Cervical opening before childbirth. Disclosure, shortening of the cervix during pregnancy. Full dilation of the cervix

Normal births never happen spontaneously. A few weeks before this event, changes in the cervix begin to occur. These changes will help the baby to be born. The fact that the baby will soon see the world is evidenced by some signs: the appearance of contractions, the discharge of water. During contractions, the cervix begins to open before childbirth, and this process determines how well the birth will go.

Childbirth: stages

Childbirth is the process of expulsion of the fetus and placenta from the uterus, during their normal course, the process is carried out naturally. In cases where it is necessary to resort to various surgical methods of delivery, childbirth is called operative.

A woman should approach this important event in her life in full readiness - if a woman has a good idea of ​​what will happen to her and how, it will be much easier for her to give birth.

Childbirth consists of periods:

Opening of the cervix;
expulsion of the fetus;
the birth of the afterbirth.

The longest in time is the first period, during which, as a result of uterine contractions, a fetal bladder is formed, the fetus moves along the birth canal, as a result of which the cervix is ​​​​fully opened during childbirth and the baby is born. In primiparous childbirth lasts up to twelve hours, for multiparous this period of time is much less - up to eight hours. Knowing how many cm is the opening of the cervix during childbirth, you can accurately name which phase of the contractions passes, how long this process will continue.

The uterus is responsible for carrying the fetus, which is a hollow muscular organ, consisting of three parts:

bottom;
body;
necks.

The processes of gestation and childbirth depend on the state of the cervix.

Opening of the cervix

Preparation of the cervix for childbirth begins at about the 32nd week. The density of the tissue area near the cervical canal still remains, but in other places the cervix softens, this process is completed by the 38th week of pregnancy. Now the fetus descends into the small pelvis and with its weight presses on the neck, which contributes to its even greater opening.

If the doctor announced to the woman that the disclosure of 1 finger, she begins to wonder how long to wait for childbirth. But this so far suggests that the pregnant woman is only physiologically prepared for childbirth. And they will begin when regular contractions appear. Therefore, opening by 1 finger will not tell you how much time is left before the birth, but will indicate that you are ready for labor. This readiness can be judged by several other parameters.

In addition to opening to the finger and softening, the neck should be shortened to a length within one centimeter. At the same time, it begins to settle down in the center of the small pelvis, although more recently it has been somewhat deviated to the side. There should also be a discharge of the mucous plug that protected the uterus throughout the pregnancy. The discharge of the cork indicates that the cervix is ​​​​ripe, and contractions may soon begin. First, the internal pharynx of the cervix opens, as the fetus moves along the birth canal, the external pharynx also stretches. In women who have given birth, this disclosure occurs simultaneously, so the whole process takes a much shorter period of time than in a primipara. And if, for example, the disclosure is 3 cm, then how long will the birth begin?

By the way, obstetricians and gynecologists often call the size of the neck opening not in centimeters, but focusing on the size of their fingers. Therefore, it is much more common for a doctor to hear - how many fingers should be open during childbirth?

Sometimes it happens that labor is already beginning, and the cervix is ​​not ready at all and is not going to open. In this case, the doctor will apply stimulation, otherwise the fetus will experience a lack of oxygen, because the placenta begins to age rapidly and lose the ability to perform its main functions.

Contraction period

Contractions refer to the first, longest, period of labor, which lasts until the cervix opens, allowing the fetus to pass. Many women are interested in the question - how many fingers should be disclosed in order for labor to begin? It can be said that before the onset of labor, the cervix is ​​​​flattened and open for at least two fingers. To answer the question - if a woman in labor has two fingers opened, then after how long she will give birth, then first you need to consider how the opening goes during contractions. But first things first.

The period of contractions is divided into a slow period, called latent, and fast (the so-called active phase of contractions). Contractions last 10-12 hours in nulliparous women and 6-8 hours in women who have given birth.

The latent phase begins from the moment when the rhythm of contractions is established, they occur with a frequency of one or two contractions in 10 minutes, this phase lasts about six hours and usually passes without severe pain. In primiparas, this phase always lasts longer. The use of medications is not yet required, but for too young or, conversely, older women, the use of antispasmodics may be required. At this time, a disclosure of 3 cm is already observed, however, it will not be possible to say exactly how long the birth will begin. At the moment, there is only an alternating contraction of the muscles of the uterus and their relaxation, as a result of which the length of the neck is shortened, the head of the fetus is located at the entrance to the small pelvis, the fetal bladder begins to put pressure on the internal pharynx, causing it to open.

