although for many this can become a significant obstacle in planning and bearing a child. Very often, it is the deformation of the cervix that becomes the main cause of involuntary abortions and early births. In addition, with strong changes in the cervix, or rather, its eversion into the vaginal part, a woman can develop: keratinization of the tissues of the cervical canal, death of the epithelium, endometritis, cervicitis, erosion, inflammation and even cervical cancer. Therefore, you should not delay timely treatment for a long time, which can prevent many health problems in the future.

Cervical deformity: treatment

When choosing a treatment for cervical deformity, many factors are taken into account: what caused the development of the disease, the degree of tissue damage, the age of the patient, concomitant infections and inflammatory processes. Most often, the deformation of the cervix is treated by surgery or destructive methods. If the changes are minor, the tissues are not deeply affected, then laser plastic surgery, cryodestruction or diathermocoagulation is prescribed. If the deformation is significant enough and there are prerequisites for the presence of neoplasms, then reconstructive plastic surgery or excision of the cervix is performed.

All these methods are aimed at restoring the natural state of the cervix, vaginal microflora and restoring reproductive function. It is also recommended to prevent the development of cancer cells and neoplasms. Treatment of cervical deformity is a rather lengthy process, but, in most cases, it is very successful, and a woman will be able to become pregnant and bear an absolutely healthy baby.

Cervical deformity is not as scary as it seems at first glance, because the disease can be diagnosed and treated, after which you can plan a pregnancy and get rid of many concomitant diseases. The main thing is to seek help from a specialist in time.

Deformation of the uterus can be both congenital and acquired. With the progression of tumor processes, the size and shape of the reproductive organ may change. Such diseases must be treated surgically.

Causes of congenital deformity of the uterus can be:

Genetic disorders.
Adverse effects on the fetus in the womb during the first trimester of pregnancy. It can be severe poisoning, experienced stress, an infectious or chronic disease.

Normally, the uterus is located in the pelvis, has the shape of a pear. The lower part of the organ smoothly passes into the neck, which is connected to the vagina. The growth and development of the fetus occurs precisely in the uterus, so its deformation and improper development can be quite dangerous.

Classification

The doctor conducted an examination and said that the uterine cavity is deformed - what does this mean? In modern medicine, several types of abnormal development of this reproductive organ are distinguished.

The uterus is in the form of an arc or saddle. The upper part of the organ is concave. Such a violation is not dangerous to the health of the patient, does not prevent the conception and normal bearing of the child.
The uterus is bicornuate. Patients with this diagnosis have an additional wall that divides the organ into two parts. With such a deformation, a woman will easily become pregnant, but there may be problems with carrying the embryo. In a bicornuate uterus, the child is cramped, and this is fraught with premature birth.
Unicornuate reproductive organ. In this case, the uterus is connected to only one ovary. Such a violation is very rare. It is difficult for patients with such a diagnosis to become pregnant, but there are chances. High risk of miscarriage or early labor.
Several queens in one organism. An extremely rare pathology. The organs are not related to each other in any way. With this anomaly, women experience pain during intimacy or menstrual bleeding. The patient can become pregnant, but the risk of miscarriage and misplacement of the embryo is quite high.

Some representatives of the fair sex do not have a uterus from birth. In this case, agenesis is diagnosed. A patient with this type of anomaly cannot become pregnant and bear a child, as the reproductive system is not developed. The girl does not have menstruation, serious hormonal disorders may occur.

Diagnostics

It is almost impossible to detect congenital deformity of the uterus during a standard gynecological examination on a chair. As a rule, doctors suspect anomalies in the development of the reproductive organ if the patient cannot become pregnant for a long time, but does not suffer from any gynecological diseases. Various diagnostic methods are used to detect deviations:

Ultrasound of the pelvic organs (transabdominal or transvaginal).
MRI. With the help of modern equipment, you can see a clear image of the uterus. This examination is not carried out during pregnancy.
Examination of the uterine cavity using a special device - a hysteroscope.
X-ray with contrast agent. Allows you to determine the shape and size of the genital organ, its functioning.
Laparoscopy. During such an operation, a puncture is made in the abdominal cavity, and a special device with a camera is inserted through it.

1 Description

Cicatricial deformity of the cervix is a disease that is a change in the vaginal and cervical canals. ICD-10 code: N88 "Other non-inflammatory diseases of the cervix."

