Cicatricial changes in the cervix after childbirth. Treatment of cicatricial deformity of the cervix. What symptoms should you pay attention to?

N88 Other non-inflammatory diseases of the cervix

Causes of cervical deformity

Deformation of the cervix can develop after certain conditions, and can also be a congenital pathology. It often happens that the development of the female reproductive system is disrupted at a certain point, and various anomalies in the structure of the female organs develop, including the cervix. Congenital anomalies, as a rule, are accompanied by concomitant anomalies of other genital organs - vagina, uterus. More often in women of reproductive age, acquired anomalies in the structure of the cervical canal occur, which arise as a result of adhesions, scars, and deformations after various surgical interventions. Cervical deformities include conditions that are accompanied by a violation of the structure and integrity of the cervix and cervical canal - this is the circular canal of the cervix, narrowing of the cervical canal and its obstruction, elongated cervix, shortening of the cervix or isthmic-cervical insufficiency, cicatricial and post-traumatic deformities cervix.

The circular canal of the cervix is a pathology in which the canal has a funnel-shaped shape due to the incorrect arrangement of muscle fibers in the circular direction. This pathology can occur with ruptures of the internal genital organs due to childbirth and their surgical treatment - suturing; in the future, this can be the cause of such a process if the tissues do not heal properly. In this case, the anatomical location of the muscle fibers of the cervix is disrupted, and it can no longer contract as before, which further contributes to the manifestation of one or another clinical picture.

A narrowing of the cervical canal is its size less than 5 millimeters. In this case, a woman of reproductive age may already experience symptoms in the form of menstrual irregularities such as oligomenorrhea, since a narrow cervical canal can interfere with normal menstruation, which prolongs the period of menstruation with small amounts of discharge. As for pregnancy, this can be a direct threat to normal labor, in case of poor opening of the cervix and an indication for cesarean section. The extreme degree of narrowing of the cervical canal is its obstruction. Obstruction of the cervical canal of the cervix is when a mechanical obstruction forms in the cervical canal, which can cause further deformities.

An elongated cervix is a pathology in which the length of the cervix is more than 45 millimeters, and this is often accompanied by a change in the consistency of the uterus and the thickness of the uterine pharynx.

Shortening of the cervix or isthmic-cervical insufficiency is a condition in which the length of the cervix is less than 35 millimeters, and this is often 20-25, which is a risk of miscarriage in the future and requires correction.

Cicatricial and post-traumatic deformities of the cervix are the most common cause of the development of various pathologies in the future. The cause most often is trauma to the genital organs after childbirth, ruptures of the cervix, damage due to incorrect positions of the fetus, incorrectly applied sutures or the consequences of their scarring, violations of the technique of surgical interventions on the cervix.

All these reasons can disrupt the normal physiological structure of the cervix, and in response to such foreign bodies, regeneration and proliferation of connective tissue develops, and subsequently scar tissue develops, which contributes to tissue deformation.

Symptoms of cervical deformation

Features of the clinical course of various cervical deformities are that symptoms are often not expressed until complications occur and the course is asymptomatic. When certain problems arise with pregnancy, childbirth or the course of certain diseases, only then can this pathology be found. But there are some peculiarities in the clinical picture of some cervical deformities.

The circular canal of the cervix is a deformation that may not manifest itself in any way due to its insignificance, that is, all physiological processes in the uterus and ovaries do not suffer. Problems may arise during the next pregnancy, when there may be incoordination of labor due to improper contraction of the muscle fibers of the circular canal of the cervix, which prevents the normal opening of the cervix.

When the cervical canal is narrowed, the first signs of this pathology may appear in the form of disruption of the ovario-menstrual cycle due to the appearance of a mechanical barrier to the normal menstrual function of the endometrium. But such changes may not occur often, and the narrowing of the canal may be asymptomatic. In the case when the deformation of the uterus, in this situation narrowing, reaches an extreme degree, then cervical obstruction develops - this is a condition that may already have pronounced clinical manifestations. Symptoms of this type of deformation may be the formation of a mechanical barrier, which in women of reproductive age can cause a delay in menstrual blood with its accumulation in the uterine cavity and the formation of an acute condition in gynecology - a hematometer. Then a clinical picture of acute abdominal pain, tension in the anterior abdominal wall occurs, and anamnesis data indicate a delay in menstruation for several weeks or several times in a row.