If there was a disclosure of 3-4 cm, then after how much the birth will begin, the doctor already sees. Complete smoothing of the neck and a dilatation of 4 cm indicates that the active phase of contractions begins. This phase for both primiparous and women who have already given birth lasts up to four hours. During this period, the subsequent disclosure is already very fast. For every hour, the cervix opens 2 cm in primiparas, and 2.5 cm in recurrent births.

If the disclosure is 5 cm, then after how much labor will begin - the doctor knows for sure. In order for the fetal head and torso to be able to pass through the birth canal, the cervix must open up to 10, sometimes up to 12 cm. Therefore, in the active phase, an experienced doctor can accurately determine both the time of birth and their course. For example, if the opening is already 6 cm, it is quite simple to answer the question - after how long the birth will begin, you just need to calculate how many centimeters are left before the cervix is ​​fully opened. At this time, the baby's head is already moving through the birth canal and the cervix opens faster and faster. The most painful contractions become after five centimeters of opening. This pain is natural, but not every woman can withstand this pain. To maintain the condition of the pregnant woman at this time, various methods of anesthesia are used. These can be non-drug methods:

Massage;
taking warm baths;
listening to soothing music;
various exercises.

If these methods are not enough, the obstetrician-gynecologist will prescribe a medication pain reliever, based on the characteristics of the woman, the complexity of the course of childbirth, and the pain threshold.

With a 3-finger opening, after how much labor will begin - you can answer quite accurately - after about two hours, the contractions should end, after which attempts will begin. By the end of the active period of contractions, the neck is already completely open, or almost completely. Usually at this time the waters break, it is believed that this is a timely process. However, if the water does not drain on its own when the cervix is ​​fully opened, the doctor has to perform a procedure for opening the fetal bladder, called an amniotomy.

Full disclosure of the cervix will occur with sufficient labor activity. With weak labor activity or its absence, the cervix does not open. In this case, it comes to stimulate labor activity.

What does the opening of the cervix look like during childbirth - we examined. Let's try to consider whether it is possible to influence this process with the help of posture.

Poses

It turns out that the horizontal position we are accustomed to slows down the process of childbirth, prevents the uterus from contracting normally, slows down the opening, and at the same time increases the pain. With the help of a properly selected posture, pain can be relieved, labor can be stimulated. What postures during childbirth are favorable for opening the cervix:

Vertical, in which, due to the force of gravity, the weight of the child is directed downward. At the same time, the child presses harder on the cervix, causing it to open faster, with attempts, it is also easier for the child to pass in this position.

Sitting position. In this case, care must be taken that the surface should be elastic, but in no case hard. For this, large inflatable balls are well suited, which will contribute to a faster opening of the neck. The legs should not be closed, it is better to spread them as much as possible to the sides.

True, in some cases, a horizontal position will still remain a necessary option, for example, with rapid labor, with a breech presentation of the fetus, and in some other serious violations of the childbirth process.

Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and her cervix prepare for the birth process. In particular, the cervix begins to "ripen" and expand, that is, it enters the stage of opening the uterine os. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and the state of the hormonal background, which determines their successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity with the vagina. Directly in the neck, the vaginal part is distinguished - the visible part that protrudes into the vagina below its arches. And also there is supravaginal - the upper part, located above the arches. In the cervix passes the cervical (cervical) canal, the upper end of it is called the internal pharynx, respectively, the lower end is the outer one. During pregnancy, there is a mucous plug in the cervical canal, the function of which is to prevent the penetration of infection from the vagina into the uterine cavity.

The uterus is the female reproductive organ, the main purpose of which is the bearing of the fetus (fetal container). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is the muscular tissue and the outer one is the serous membrane. The main mass of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during the birth act.

Periods of childbirth

The birth process lasts quite a long time, and normally in primiparous women in labor it is 10-12 hours, while in multiparous women it lasts about 6-8 hours. Childbirth itself includes three periods:

• I period - the period of contractions (opening of the uterine os);
• II period is called the period of attempts (the period of expulsion of the fetus);
• III period - this is the period of separation and discharge of the child's place (afterbirth), therefore it is called the afterbirth period.