The cervical canal is located in the lower part of the uterus. Its walls are lined with epithelial cells that produce alkaline mucous secretions. With the development of cicatricial deformity, the mucous membrane of the cervical canal enters the vaginal canal, which has an acidic environment.

As a result of an imbalance, the protective functions of the reproductive system weaken, it begins to malfunction. Mucus secretions change their composition. This contributes to the development of infectious and inflammatory diseases.

Recommended
Colposcopy of the cervix - how is the procedure performed and how to prepare for it?

2 reasons

The highest degree of risk of cicatricial deformity occurs after assisted delivery using an extractor or medical forceps. Independent childbirth can lead to the development of pathology if they were complex and accompanied by multiple internal tears.

Surgical interventions, surgical abortions, violations of the suturing technique lead to the development of deformation. The congenital type of pathology is very rare. It is associated with physiological and hormonal failures.

3 Symptoms and complications

After tissue rupture, its healing begins. The process is the replacement of organ tissue with connective tissue. In this case, the following processes are observed:

there are disturbances in blood microcirculation;
there is a redistribution of nerve cells;
trophic changes in the structure of the canal develop, which contribute to its deformation and eversion of the mucosa into the vaginal canal;
sometimes cervical-vaginal fistulas are formed.

For a long time, the pathology does not manifest itself in any way externally. As it progresses, there are:

aching pain in the pelvis, radiating to the lower back;
violations and failures in the duration and frequency of the menstrual cycle;
pain during sexual intercourse;
copious menstrual flow;
stretching white vaginal discharge.

Complications of cicatricial deformity of the cervix include:

cervicitis;
endometritis;
endocervicitis;
erosion;
keratinization of the tissues of the cervical canal;
violation of the development of the epithelium;
oncology.

4 Effects on pregnancy and childbirth

Pathology can lead to infertility or problems with bearing a fetus. This is possible for several reasons:

an imbalance in the acidity of cervical mucus is an obstacle to the penetration of spermatozoa into the uterus and their normal functioning;
due to a violation of the protective mechanism, the risk of miscarriage and the possibility of infection of the fetus through the vagina increases.

During pregnancy, a woman with a deformity is advised to observe sexual rest and limit physical activity. If during childbirth the cervix opens on its own, the birth process passes through the natural birth canal. In the absence of disclosure, a caesarean section is performed.

5 Diagnostics

If you change the nature of the discharge or the composition of the mucus, the appearance of pain or bleeding, you should immediately visit a gynecologist. Your doctor will examine you with a speculum or colposcope. Signs of cicatricial deformity of the cervix are:

canal eversion;
the presence of scars near the sutures that arose during the suturing of birth gaps.

In the process of colposcopy, the doctor examines changes in the surface of the cervical canal, complications of the pathology, and takes tissue for biopsy. If the problem is congenital, tests are prescribed to determine the level of hormones in the woman's body.

The gynecologist may prescribe additional studies:

bacteriological tests;
PCR diagnostics;
smear for cytology.

Differential diagnosis is carried out to exclude functional disorders during childbirth. During the birth process itself, when the first signs of deformation usually appear, it is necessary to distinguish the pathology from the secondary weakness of labor activity. The latter is characterized by a slow opening of the cervix (insufficient for normal childbirth), but with positive dynamics. With deformation, disclosure does not occur at all; instead, the doctor may notice a curvature of the organ.

General concept

Most people know what a scar or scar is. This formation, consisting of connective tissue, appears as a result of the healing of deep wounds, injuries or inflammatory diseases.

A scar heals not only the skin. The mucous membranes of the stomach and intestines are scarred (after ulcers and operations), the uterus and cervical canal, gallbladder, the myocardium is scarred after ischemia. A scar can heal tissues of almost any organ.

Basically, scar tissues are represented by collagen, they are dense and can cause deformation of the organ. Due to their appearance in the surrounding tissues, the processes of blood microcirculation are disturbed, and, consequently, their trophism (nutrition) suffers. The innervation of the tissue may be disturbed.

The connective tissue of the scar is not able to perform the function of the tissues that they replaced.

Effects

Since the scar is not functional as a mucosal lining of the cervix (cervical canal), the mucosa partially loses its function. As a result, cicatricial deformity of the cervix:

It leads to a decrease in the barrier functions of the mucous membrane of the cervical canal due to a violation of the production of cervical mucus and its qualities.
May be accompanied by ectropion (eversion of the mucous lining of the cervical canal into the vagina).