An elongated cervix is a pathology that is also often asymptomatic. Sometimes in women who have not previously given birth, the first signs of the disease may be dyspareunia - a disruption of the normal process of sexual intercourse, in which the woman does not receive pleasure and sexual desire decreases. This is due to the fact that the elongated cervix does not have a sufficient number of receptors and the blood supply may be poor, which disrupts normal sexual intercourse. There are no painful sensations, since the internal structure is not changed and there are no obstacles. Often a symptom of this type of deformation can be infertility, since problems with conception arise due to the fact that the sperm cannot reach the fallopian tube for the normal fertilization process. Also, a dense mucus plug may form in the elongated cervical canal, which has an acidic environment, which also prevents the passage of sperm.

Symptoms of a long cervix may manifest for the first time during pregnancy or already during childbirth. During pregnancy, the normal attachment of the placenta may be disrupted, since the anatomical structure of the uterine pharynx is disrupted and the placenta may have a central, lateral or low attachment. Problems may also arise during childbirth - there are obstacles to the normal passage of the baby through the birth canal, since the elongated cervix is not dilated enough and the baby's head or the presenting part may remain in the same plane for a long time, which increases the risk of developing hypoxia and may require additional methods - the application of obstetric forceps . This can further injure the birth canal and lead to secondary deformities of the cervix.

Shortening of the cervix, as a type of deformation, has clinical symptoms during pregnancy, since there is a threat of miscarriage. This is due to the fact that normally the length of the cervix throughout pregnancy should be at least 35 millimeters, then at 34-36 weeks the length of the cervix decreases as it prepares for childbirth, and its length is approximately 34-36 millimeters, but maybe 30 and this is considered a normative indicator. In case of non-compliance with these indicators, there may be a pathological birth or complications during childbirth in the form of premature rupture of amniotic fluid, entanglement of the umbilical cord, therefore this type of deformation requires timely diagnosis and treatment.

Cicatricial and post-traumatic deformities of the cervix very often do not manifest themselves, but they require increased attention in women of reproductive age. These deformities occur after a traumatic birth, and symptoms may appear as early as the next pregnancy. In this case, the normal contraction and opening of the cervix will be disrupted, which may contribute to protracted labor or, due to pronounced scar changes, may become an indicator for a caesarean section. The first signs of such deformities may be pain during sexual intercourse, which can be caused by cervical scars that disrupt normal contractions during arousal and disrupt the outflow of blood from the pelvic veins. Secondarily, congestion in the pelvis may develop with further inflammatory or other diseases of the female reproductive system.

Cicatricial deformation of the cervix most often occurs with a large fetus or with abnormal fetal positions. Deformation of the cervix after childbirth can also be asymptomatic, so it is necessary to carefully examine the birth canal and properly manage the postpartum period.

Complications and consequences

Considering the fact that cervical deformation is in most cases asymptomatic, very often these conditions are diagnosed when complications appear. Such complications can appear during childbirth, and then it is very dangerous. Hypoxia of the fetus may occur if its passage through the birth canal is disrupted, as well as birth injuries, cephalohematomas and other disorders of the fetus.

Diagnosis of cervical deformity

The asymptomatic course of various types of cervical deformities complicates timely diagnosis. Such patients have no complaints, and upon examination no special changes are detected.

But it is still necessary to carefully examine the woman even during a routine examination. When examining women with such deformities, there are no special changes: during a bimanual vaginal examination, no complaints or symptoms are identified. Examination in mirrors is also uninformative due to the fact that only the cervix itself is visible, but if the scar deformities are very pronounced, then changes may be visible. Then it is not difficult to suspect the diagnosis. It is necessary to carefully collect a general history and obstetric history, detailing the number of births, their course, and consequences, because this will help to find out whether this woman has risk factors.