The longest stage of the birth act is the period of opening of the uterine os. It is caused by uterine contractions, during which the fetal bladder is formed, the fetal head moves along the pelvic ring and cervical opening is provided.

Contraction period

First, contractions arise and are established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30 - 40 seconds, and relaxation of the uterus 80 - 120 seconds. Prolonged relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower uterine segment, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself is stretched and lengthened.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the small pelvis, separating the amniotic fluid, as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts as a hydraulic wedge, wedged into the internal os, opening it.

In first-borns, the latent phase of disclosure is always longer than in women giving birth for the second time, which causes a longer total duration of labor. Completion of the latent phase is marked by complete or almost complete smoothing of the neck.

The active phase begins with 4 cm of cervical dilatation and lasts up to 8 cm. At the same time, contractions become more frequent and their number reaches 3–5 in 10 minutes, the periods of contraction and relaxation of the uterus equalize and amount to 60–90 seconds. The active phase lasts for primiparous and multiparous 3-4 hours. It is in the active phase that labor activity becomes intense, and the cervix opens quickly. The fetal head moves along the birth canal, the cervix has completely passed into the lower uterine segment (merged with it), by the end of the active phase, the opening of the uterine os is complete or almost complete (within 8–10 cm).

At the end of the active phase, the fetal bladder opens and the water is poured out. If the cervical opening has reached 8 - 10 cm and the water has departed - this is called a timely outflow of water, the discharge of water at the opening of up to 7 cm is called early, with 10 or more cm of opening of the pharynx, an amniotomy is indicated (the procedure for opening the fetal bladder), which is called a belated outflow of water.

Terminology

The opening of the cervix does not have any symptoms, only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing the neck is progressing, one should decide on obstetric terms. In the recent past, obstetricians determined the opening of the uterine os in the fingers. Roughly speaking, how many fingers the uterine pharynx passes through, such is the opening. On average, the width of the "obstetric finger" is 2 cm, but, as you know, everyone's fingers are different, so measuring the opening in cm is considered more accurate. So:

• if the cervix is ​​​​opened by 1 finger, then they say about the opening of 2 - 3 cm;
• if the opening of the uterine os has reached 3–4 cm, this is equivalent to opening the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
• an almost complete opening is indicated by the opening of the neck by 8 cm or by 4 fingers;
• full disclosure is fixed when the cervix is ​​completely smoothed (the edges are thin) and passable for 5 fingers or 10 cm (the head falls to the pelvic floor, turning with an arrow-shaped seam in a straight size, there is an irresistible desire to push - it's time to go to the delivery room for the birth of a baby - the beginning of the second period childbirth).

How does the cervix mature?

The harbingers of childbirth that have appeared indicate the imminent onset of the birth act (from about 2 weeks to 2 hours):

• the bottom of the uterus descends (for 2-3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the small pelvis, a woman feels this sign by easing breathing;
• the pressed head of the fetus presses on the pelvic organs (bladder, intestines), which leads to frequent urination and constipation;
• increased excitability of the uterus (the uterus “hardens” when the fetus moves, the woman moves abruptly, or when the abdomen is stroked / pinched);
• appearance is possible - they are irregular and rare, pulling and short;
• the cervix begins to "ripen" - softens, skips the tip of the finger, shortens and "centers".

The opening of the cervix before childbirth proceeds very slowly and gradually over a month, and intensifies on the last day - two on the eve of childbirth. In nulliparous women, the dilatation of the cervical canal is about 2 cm, while in multiparous women, the dilatation exceeds 2 cm.

To determine the maturity of the cervix, a scale developed by Bishop is used, which includes an assessment of the following criteria:

• the consistency (density) of the neck: if it is dense, this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both from the inside and outside - 2 points;
• the length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - a score of 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
• patency of the cervical canal: a closed external pharynx or skips the tip of a finger - a score of 0 points, the cervical canal is passable to a closed internal pharynx - this is estimated at 1 point, and if the canal passes one or 2 fingers through the internal pharynx - it is estimated at 2 points;
• how the neck is located in relation to the wire axis of the pelvis: directed backwards - 0 points, shifted anteriorly - 1 point, located in the middle or "centered" - 2 points.

When summing the points, the maturity of the cervix is ​​​​estimated. An immature neck is considered with a score of 0 - 2 points, 3 - 4 points is regarded as an insufficiently mature or ripening neck, and with 5 - 8 points they speak of a mature neck.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to the maternity hospital and at 38-39 weeks at the appointment at the antenatal clinic).