Ectropion occurs due to rupture of the circular muscles of the cervix. The longitudinal muscle tissues located at the lips of the cervical canal remain intact. They continue active contractions without meeting the resistance of the circular muscles. The external os of the cervix undergoes deformation, turns out and sags into the vagina. Sagging tissues are exposed to the acidic vaginal environment. They erode, the glands of the mucous lining atrophy and stop producing the usual mucus.

The result of such anatomical and physiological changes is an increased predisposition of the female genital organs to inflammatory processes:

Endocervicitis.
Endometritis.
Ectopia and true erosion.
tissue atrophy.

The main feature of a healthy cervix is the presence of a mucous plug in it, which is formed and located in the canal due to its special spindle shape. And it is she (cork) that performs the barrier function of the cervix.

The appearance of scars on the mucous membrane of the cervical canal is considered one of the key points predisposing to keratinization of the mucous lining, the degeneration of epithelial cells up to the development of cervical cancer. The formation of scar tissue can cause a curvature of the cervix. Such changes, complementing each other, become a threat to the reproductive function of the female body, leading to:

Infertility.
miscarriages.
Bleeding.
Leakage of amniotic fluid during subsequent pregnancies.
Premature birth.
Violation of the ability to give birth independently and the need for operative delivery.

In addition, scarring and curvature of the cervix can cause discomfort and pain in a woman.

The reasons

Such changes are usually secondary. There are few reasons for the development of this pathology. The main ones are considered to be:

Injuries and ruptures (birth, resulting from abortions, diagnostic curettage, and for other reasons).
Surgical interventions.
Inflammation (chronic and severe), leading to adhesive changes and scarring of tissues.

Most often there is a deformation of the cervix after childbirth. This leads to:

The birth of a large fetus (more than 4.5–5 kg).
Breech presentation.
Insufficient elasticity of the walls of the cervical canal due to chronic inflammatory diseases of the genital organs.
Rapid childbirth, accompanied by cracks and ruptures.
Untimely and excessive attempts.

There may be other provoking factors that caused a violation of the integrity of the cervix.

Such gaps can be of different depths and lengths, touch the uterus and violate the integrity of the vaginal tissues. If tears are detected early and properly sutured, they usually heal without deformities.

The suture used to close internal tears is self-absorbable. Therefore, it is not necessary to remove the stitches, the damage (if there is no secondary infection) heals well.

If not all tissue ruptures were sewn up, most likely they will grow together anyway, but with the formation of scars and deformation of the shape of the cervix.

One of the rarest cases of the development of such a pathology is primary cicatricial changes (congenital). In this case, their cause is considered to be a hormonal imbalance.

signs

Quite often, cicatricial deformity of the cervix does not manifest itself symptomatically in a mild degree. And it is found only as a result of a gynecological examination. If the changes are pronounced, then unpleasant symptoms may appear:

Pain in the pelvic region radiating to the lumbar region.
Discomfort in the lower abdomen (heaviness and pronounced pulling discomfort).
Discharge (white, slimy, stretchy).
Painful intercourse.
Abundant menstruation with severe pain syndrome.
Shift in the menstrual cycle.

If the pathology is primary, then in addition to the described violations, there may be cycle disorders, early menarche, severe and painful bleeding.

Diagnostics

The main diagnostic method is a gynecological examination by a gynecologist. That's just mild cicatricial changes in the cervix and eversion of the mucous membrane in the vagina presents difficulties in diagnosis. A severely deformed cervical canal does not cause diagnostic difficulties.

According to literary sources, in at least 70% of cases, ectropion, combined with cicatricial changes, is diagnosed as ectopia. That is, as a physiologically variable condition that does not require treatment.

Additional diagnostic methods used by a gynecologist are:

Colposcopy.
Cytological analysis of tissues.
Examination of the vaginal secretion for the presence of pathogenic bacterial microflora.
Blood tests (PCR method is most often used).

If primary deformity is suspected, the patient is asked to take blood tests for hormones.

Treatment

Therapeutic tactics are developed for each patient separately. And it depends on several factors:

The severity of the condition.
Realization of the childbearing function (that is, whether the woman has children).
age.
Associated pathologies.