Tests do not allow us to suspect this pathology, since general clinical laboratory tests - complete blood count and urine test - are normal. The absence of changes in the general blood test can only exclude inflammatory diseases. Special laboratory tests - smear of the cervical canal for flora and dysplasia - are also unchanged in the absence of concomitant pathology.

Instrumental diagnostics is the “gold standard” in diagnosing various types of deformation, as it allows you to visualize any changes.

Changes in the size of the cervical canal can be diagnosed using ultrasound. For this, a special method is used - cervicometry - this method consists of an ultrasound examination of the cervix and measuring its size. This makes it possible to measure the length of the cervix, its width and the size of the uterine pharynx, which makes it possible to judge the pathology of lengthening and shortening of the cervix. Ultrasound also makes it possible to detect cicatricial deformities of the cervix, if they are significant, since the heterogeneous structure of the cervix is visualized.

Differential diagnosis

Differential diagnosis of various deformities must be carried out primarily with various functional disorders during childbirth. Since the first signs of cervical deformation may occur during childbirth, it is necessary to clearly differentiate secondary weakness of labor with anatomical disorders of the cervix in the form of its deformation. When labor is weak, the cervix opens, but its dynamics are not sufficient for normal childbirth. When the cervix is deformed, it cannot open and its uneven structure is visualized.

It is also necessary to carry out differential diagnosis of cervical deformation, which occurs during infertility. Then many inflammatory factors can be excluded, and the cause of infertility may be different. To do this, it is necessary to carefully examine the woman with mandatory hysterography, which makes it possible to identify defects not only of the cervix, but also of the uterine cavity itself.

Treatment of cervical deformity

Treatment of cervical deformity between births or in women of non-reproductive age is not required, as this condition is not dangerous. In case of infertility, preparation for pregnancy or during pregnancy, measures must be taken as complications may occur.

Treatment of cervical deformity before childbirth can be conservative or surgical. It includes the complex action of massage to improve the outflow of blood and lymph, physical exercises to strengthen the muscles of the pelvis and perineum as a coordinated action of these muscles during childbirth, as well as medicinal methods.

Since deformities involve anatomical disorders, drug treatment methods may be ineffective in the radical correction of this pathology; there may be only symptomatic therapy for certain conditions that are caused by cervical deformation. For example, if the normal opening of the uterine pharynx is disrupted due to a long cervix or deformation, labor is stimulated. This can be done using mechanical methods - a Foley catheter or using amniotomy or manual placental abruption over a short distance. You can also stimulate labor by using kelp. Kelp is seaweed, from which special sticks are made, which increase in size 5-6 times in the vagina and stimulate the opening and smoothing of the cervix. Prostaglandins E2 – misoprostol – are also widely used. This drug, called “Mirolut,” is available in the form of tablets, 4 tablets per pack at a dose of 200 mcg of active substance, and 4 tablets are administered rectally at once. This method of inducing labor with a long cervix is widely used, as it is affordable and effective. Prostaglandins can be used in the form of vaginal suppositories or ointments. Such methods of stimulation are possible only in the absence of scars on the uterus, that is, when previous births were carried out naturally.

Surgical treatment methods have priority in the case of significant deformities of the cervix, since it is possible to correct such deformities. Various surgical treatment methods are used, depending on the type of pathology. Minimally invasive interventions are often performed for certain indications, since they are less traumatic, especially if pregnancy is also planned. In case of disturbances in the structure of the cervix due to deformations, such as narrowing or obstruction of the cervical canal, a special procedure is performed - bougienage of the cervical canal. This is an intervention that consists of expanding the canal with a special tool - a bougie. This is most often a metal tool, which is selected by number, which corresponds to its size, and starting from the smallest to the widest. It is often necessary to repeat the procedure several times, since once is not enough. This intervention is effective for small degrees of narrowing.

In case of more pronounced deformations and huge scar changes in the cervix, open surgical interventions are performed with further cervical plastic surgery. They can perform a small excision of the deformed part of the cervix and subsequently suture such amputations with dilation of the cervix. The choice of surgical treatment method is carried out individually, taking into account the degree of deformity, age and purpose of treatment.