If a woman is already in the maternity ward, a vaginal examination to determine the process of opening the uterine os every 4 to 6 hours or according to emergency indications:

• discharge of amniotic fluid;
• carrying out a possible amniotomy (weak birth forces, or a flat fetal bladder);
• with the development of anomalies of generic forces (clinically narrow pelvis, excessive labor activity, discoordination);
• before regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
• the occurrence of discharge with blood from the genital tract;
• in the case of established regular labor activity (preliminary period that turned into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of disclosure, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on the soft tissues of the genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the swept suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. Be sure to evaluate the fetal bladder (integrity, functionality).

According to the subjective signs of disclosure and the data of the vaginal examination, a partogram of childbirth is compiled and maintained. Contractions are considered subjective signs of childbirth, in particular, the opening of the uterine os. Criteria for evaluating contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). Partogram of childbirth allows you to visually record the dynamics of the opening of the uterine os. A graph is drawn up, horizontally indicating the duration of labor in hours, and vertically opening the cervix in cm. Based on the partogram, one can distinguish between the latent and active phases of labor. The steep rise of the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

The opening of the cervix during pregnancy, that is, long after childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not fulfill their main function in the process of gestation - obturator. In this case, the neck softens, shortens and smoothes, which does not allow the fetus to be kept in the fetus and leads to spontaneous abortion. Termination of pregnancy, as a rule, occurs in 2 - 3 trimesters. The failure of the cervix is ​​evidenced by the fact of its shortening to 25 mm or less at 20-30 weeks of gestation.

Isthmic-cervical insufficiency is organic and functional. The organic form of the pathology develops as a result of various cervical injuries - artificial abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is due either to a hormonal imbalance or an increased load on the neck and isthmus during pregnancy (multiple pregnancies, excess water or a large fetus).

How to keep a pregnancy when dilating the cervix

But even with a cervical opening of 1 - 2 fingers in a period of 28 weeks or more, it is likely to keep the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases are appointed:

• bed rest;
• emotional peace;
• sedatives;
• antispasmodics (magne-B6, no-shpa,);
• tocolytics (ginipral, partusisten).

Be sure to carry out treatment aimed at the production of surfactant in the lungs of the fetus (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature opening of the cervix is ​​​​surgical - stitches are applied to the neck, which are removed at 37 weeks.

The cervix is ​​immature - what then?

The opposite situation is possible, when the cervix is ​​“not ready” for childbirth. That is, the hour X has come (the expected date of birth), and even several days or weeks have passed, but there are no structural changes in the cervix, it remains long, dense, rejected backwards or forwards, and the internal pharynx is impassable or passes the tip of the finger. How do doctors act in this case?

All methods of influencing the neck, leading to its maturation, are divided into drug and non-drug. Medical methods include the introduction into the vagina or into the cervix of special gels and suppositories with prostaglandins. Prostaglandins are hormones that accelerate the process of maturation of the cervix, increase the excitability of the uterus, and in childbirth, their intravenous administration is practiced in case of weakness of the birth forces. Local administration of prostaglandins has no systemic effect (no side effects) and contributes to the shortening and smoothing of the neck.

Of the non-drug methods of stimulating the opening of the cervix, the following are used:

Sticks - kelp

Sticks are made from dried kelp algae, which are highly hygroscopic (absorb water well). Such a number of sticks are introduced into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for opening the cervix is ​​represented by a flexible tube with a balloon fixed at one end. A catheter with a balloon at the end is inserted into the cervical canal by a doctor, the balloon is filled with air and left in the neck for 24 hours. Mechanical action on the neck stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, in some maternity hospitals they refused to conduct a cleansing enema for a woman who came to give birth, but in vain. The free intestine, as well as its peristalsis during defecation, increases the excitability of the uterus, increases its tone, and, consequently, accelerates the process of opening the cervix.

Question answer

How can you speed up the opening of the cervix at home?

• prolonged walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the small pelvis, further stimulating the opening of the cervix;
• watch the bladder and intestines, avoid constipation and prolonged abstinence from urination;
• eat more salads from fresh vegetables seasoned with vegetable oil;
• take a decoction of raspberry leaves;
• stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
• Are there any specific neck opening exercises?