For the treatment of this pathology, destructive methods and surgical plastics are used. The main therapeutic task is not only the elimination of cicatricial changes in the cervix and its return to the physiological position.

Therapy solves several more important tasks:

The return of a woman's ability to reproduce.
Restoration of the barrier functions of the cervical mucosa.
Normalization of the microflora of the vagina.
Prevention of mucosal atrophy and its cancerous degeneration.

Destructive methods give a good result with a mild degree of scarring. Thanks to them, altered tissues are destroyed and the normal lining of the cervix is restored.

There are several destructive methods, the main ones are:

diathermal coagulation.
cryogenic destruction.
Laser evaporation (vaporization).

Modern bloodless surgical techniques include ultrasonic, radio wave and electrical methods that allow the destruction of pathologically formed tissues.

Severe cicatricial deformity of the cervix is corrected by excision. The average postoperative period is 10 days, the average recovery period is 90 days. At the same time, experts advise sexual abstinence. In addition, a gentle labor regime is recommended for a woman (physical exertion should be avoided), and the rules of intimate hygiene should also be strictly observed.

Cicatricial deformity of the cervix, fortunately for women, is rare.

rehabilitation period

You need to visit your doctor regularly during the rehabilitation period, and conscientiously follow his recommendations. This will allow the healing process to proceed as quickly and efficiently as possible.

In some cases, antibiotic therapy is recommended for patients to eliminate inflammation. Or the use of local antiseptics. It may be necessary to restore the vaginal microflora.

You can think about planning a pregnancy 4–5 months after successful tissue healing, if the process went without complications.

Characteristics of the pathology

Every woman, having heard that she has a deformity of the cervix, wants to know what it is. Most often, this is the name of the condition in which the integrity of the cervix (its visible vaginal part) is broken, and a scar has formed at the site of damage. It is he who leads to visible changes in the shape of the cervix and cervical canal. But there are other types of deformities, and for some, surgical treatment is recommended.

Deformation of the cervix leads to the fact that the blood microcirculation in its tissues is disturbed, nerve cells begin to gradually die. This provokes the appearance of trophic changes in the tissues of the cervical canal. Sometimes even the uterus is involved in the process: its mucous part turns into the vagina, cervical-vaginal fistulas form.

Types of pathologies

Cervical deformity can be acquired or congenital. But congenital pathology is extremely rare. Hormonal disruptions in the body can lead to the appearance of pathology.

Doctors believe that congenital deformity can occur under the influence of negative factors on the mother's body in the first 3 months of pregnancy. These include stress, infectious lesions, intoxication. Also, the cause of a birth defect can be genetic failures. Such a change in the shape of the cervix is accompanied by anomalies in the development of other organs (uterus, vagina).

Most often, women are diagnosed with cicatricial deformity of the cervix.

But there are other pathologies of the cervical part of the uterus:

narrowing of the cervical canal: the diagnosis is made if its dimensions do not exceed 5 mm;
circular canal: improper arrangement of muscle fibers leads to the appearance of a funnel-shaped cervical canal;
lengthening or shortening: the length is less than 35 mm or more than 45 mm.

These deformations of the cervix lead to disruption of menstrual and reproductive function. Women who are planning a pregnancy, be sure to select the optimal treatment tactics.

Reasons for the appearance

Most often, violations of the shape and integrity of the neck occur as a result of:

injuries during childbirth, for example, due to ruptures of the cervix during the passage of the baby's head;
damage that arose due to the incorrect location of the fetus;
violations of the technique of surgical interventions;
improper suturing.

These reasons lead to the fact that the physiologically normal structure of the cervical part of the uterus is violated. Scar tissue forms on the damaged areas, and the cervix is deformed. Timely diagnosis and treatment can prevent problems in the future.

Why does pathology occur?

In most cases, severe childbirth provokes the onset of pathology, during which lateral tears appear on the cervix.

Also, the condition occurs during surgical interventions for obstetrics - illiterate forceps, insufficiently qualified suturing. Cause cervical changes abortion and gynecological curettage.

One of the factors that increase the risk of deformity is hereditary pathology, in which scars in the cervical canal are formed against the background of hormonal disruptions. The human papillomavirus affects the development of deformation.

The mechanism of development of pathology

The cells of the cylindrical epithelium, which make up the lower region of the cervical canal, constantly produce a mucous secret. In the presence of provoking factors - traumatic injuries and hormonal imbalance - the alkaline balance of the environment is disturbed, and the mucosa drops to a much less alkaline, but more acidic environment of the vagina.