Traditional treatment of cervical deformity

Traditional methods of treating cervical deformities prevail because they do not cause harm when planning pregnancy and can reveal a pronounced effect in certain cases. They use both herbal and traditional methods of treatment. If cervical deformations interfere with the normal dilatation of the cervix already during childbirth, then methods are used that help relax slightly deformed cervical tissues.

The main methods used for this are:

Sea buckthorn oil also has an anti-inflammatory effect in addition to its relaxing effect. Sea buckthorn oil, which can be purchased at a pharmacy, is dipped into a tampon and inserted into the vagina for 2 hours, which is best done before bed. The course consists of at least ten procedures.
Treatment with honey - one tablespoon of honey must be diluted in a liter of boiled water and douched twice a day. This course must be completed over 7-10 days. Honey has a pronounced relaxing effect on the uterine myometrium, and also has a bacteriostatic and immunomodulatory effect.
Using celandine - pour a tablespoon of dried celandine leaves into a glass of boiled water and boil for another five minutes, then let cool and strain. This decoction should be drunk half a glass three times a day for about a week.
Acacia shows a good effect in the treatment of cervical deformities. To prepare the tincture, you need to collect acacia flowers, dry them, add alcohol and leave in a dark place for at least a day, and then dilute with boiled water, take one tablespoon three times a day. The course of treatment lasts one month.
Burdock juice perfectly relieves irritation, swelling and has a healing and antispasmodic effect, which enhances the regeneration of the myometrium and improves its ability to relax. To prepare a healing solution from pre-washed burdock leaves, you need to squeeze out the juice and take one teaspoon three times a day for five days, and then one teaspoon twice a day for another five days.

Herbal infusions are also widely used in the treatment of cervical deformities, as they contribute to the normal nervous regulation of the processes of contraction and relaxation of the cervix.

Basic recipes using herbs:

They recommend a soothing and strengthening herbal tea, which has a hysterotropic effect. To do this, raspberry, strawberry and hawthorn leaves are infused in boiled water and boiled for another five to ten minutes, after which they are drunk instead of tea up to four times a day.
Plantain leaf, horsetail, nettle and lemon balm leaves, dandelion root must be poured into one liter of water and boiled. After this, you need to leave the decoction for 3-4 hours and take a teaspoon in the morning before meals.
Oregano herb, birch buds, St. John's wort leaves, calendula, chamomile, celandine, linden and string are poured with boiling water, infused and drunk half a glass 4 times a day.
Hop cones, valerian, linden, coriander, motherwort and oregano should be poured with a liter of hot water and, after steeping, drink 2 teaspoons in the morning and evening.
blackberry inflorescences and fruits, you can also use blueberries, pour boiling water and leave, add honey for taste and drink a teaspoon three times a day.

Use of homeopathic remedies may be effective if cervical deformities are combined with other hormonal disorders. Homeopathic remedies are also used to treat this pathology. Their main effect is aimed at regulating normal hormonal levels and this contributes to the normalization and tone of the cervix, especially when it is deformed.

The most famous homeopathic medicine that has an effective effect is Caulophyllum, a plant extract that is available in the form of homeopathic granules. During pregnancy, two weeks before childbirth, it is used for prophylactic purposes against cervical deformation in the form of 3 granules twice a day. Already during childbirth, in case of incoordination or weakness of labor, the drug is used 3 capsules every half hour.

Another drug used in this case is Pulsatilla. In addition to its pronounced myotropic effect, it also has a relaxing and analgesic effect. This effect contributes to the normalization of the tone of the uterus and the normal dynamics of dilatation of the cervix in case of cicatricial changes. The drug is available in homeopathic granules and is used in the same dosage and according to the same principle.

The drug Arnica has the same effect, but in addition to the analgesic and hysterotropic effect, its additional function is revealed - the prevention of postpartum hemorrhage. This prevents secondary traumatic injuries.