At home, walking up the stairs, swimming and diving, bending and turning the torso accelerates the maturation of the neck. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, yoga. In maternity hospitals there are special gymnastic balls, the seat and jumps on which, during the period of contractions, accelerate the opening of the uterine os.

Does sex really help prepare the cervix for childbirth?

Yes, having sex in the last days and weeks of pregnancy (subject to the integrity of the fetal bladder and the presence of a mucous plug in the cervical canal) contributes to the maturation of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, the semen contains prostaglandins, which have a beneficial effect on the process of maturation of the cervix.

At what opening do attempts begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in a woman in labor already at 8 cm. But until the cervix opens completely (10 cm), and the head sinks to the bottom of the small pelvis (that is, it can be felt by a doctor by pressing on the labia) - you can’t push.

The cervix before childbirth should change significantly, it softens, then shortens and smoothes, and finally, it begins to open. This process is called the maturation of the cervix, with the first and repeated births, it takes place in different ways.

Throughout pregnancy, the cervix was a strong lock that closes the exit from the uterus and preserves the pregnancy.. A hard, long neck did not allow microorganisms to enter the uterus to the baby, and was an obstacle to his premature birth.

However, such a neck is not needed at all during childbirth, and under the influence of a growing level of estrogen and prostaglandin hormones, it begins to change. Softening and shortening of the cervix run in parallel, and usually this process is accompanied by an increase in mucous secretions.

Softening of the cervix before childbirth begins long before the onset of real labor, from a period of 35-36 weeks. This happens due to contractions of the muscles of the uterus, contractions-harbingers. Even if you don't feel them, all women have them. At the same time, the length of the cervix before childbirth also decreases; by the time real contractions begin, the cervix will shorten by about 2 times.

During the birth itself, its smoothing will begin, which will end with full disclosure. In order for the baby to be born, the cervix will have to open up to 10 cm, roughly speaking, to the width of 5 fingers of the hand. Most women go into labor with 1-2 fingers already dilated.

The opening of the cervix before childbirth occurs gradually and almost painlessly, and is accompanied by the discharge of the mucous plug.

The opening of the cervix before childbirth in primiparous and multiparous women occurs in different ways. The cervix consists of two circular fibers that form the internal and external os of the uterus. At the first birth, the internal os opens first, and only then does the external opening begin. With repeated births, there is a simultaneous disclosure of the internal and external os of the uterus. The size of the cervix before childbirth decreases due to its opening and gradual smoothing.

Since the condition of the cervix determines the readiness of the pregnant woman for the onset of childbirth, in the last weeks of pregnancy you will again have to remember the existence of a gynecological chair. At each visit to the gynecologist, the doctor will evaluate her condition during a vaginal examination. Examination of the cervix before childbirth allows you to assess how soft it is, the degree of opening, and how short and flattened the cervix is.

By the beginning of childbirth, the cervix is ​​​​not only shortened and smoothed, there is a change in its direction in the woman's small pelvis. During pregnancy, it is tilted backwards, being, as it were, behind the head of the child, and therefore difficult to reach. By childbirth, the neck is shifted anteriorly, along the wire axis of the pelvis, and now it becomes easily accessible during examination.

A soft, open and short cervix before childbirth indicates their imminent onset. A hard and immature cervix before childbirth can cause labor not to start on time, or there will be anomalies in labor with long, painful contractions, as the cervix will have to soften and open very quickly, during the birth itself. This does not always work out, and then childbirth can end in a caesarean section, because the cervix has not opened.

If your pregnancy is approaching full-term, and there are no signs of cervical ripening, the doctor can speed up this process with the help of kelp or gel.

The main organ in a woman's body, without which it would be impossible to endure and give birth to a baby, is the uterus. The uterus is a hollow muscular organ. It distinguishes 3 main parts: bottom, body and neck. As you can see, the cervix is ​​an integral part of the main organ during pregnancy, respectively, the normal course of the processes of gestation and natural childbirth will also depend directly on its condition. How? Let's figure it out.

Cervix during pregnancy

The cervix is ​​a tube connecting the uterus and the vagina, the ends of which end in holes (the internal pharynx opens into the uterus, the external one opens into the vagina), and the cervical canal passes inside. Normally, throughout almost the entire period of pregnancy, it should have a dense texture with a tightly closed cervical canal, which allows you to keep the fetus in the uterine cavity, and also protect it from the penetration of infections from the vagina.

information Only a few weeks before the date of the expected birth, the cervix begins to undergo changes that will later allow the baby to move freely through the woman's birth canal and be born unhindered.