A change in acidity causes inflammatory processes, the consequence of which is a violation of the trophic tissue of the cervical canal. The uterus is everted by the mucous membrane into the vaginal area and vaginal-cervical fistulas are formed.

There are other painful conditions:

endometritis;
cervicitis;
endocervicitis.

This leads to the appearance of erosion, atrophy of the epithelium, keratinization of the cells lining the cervical canal, and can become an insidious impetus to the onset of cancerous cell transformations.

Also, the scar neck significantly reduces the quality of sexual life and reduces the possibility of conception, and if it occurs, it prevents the pregnancy from being carried out for the prescribed period.

Symptoms and diagnosis of the disease

In some cases, the patient may complain of aching pain in the lower abdomen - mainly during the menstrual cycle - and the appearance of profuse leucorrhoea.

Changes in the menstrual cycle may also occur - the cycle is broken, the amount of discharge increases, etc.

But in most cases, the disease develops asymptomatically and is detected during a gynecological examination.

Usually, diagnosis is not a problem - in the gynecological mirror, the eversion of the cervical canal and visual cicatricial changes at the places of suturing or at breaks are immediately visible. If confirmation of the diagnosis is required, then a colposcopy is prescribed.

Laboratory studies to determine the severity of the pathology:

smears for bacterial flora and cytology;
PCR - diagnostics.

During colposcopy, changes in the folds of the cervical canal are assessed and a tissue sample is taken for a biopsy - a histological examination.

If the patient has congenital eversion, it is necessary to take a course of tests to determine the level of sex hormones.

Influence of a scar cervix on pregnancy and childbirth

Scars localized in the area of the cervical canal may not affect conception - if the disease proceeded without pronounced symptoms - but the condition negatively affects the course of pregnancy. This increases the risk of miscarriage, increases the possibility of infection of the fetus with an infection in ascending ways - through the vagina.

A pregnant woman needs to be attentive to herself, observe sexual rest, and, if possible, reduce activity. The decision on additional therapeutic intervention at this stage is made by the gynecologist observing the pregnancy.

With scarring of the cervix, childbirth can occur naturally - if the cervix has opened itself - but a caesarean section may be necessary.

As already mentioned, most cases of deformation of the cervical canal occur just after childbirth, if deep tears have not been repaired or sutured not thoroughly enough.

Deformation of the cervix after childbirth

Cicatricial deformity of the cervix

Cervical deformity: consequences

Sources

https://uterus2.ru/disease/deformatsiya-matki.html
http://noprost.ru/gynecology/erosion/rubcovaya-deformaciya-shejki-matki.html
https://flovit.ru/medicina/ginekologiya/rubcovaya-deformaciya-shejki-matki.html
http://ginekola.ru/ginekologiya/shejka-matki/lechenie-deformatsii-shejki-matki.html
https://mjusli.ru/zhenskoe_zdorove/ginekologicheskie_zabolevanija/rubcovaya-deformaciya-shejki-matki
http://www.probirka.org/zhenskoe-besplodie/8988-deformatsiya-sheyki-matki.html

There are many diseases and problems of the female genital area, and all of them require proper treatment in order to preserve the ability of a woman to have children and ensure the normal functioning of the body. Some pathologies are widespread, and there are those that are rare, but can end in failure. One of them is the deformation of the cervix.

Collapse

What is a disease?

Deformation of the uterus is a change in the normal position of the cervix and part of the vagina. There are many reasons for the formation of pathology, but it should be noted that the disease is diagnosed relatively rarely. Deformations include:

Circular canal of the cervix.
Narrowing of the lumen.
Violation of the patency of the neck.
Length reduction.
Cicatricial changes.

Pathology may not always show its symptoms and it is problematic to correct this deviation from the norm until a woman visits a gynecologist.

The reasons

A deformed cervix is a congenital pathology or develops as a result of certain conditions. If we are talking about a hereditary form, then, as a rule, abnormalities in the development of other genital organs, such as the uterus or vagina, are diagnosed along the way.

But most often, the deformation of the neck occurs under the influence of the following factors:

The formation of adhesions in the pelvic organs.
Deformation after a rough intervention, for example, an abortion.
Scar formation as a result of gynecological procedures.
Ruptures of the cervix during labor.