These are the main methods of treating this pathology, both folk and herbal remedies, and their timely use helps to avoid complications.

Content

The female reproductive system is represented by a hollow organ - the uterus, the cervix of which performs barrier and mechanical functions, as well as the ovaries and tubes. A disruption in the functioning of one of the components will certainly lead to a change in the functioning of the other. One of the diagnosed pathologies in obstetrics and gynecology is cicatricial deformity of the cervix - what is it?

Characteristic

Most often, connective tissue grows at the site of ectropion. Ectropion appears as a result of ruptures of the muscles and mucous membrane of the neck. In this case, the external cervical pharynx becomes deformed, everting into the vaginal canal. Sagging areas are exposed to the acidic environment of the vagina.

Due to altered acidity, the risk of inflammation increases. Such unhealthy processes introduce an imbalance in the nutrition of epithelial cells. As a result, the formula of mucus produced is disrupted, which leads to infectious attacks.

Thus, cicatricial deformity is a pathological change in the cervical canal, which provokes a violation of the anatomical shape of the cervix. The result of tissue tears is excessive growth of connective tissue, narrowing, fusion and scarring.

Such injuries are characterized by varying length and depth and can affect the uterus. As the scar forms, it thickens and becomes inextensible. As a result, the cervical canal either narrows or cannot close completely. This leads to a number of complications both during pregnancy and in everyday life. Violation of the anatomy of the cervical canal leads to an increased likelihood of pathogenic flora entering the uterus. During pregnancy, there is a risk of developing isthmic-cervical insufficiency.

Scar deformation can lead to to the inability to become pregnant and bear a child.

A number of reasons lead to the formation of scar lesions.

Complicated childbirth. With rapid delivery, cervical ruptures occur. The heavy weight of the fetus and its incorrect position also contribute to ruptures. The risk of scar damage increases in primiparous women after thirty years of age.
Incorrect suturing. This procedure requires high skill and experience of the doctor. If suturing is incorrect or the medical thread is excessively tightened, the restoration process may become complicated, causing deformation.
Mechanical disruption of the integrity of the epithelium. When performing gynecological procedures, abortions, operations, the instruments used damage the mucous membrane of the cervical canal.
The result of conization and destruction of pathological formations using electrotechnologies in gynecology (diathermocoagulation, electric loop).

In rare cases, the pathology can be congenital and accompanied by diseases of the genitourinary system.

Often, cicatricial deformation of the cervix does not manifest itself in any way. Occasionally, nonspecific symptoms are recorded, which can also occur with other gynecological ailments:

pathological discharge of a purulent nature;
bloody issues;
pain during sexual intercourse.

If the described signs are ignored and a delay in contacting a gynecologist, the pathology is complicated by endometritis, erosion, keratinization of tissues and even provokes the development of carcinoma.

Treatment

A qualified gynecologist will notice scar deformation already at the initial examination. The doctor examines the cervix using mirrors and takes biological material for cytology. For a more detailed examination, colposcopy is performed, which demonstrates scar changes on an enlarged scale. The doctor also collects affected tissue for biopsy.

The advantages of surgical treatment methods pathology is not only the complete removal of scar lesions, but also the possibility of examining the excised tissue for the presence of atypical cells.

After conducting research and confirming the diagnosis, the doctor chooses an individual treatment regimen for cicatricial deformity of the cervix, always taking into account:

age range;
hormonal background;
area of the affected surface;
associated diseases.

The main goal of treatment is to restore cervical integrity, helping to normalize the protective properties of the reproductive system. Therapy with pharmacological agents makes sense only for hormonal dysfunction or inflammation. In other cases, scar lesions are removed.

The doctor determines the required type of intervention depending on the degree of damage and the age of the patient.

Exposure to radio waves, lasers and electric current. Through radio wave treatment, the affected parts of the tissue are rejected. Diathermocoagulation and laser vaporization are also used. Destructive ablative methods are considered gentle and are effective for minor scar changes. This treatment is successfully used in young women who have not yet given birth, since rapid regeneration of the cervical lining occurs.
Conization. Cutting off the cone-shaped part of the affected neck. Such radical treatment methods are used in women who have left the reproductive period.