Sometimes these changes can start ahead of time. The opening of the cervix during pregnancy is a poor diagnostic sign that threatens the loss of a child or premature birth. The reasons for this condition are often:

• Burdened obstetric history (abortions, miscarriages in the early and late stages);
• Injuries of the cervix (operations, childbirth with a large fetus, ruptures in previous births);
• Cervical erosion;
• Hormonal disorders (progesterone deficiency).

Softening and opening of the cervix should occur immediately before childbirth!

Disclosure

In the process of progression of pregnancy in the cervix, there is a partial replacement of muscle tissue with connective tissue. "Young" collagen fibers are formed, which have increased flexibility and extensibility than similar ones outside of pregnancy. Some of them are absorbed, forming the main substance, which leads to an increase in the hydrophilicity of the tissue. Clinically, this is manifested by loosening and shortening of the cervix and gaping of the cervical canal.

Preparation of the cervix for childbirth begins at about 32-34 weeks of pregnancy. It begins to soften along the periphery, but the area of ​​dense tissue along the cervical canal is still preserved. In nulliparous women, during vaginal examination, the external os can pass the tip of the finger, in multiparous women, the canal becomes passable to the internal os for 1 finger. Already by 36-38 weeks, the cervix is ​​\u200b\u200balmost completely softened. The fetus begins to descend into the small pelvis, with its weight it creates a certain pressure on the neck, which helps to further open it.

The opening of the neck begins with the internal pharynx. In primiparas, the canal takes the form of a truncated cone with the base facing upwards. The fruit, gradually moving forward, stretches the external pharynx. In multiparous women, the opening of the cervix is ​​easier and faster, due to the fact that the external os by the end of pregnancy is most often already open by 1 finger. In them, the opening of the external and internal pharynx occurs almost simultaneously.

Immediately before the onset of labor, the cervix of the uterus, both in primiparous and multiparous women, is sharply shortened (smoothed), exhausted, the canal is passed by 2 fingers or more. Gradually, there is a complete opening of the cervix up to 10-12 cm, which allows the head of the fetus and its trunk to pass through the birth canal.

Possible problems

Starting from the 37-38th week of pregnancy, the dominant of pregnancy is replaced by the dominant of childbirth, and the uterus turns from a fetus-place into an expelling organ. Some pregnant women are very afraid of the date of birth, building a psychological barrier to the formation of that very necessary dominant. Against the background of nervous overstrain and the lack of proper psychoprophylactic preparation for childbirth, a woman experiences inhibition of the production of the necessary hormones. The cervix remains unchanged, and the preparation for childbirth of the body is delayed.

For a complete and normal opening of the cervix, the development of regular labor activity is necessary. If weakness of labor pains develops, the process of opening the neck also stops. Not infrequently, this happens with polyhydramnios (overdistension of the uterus occurs and, as a result, a decrease in its contractility) or oligohydramnios (a flaccid or flat fetal bladder does not allow the cervix to be properly affected).

Women over the age of 35 are at risk of this problem. In their case, the cause may be the rigidity (decrease in elasticity) of the tissues.

remember The general condition of a woman's body before childbirth plays an important role. The presence of extragenital endocrine diseases (diabetes mellitus, hypothyroidism, obesity) often leads to the development of complications during childbirth.

Stimulation of the preparation of the cervix for childbirth

Often, just before the date of the expected birth, after visiting the doctor, a woman may find out that her cervix is ​​\u200b\u200b“not mature” and there is a need to artificially prepare her for childbirth. This issue becomes especially relevant after the 40th week of pregnancy, since at these times the placenta depletes its functionality, which leads to fetal hypoxia.

Stimulation of this process can be carried out by two methods: drug and non-drug.

Medical method allows you to achieve the desired result with the help of medicines and only in a hospital setting.