Depending on the cause of the pathology, it is either amenable to adjustment or not.

Symptoms of pathology

The disease is characterized by the fact that up to a certain point it can proceed without obvious signs. It is found only when a woman has problems conceiving or bearing a baby, or at the next examination by a doctor.

But still, some features of the course of the disease can be noted:

With the circular canal of the cervix, no changes are observed. But the problem appears during labor, when the muscle fibers of the neck contract incorrectly, which prevents it from opening.
If the cervix is narrowed, then this can manifest itself as a violation of menstruation. It becomes more scarce due to the existing barrier to the normal outflow of blood.
With obstruction of the cervix, there is a delay in menstruation, blood accumulates in the uterus. The woman has abdominal pain, tension of the abdominal wall.
An elongated neck can affect sexual intercourse, or rather the sensations of a woman during it. Sexual desire decreases, and orgasm is dulled due to an insufficient number of receptors.
A shortened cervix can make itself felt while carrying a baby. The risk of miscarriage and premature birth increases.
Cicatricial deformity of the cervix can manifest itself as pain during intimacy. Over time, inflammatory processes of the pelvic organs may develop.

Considering that the pathology is often asymptomatic, it is important for timely diagnosis and treatment to be regularly examined by a doctor.

Varieties of the disease

Pathology is of two types:

Despite the fact that pathological changes may not manifest themselves in any way or give minor symptoms, a woman should see a doctor at the slightest suspicion of deviations from the norm.

If cicatricial deformity is detected, then effective treatment can restore the natural state of the cervix.

Diagnosis of the disease

If a woman begins to feel unpleasant symptoms, then you should not self-diagnose and self-medicate. You need to hurry to see a gynecologist. An accurate diagnosis is made on the basis of:

Interviews with the patient. The doctor will ask the woman about signs and suspicious symptoms, ask how long ago she began to experience them, what preceded this.
Then an inspection is required. In the mirrors, a strong defect can be seen immediately, especially if it is a cicatricial deformity.
To clarify the diagnosis, the gynecologist will take a smear for cytological examination.
Bacteriological tests are required.
A colposcopy is prescribed, which allows you to examine the surface of the cervical canal, to identify complications.
Biopsy required.
Cervicometry is used - this is an ultrasound examination of the uterus, which allows you to immediately recognize cicatricial changes, visualize the heterogeneous structure of the cervix.
Urine and blood tests, as a rule, are not prescribed, since there are no changes there with such pathologies.
If a woman has a congenital deformity, then it is required to take tests for hormone levels.

Is it possible to give birth with a deformity of the cervix?

Of course, no one can forbid a woman to give birth, but it must be borne in mind that this pathology can complicate the process of bearing a baby and childbirth. The following facts can be noted:

If a narrowing of the canal is diagnosed, then this can lead to a violation of labor activity, the uterus does not open well, which may be an indication for a caesarean section.
A shortened neck does not prevent fertilization, but, as a rule, it is rather difficult for a woman to bear a baby, and premature births are often observed.
An elongated cervix can interfere with the proper attachment of the placenta. And in the process of giving birth to a baby, it cannot fully open, which makes it difficult for the child to pass through the birth canal of the mother. There is a danger of developing oxygen deficiency.

All these risks can be eliminated if, before planning a pregnancy, you undergo a complete examination and identify existing pathologies.

Therapy

The tactics of treatment, if cervical curvature is diagnosed, is selected for each patient purely individually. The method of therapy will depend on several factors:

The severity of pathology and its varieties.
Does the woman plan to have children in the future.
age.
The presence of chronic diseases.

The main task of treatment is the elimination of cicatricial changes and the return of the cervix to its natural position. We can name the main methods of therapy:

Medical treatment.
destructive ways.
Surgical intervention.

As for drug therapy, it is only advisable if the neck deformity is provoked by hormonal disorders or inflammatory pathologies. The choice of drugs will depend on the causative agent of the infection or the degree of lack of hormones.

Destructive methods include:

Cryodestruction - removal of affected tissues after freezing with liquid nitrogen.
Diathermocoagulation. The deformed areas are exposed to high frequency currents.
Laser plastic.