It should be understood that after removing many scars, an additional operation will be required - plastic restoration of the neck.

After surgical interventions, treatment is carried out aimed at blocking inflammation and regenerating the vaginal microflora. In addition, it is necessary to take preventive measures to prevent recurrence of deformity in the cervical canal. For this, proteolytic enzymes are used - Longidase, Wobenzym - the most popular drugs.

If cicatricial deformity is diagnosed during pregnancy, you should be regularly monitored by a gynecologist. Since such a pathological condition of the cervix can negatively affect the course of pregnancy. In addition, there is a possibility of intrauterine infection due to the unhindered penetration of pathogenic bacteria into the uterine cavity.

In difficult cases and when diagnosing isthmic-cervical insufficiency, sutures are placed on the cervix. An alternative to surgical interventions during pregnancy is the placement of an obstetric pessary, which supports the cervix until delivery.

With timely detection of deformed tears and their correct excision, restoration occurs without deformation.

Cicatricial deformity of the cervix is a serious pathology that requires competent treatment. Carrying out reconstructive operations restores the healthy shape of the cervix and its protective functions.

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

Collapse

What is the disease?

Uterine deformation 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.
Impaired cervical patency.
Reducing length.
Scar changes.

Pathology may not always manifest its symptoms and correcting this deviation from the norm is problematic until the woman visits a gynecologist.

Causes

A deformed cervix can be a congenital pathology or develops as a result of certain conditions. If we are talking about a hereditary form, then, as a rule, anomalies in the development of other genital organs, for example, the uterus or vagina, are simultaneously diagnosed.

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

Formation of adhesions in the pelvic organs.
Deformation after gross intervention, for example, 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 correctable or not.

Symptoms of pathology

The disease is different in that up to a certain point it can occur without obvious signs. It is discovered only when a woman has problems conceiving or carrying a baby or during her next examination by a doctor.

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

With a circular canal of the cervix, no changes are observed. But the problem appears during labor, when the muscle fibers of the cervix contract incorrectly, which prevents it from opening.
If the cervix is narrowed, this may result in menstrual irregularities. It becomes more scarce due to the existing obstruction to the normal outflow of blood.
If the cervix is obstructed, menstruation is delayed and blood accumulates in the uterus. A woman experiences abdominal pain and tension in the abdominal wall.
An elongated neck can affect sexual intercourse, or rather the woman’s sensations during it. Sexual desire decreases and orgasm dulls due to an insufficient number of receptors.
A shortened cervix can make itself felt during pregnancy. The risk of miscarriage and premature birth increases.
Cicatricial deformation 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, for timely diagnosis and treatment it is important to undergo regular examination by a doctor.

Types of disease

There are two types of pathology:

Despite the fact that pathological changes may not manifest themselves at all 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 she should not self-diagnose or self-medicate. You need to rush to see a gynecologist. An accurate diagnosis is made based on:

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

Is it possible to give birth with a deformed cervix?

Of course, no one can forbid a woman from giving birth, but we must keep 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, this can lead to disruption of labor; the uterus dilates poorly, which may be an indication for a cesarean section.
A shortened cervix does not prevent fertilization, but, as a rule, it is quite difficult for a woman to bear a baby, and premature birth is often observed.
An elongated cervix may interfere with the proper attachment of the placenta. And during the birth of a baby, it cannot fully open, which makes it difficult for the child to pass through the mother’s birth canal. There is a danger of developing oxygen deficiency.

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

Therapy

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

The severity of the pathology and its varieties.
Does the woman plan to have children in the future?
Age.
Presence of chronic diseases.

The main goal of treatment is to eliminate scar changes and return the cervix to its natural position. The main methods of therapy can be named:

Drug treatment.
Destructive methods.
Surgical intervention.

As for drug therapy, it is advisable only if the deformation of the cervix 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 hormone deficiency.