• Introduction to the cervical canal of kelp sticks. Sticks of kelp (seaweed) are placed in the cervical canal for its entire length. Under the influence of moisture, after about 4-5 hours, they begin to swell, mechanically opening the channel. Laminaria also secrete endogenous prostaglandins necessary for the maturation of the cervix. Gradual mechanical and biochemical action of kelp sticks leads to quick and careful preparation of the cervix for childbirth;
• Introduction to the cervical canal of synthetic prostaglandin in the form of candles or gel. Allows you to achieve the desired effect within a few hours;
• In a hospital setting, amniotomy(piercing of the amniotic sac). After this procedure, the anterior waters leave, the fetal head descends, the pressure on the neck increases, and the opening begins to occur faster.

Non-drug method can be used at home, but you should be extremely careful and take into account all the pros and cons.

• Cleansing enema. Its use irritates the back wall of the uterus, causing it to contract. It was also noticed that after this procedure, the mucosal plug is discharged, and the opening of the cervix begins. But it can be done only for those women whose expected date of birth has already come or gone;
• Sex. Natural labor stimulant. Firstly, it causes contraction of the muscles of the uterus, increasing blood flow to it. Secondly, semen contains prostaglandins, the "hormone of childbirth." Contraindication: departed (high probability of infection);
• Physical exercise. Long walks, cleaning the house, climbing stairs to the upper floors. Contraindicated in hypertension, placenta previa.

Now you know how, when and why the cervix is ​​prepared for childbirth. You know the reasons why this might not happen and how you can fix it. Having the information, you can correct or prevent the possible occurrence of problems. Do not forget one thing: it is better to do this in consultation with your doctor!

Every girl and woman knows well how her reproductive system is located and how it functions. Few questions are raised by such organs as the ovaries, uterus, vagina, etc. But no one really cares about purpose. Although it is she who takes one of the important roles in bearing, conceiving and giving birth to children. An experienced doctor, just by looking at her, can accurately determine whether a woman gave birth or not, whether she had abortions, how soon she should expect the next menstruation, and diagnose pregnancy with 95% certainty.

So what is the cervix?

The uterus is an unpaired female muscular organ, it is in it that the human embryo develops. The organ is located in the middle of the cavity Gradually passes from below into the cervix.

The cervix is ​​an organ that looks like a connecting tube that connects the vagina and uterus. Its form, in most cases, depends on whether the woman gave birth or not. The length of this "tube" is about 3-4 centimeters, and the width is about 3 centimeters.

Changes during pregnancy and dilatation of the cervix before childbirth

During pregnancy, the cervix changes and undergoes many changes. Before pregnancy, it is light pink in color, and during pregnancy it acquires a bluish tint. The change in color is associated with the resulting dense vascular network and blood supply.

If at the initial stages deviations in the development or diseases of the cervix are detected, then with timely treatment, the pregnancy can be saved. The fact is that premature opening of the cervix is ​​​​very dangerous. That is what causes spontaneous abortion - miscarriage. In order to avoid miscarriage, in diseases that cause the cervix to open prematurely, doctors use various methods of “strengthening” the cervix, up to suturing it, which is removed before the birth itself.

By the end of pregnancy, the cervix changes, becomes softer, and "ripens". Thus, the female body prepares for childbirth. Before their onset, the cervix smoothly passes into the region of the center of the small pelvis, its length decreases from 3 centimeters to 10 millimeters. The canal gradually opens up by 6-10 cm. The very transition of this cervical canal to the lower segment becomes smooth.

At the end of pregnancy, before the onset of labor, the expansion of the internal os and short contractions with a momentary sensation of pain suggest the onset of labor. At this time, the cervix gradually opens, and as a result, it has a diameter of about 10 centimeters. It is this pronounced action of the cervix that allows the fetus to exit through the birth canal.

It happens that the opening of the cervix is ​​not enough and it is not enough for the passage of the child, so the organ ruptures. This gap can happen not only for this reason, but also because of the rapid labor activity, large fetus, due to childbirth with weak early attempts, etc.

Therefore, if a woman in labor already has a cervical opening that is not yet sufficient for the birth of a child and / or there are weak or no contractions at all, then usually in such cases, doctors decide to stimulate labor. To stimulate labor activity, special medications are used.

For a woman, if you listen to your feelings, it is easy to feel the opening of the cervix, the following symptoms occur:

• Unpleasant sensations at the location of the neck, as if an instant pricking with a needle.
• The back (lower back), hips begins to “whine”.
• spasm-like.

After childbirth, the doctor is obliged to examine the patient, check her cervix. If he finds tears, he will put on the cervix, usually with special absorbable threads.