These methods will help to cope with the pathology, if the changes are minor. Otherwise, operational methods are used:

excision method. Scar tissue is removed, but the method of operation is selected individually. Can be used: laser, radio waves.
If the cervical canal is narrowed or there is an obstruction, then bougienage is performed using a special tool. It should be noted that most often the procedure is required to be carried out several times.
In the presence of large curvatures or cicatricial lesions, an operation is performed followed by a neck plasty.

After surgical reconstruction, the birth of a baby in a natural way is impossible.

Recovery after surgery takes about 10 days, but given the complexity, it can be up to 3 months.

Complications and consequences

The disease is treatable, although it will take a lot of time and effort. In the absence of effective treatment, pathology is fraught with the development of the following complications:

The development of cervicitis, endometritis, which increases the risk of erosion.
The risk of keratinization of the tissues of the cervical canal increases.
Violation of the formation of the epithelium.
Tissue death and development of malignant tumors.
The strongest inflammatory processes.
With the cicatricial form of the disease, the ability to conceive is reduced.
The risk of premature birth and miscarriage increases.

The consequences are not pleasant, but a timely diagnosis will allow you to choose an effective therapy and get rid of the pathology.

It is impossible to make sure to avoid damage to the cervix and its deformation. But only an attentive attitude to one's health significantly reduces the risk of developing the disease. Proper treatment tactics will prevent the development of serious complications.

(RDSHM) - post-traumatic or congenital violation of the anatomical shape of the cervix with the failure of its cervical canal. In most cases, clinical symptoms are mild. Pathology can be manifested by the presence of cervical whites, dyspareunia, pelvic pain, an increase in the duration of menstruation. When making a diagnosis, the data of the anamnesis, examination in the mirrors, colposcopy, cytomorphological and laboratory studies are taken into account. Surgical methods are used for treatment: ablation, tracheloplasty, conization, trachelectomy, circular suture.

General information

According to various studies in the field of gynecology, the frequency of post-traumatic and congenital cicatricial changes in the cervix ranges from 15.3 to 54.9%, while at reproductive age it can reach 70%. The disease is more often detected in women who have given birth to a child for the first time over the age of 30 years. In patients with cervicitis, the likelihood of post-traumatic replacement of normal epithelium with scar tissue increases. The high importance of prevention, timely diagnosis and treatment of RDSM is due to the significant influence of the disease on the increased risk of infertility, inflammatory and oncological processes.

Causes of RDSHM

The formation of scars that violate the normal anatomical structure of the cervix is usually caused by processes and interventions in which the epithelium with underlying muscles and connective tissue is damaged. The most common causes of cicatricial deformity are:

Pathological childbirth. Cervical ruptures occur during rapid labor with insufficient opening of the cervical canal, the imposition of obstetric forceps, a large fetus or its incorrect position. The probability of damage is twice as high in nulliparous older than 30 years.
Invasive manipulations. During abortions, medical diagnostic procedures and endoscopic operations in the uterine cavity and on its appendages, the doctor inserts instruments through the cervical canal. In this case, the integrity of the epithelium is violated.
Mistakes in suturing. The regeneration process suffers from insufficient or incorrect suturing of gaps that occurred during childbirth, or from rough invasive manipulations.

It is extremely rare for a scar type neck deformity to be congenital. In such cases, the disease is usually accompanied by pathology from other organs of the female genital area.

Pathogenesis

During the formation of cicatricial deformity, the process of physiological restoration of areas of the damaged exo- and endocervix is disrupted. Instead of epithelial cells in the rupture zone, connective tissue proliferates. At first, it is quite elastic, but as the scar forms, it becomes denser, loses its ability to stretch and contract. As a result, the cervical canal does not close completely and loses its protective function. In repeated births, the cervix with cicatricial changes cannot fully open, which complicates their course. With deep tears, the edges may heal in the form of flaps. The failure of the cervical canal is accompanied by the development of ectropion.

Classification

When determining the degree of RDSHM, criteria such as the consistency of the external pharynx, the number and size of scars, the state of the endo- and exocervix, and surrounding tissues are taken into account. There are four degrees of cicatricial deformation changes:

Idegree. The external os passes the tip or the entire finger of the doctor. The cervical canal has the shape of a cone, the apex of which is the internal uterine os. The depth of single or multiple old ruptures does not exceed 2 cm. Signs of ectropion of the lower parts of the cervical canal are revealed.
IIdegree. The external uterine os cannot be identified. The cervix is "split" into separate anterior and posterior lip with old ruptures extending to the fornix. Endocervix is completely everted.
IIIdegree. Old breaks reach the vaginal vaults. The external pharynx is not defined. One of the lips of the neck is hypertrophied. Epithelial dysplasia and signs of an inflammatory process are noted.
IVdegree. Manifested by a combination of old tears that extend to the vaults of the vagina, with insufficiency of the pelvic floor muscles.