Destructive methods include:

Cryodestruction is the removal of affected tissue after freezing with liquid nitrogen.
Diathermocoagulation. The deformed areas are exposed to high frequency currents.
Laser plastic surgery.

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

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 obstruction, then bougienage is performed using a special instrument. It should be noted that most often the procedure needs to be carried out several times.
In the presence of large curvatures or scar lesions, surgery is performed followed by cervical plastic surgery.

After surgical reconstruction, it is impossible to give birth to a baby naturally.

Recovery after surgery takes about 10 days, but taking into account the complexity, it can reach 3 months.

Complications and consequences

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

Development of cervicitis, endometritis, which increases the risk of erosion.
The risk of keratinization of the tissues of the cervical canal increases.
Impaired epithelial formation.
Tissue death and development of malignant tumors.
Severe inflammatory processes.
With the scar form of the disease, the ability to conceive is reduced.
The risk of premature birth and miscarriages increases.

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

It is impossible to play it safe to avoid damage to the cervix and its deformation. But only careful attention to your health significantly reduces the risk of developing the disease. Correct treatment tactics will prevent the development of serious complications.

(RDSM) - post-traumatic or congenital disorder of the anatomical shape of the cervix with incompetence of its cervical canal. In most cases, clinical symptoms are mild. The pathology can be manifested by the presence of cervical leucorrhoea, dyspareunia, pelvic pain, and an increase in the duration of menstruation. When making a diagnosis, data from anamnesis, speculum examination, colposcopy, cytomorphological and laboratory tests are taken into account. Surgical methods are used for treatment: ablation, tracheloplasty, conization, trachelectomy, and 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 in 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. 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 ADSM is due to the significant impact of the disease on increasing the risk of infertility, inflammatory and oncological processes.

Causes of RDSM

The formation of scars that disrupt the normal anatomical structure of the cervix is usually caused by processes and interventions that damage the epithelium with underlying muscles and connective tissue. The most common causes of scar deformity are:

Pathological birth. Cervical ruptures occur during rapid labor with insufficient opening of the cervical canal, the application of obstetric forceps, a large fetus or its incorrect position. The likelihood of damage is twice as high in primiparous women over 30 years of age.
Invasive manipulations. During abortions, therapeutic and diagnostic procedures and endoscopic operations in the uterine cavity and its appendages, the doctor inserts instruments through the cervical canal. In this case, the integrity of the epithelium is violated.
Errors when placing sutures. The regeneration process suffers when ruptures that occur during childbirth are insufficiently or incorrectly sutured, or when invasive manipulations are carried out roughly.

It is extremely rare that a scar-type cervical deformity is congenital. In such cases, the disease is usually accompanied by pathology in other organs of the female genital area.

Pathogenesis

When scar deformation forms, the process of physiological restoration of areas of damaged exo- and endocervix is disrupted. Instead of epithelial cells, connective tissue proliferates in the rupture zone. At first it is quite elastic, but as the scar forms, it becomes denser and 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 scarred changes cannot fully open, which complicates its course. With deep tears, the edges can heal in the form of flaps. Incompetence of the cervical canal is accompanied by the development of ectropion.

Classification

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

Idegree. The external pharynx allows the tip or entire finger of the doctor to pass through. 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 tears does not exceed 2 cm. Signs of ectropion of the lower parts of the cervical canal are revealed.
IIdegree. The external os cannot be identified. The cervix is “split” into separate anterior and posterior lips, with old tears extending into the fornix. The endocervix is completely everted.
IIIdegree. Old tears reach the vaginal vaults. The external os is not defined. One of the lips of the neck is hypertrophied. Epithelial dysplasia and signs of an inflammatory process are noted.
IVdegree. It manifests itself as a combination of old ruptures that extend to the vaginal vaults, with insufficiency of the pelvic floor muscles.