Symptoms of RDSHM

With grade I RDMS, the only symptom of the disease is often an increased amount of mucous cervical discharge. With cicatricial deformity II-IV degree, some patients complain of pulling or aching pains in the lower abdomen and in the lumbosacral region. The accession of the infection is accompanied by a change in the color of the whites, which become cloudy, whitish or yellow. The cyclicity of menstruation is usually not disturbed, but their duration can increase by 1-2 days. In 13-15% of cases, women report pain during intercourse. One of the signs of a cicatricial deformation process in the neck area is the inability to conceive or bear a child.

Complications

Cicatricial deformity is often complicated by the addition of a secondary infection with the development of chronic cervicitis. The insufficiency of the protective function of the cervical canal leads to the spread of the inflammatory process to the endometrium, fallopian tubes and ovaries. Since the endocervix is constantly exposed to the acidic environment of the vagina, the likelihood of developing erosion, dysplasia, leukoplakia, polyps, and malignant tumors increases dramatically. A scar-changed cervix during childbirth shows functional failure - natural childbirth is delayed or becomes impossible. The disease is one of the causes of cervical infertility.

Diagnostics

Cicatricial changes in the cervical canal and cervix can be suggested by the presence of a history of complicated births or invasive procedures. To confirm the diagnosis, the examination plan includes:

Gynecological examination on chair. When viewed in the mirrors, an expansion of the external os, old tears, signs of ectropion are revealed. During a vaginal examination, the external os is passable for the gynecologist's finger.
Colposcopy. Under a microscope, the nature of cicatricial changes in the surface of the cervix and cervical canal is studied in more detail.
Cytomorphological study. Cytology of smears and biopsy histology allow assessing the condition of cervical cells, as well as detecting tissue degeneration in time.
Laboratory diagnostics. To identify specific and non-specific infectious agents in the presence of an inflammatory process, serological tests, PCR and planting on the flora are used.

Detection of gross cicatricial changes facilitates the diagnosis. If there are complications, consultation with an oncogynecologist and a dermatovenereologist may be required.

Treatment of RDSM

Since the disease is accompanied by anatomical changes, surgical methods are most effective for its treatment. The choice of a specific technique is determined by the degree of deformity, the reproductive plans of the woman and the presence of complications. The following types of operations are recommended:

Ablative methods. To remove scar tissue, ectropion, areas of the endocervix with polyps, dysplasia or leukoplakia, radio wave and argon plasma treatment, laser vaporization, cryodestruction, diathermocoagulation are used. Ablation is effective in deformity of the 1st degree in patients of reproductive age planning a pregnancy.
Tracheloplasty. During reconstructive operations, the method of partial or complete dissection removes scar tissue while maintaining the muscle layer and mucosa, and restores the cervical canal. The method is indicated for women of childbearing age with II-III degree of cicatricial deformity.
Conization and trachelectomy. Excision of the affected areas or amputation is performed when the deformity is combined with intraepithelial neoplasia or incompetence of the muscles of the pelvic floor. Radical surgeries are more often performed in patients who are out of reproductive age.
Purse-string sutures. When signs of isthmic-cervical insufficiency appear during pregnancy, the locking function of the cervix is restored mechanically. An alternative to the operation in this case may be the installation of an obstetric pessary.

Auxiliary drug treatments are aimed at stopping the inflammatory process. After sanitation of the vagina, patients are prescribed drugs to restore its normal microflora.

Forecast and prevention

Reconstructive plastic surgery in 90-93% of cases allows you to restore the normal shape and function of the cervix. The effectiveness of purse-string sutures in pregnant patients with cicatricial deformity complicated by isthmic-cervical insufficiency ranges from 70 to 94% (depending on the chosen technique). For the prevention of the disease, a reasonable appointment of invasive procedures, timely registration during pregnancy, proper preparation for childbirth and their competent management are recommended. In the presence of traumatic ruptures, their timely suturing with subsequent control by a gynecologist is important.