Symptoms of ADSM

In stage I RMS, the only sign of the disease is often an increased amount of mucous cervical discharge. With grade II-IV scar deformity, some patients complain of nagging or aching pain in the lower abdomen and in the lumbosacral region. The addition of infection is accompanied by a change in the color of the leucorrhoea, which becomes cloudy, whitish or yellow. The cyclicity of menstruation is usually not disrupted, but their duration may increase by 1-2 days. In 13-15% of cases, women report pain during sexual intercourse. One of the signs of a scar deformation process in the cervical 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 sharply. A scarred cervix during childbirth exhibits functional failure - natural childbirth is delayed or becomes impossible. The disease is one of the causes of cervical infertility.

Diagnostics

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

Gynecological examination on a chair. When examined in the mirrors, expansion of the external pharynx, old tears, and 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 scar changes on the surface of the cervix and cervical canal is studied in more detail.
Cytomorphological study. Smear cytology and biopsy histology make it possible to assess the condition of the cervical cells, as well as timely detect tissue degeneration.
Laboratory diagnostics. To identify specific and nonspecific infectious agents in the presence of an inflammatory process, serological tests, PCR and flora culture are used.

Detection of gross scar changes facilitates diagnosis. If there are complications, consultation with a gynecological oncologist and dermatovenerologist may be required.

Treatment of RDSM

Since the disease is accompanied by anatomical changes, surgical methods are the most effective for its treatment. The choice of a specific technique is determined by the degree of deformation, the woman’s reproductive plans 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, and diathermocoagulation are used. Ablation is effective for grade I deformity in patients of reproductive age planning pregnancy.
Tracheloplasty. During reconstructive operations, scar tissue is removed using the method of partial or complete dissection while preserving the muscle layer and mucous membrane, and the cervical canal is restored. The method is indicated for women of childbearing age with II-III degree of scar deformity.
Conization and trachelectomy. Excision of the affected areas or amputation is performed when the deformity is combined with intraepithelial neoplasia or failure of the pelvic floor muscles. Radical operations are more often performed in patients who have passed reproductive age.
Purse-string sutures. If signs of isthmic-cervical insufficiency appear during pregnancy, the locking function of the cervix is restored mechanically. An alternative to surgery in this case may be the installation of an obstetric pessary.

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

Prognosis and prevention

Carrying out reconstructive plastic surgery in 90-93% of cases allows you to restore the normal shape and function of the cervix. The effectiveness of applying purse-string sutures to pregnant patients with cicatricial deformity complicated by isthmic-cervical insufficiency ranges from 70 to 94% (depending on the chosen technique). To prevent the disease, it is recommended to justify the appointment of invasive procedures, timely registration during pregnancy, proper preparation for childbirth and its competent management. If there are traumatic ruptures, it is important to have them sutured in a timely manner with subsequent monitoring by a gynecologist.

Cervical deformation is a change in the natural state of the cervix, as well as its vaginal part. Most often, deformation of the cervix occurs after abortion, during childbirth, since small cracks and tears form during the passage of the fetus through the cervix, 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 smoothes, allowing it to open 8-10 cm and allow the baby's head to pass through easily. Quite often, cervical ruptures occur during the passage of the fetus through the birth canal. The causes of these undesirable phenomena may be: previous ruptures during childbirth, high weight of the child, gynecological operations, abortions, weak labor followed by rapid labor, incorrectly selected obstetric forceps, untimely strong attempts. As a result, cervical ruptures form. Tears and cracks can be of different depths and even touch the vagina and the uterus itself. Therefore, at the end of labor, the doctor is obliged to carefully examine the cervix and the uterus itself for ruptures. If any are detected, they are sutured with special threads, which will resolve themselves over time.

If not all ruptures were detected and sutured, the cervix becomes deformed, its shape and pharynx change. The woman in labor herself may not feel any changes. Most often, an irregular cervix does not cause any concern to the woman and does not in any way affect the patient’s well-being. But this factor can play a decisive role in planning a future pregnancy, since an abnormal cervix can lead to involuntary miscarriages, bleeding, leakage of amniotic fluid and, as a result, premature birth. Therefore, it is very important after childbirth to undergo an examination of the cervix 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 incorrectly sutured or not sutured at all become healed. After which the woman develops cicatricial deformity of the cervix. In this case, the cervix becomes deformed and turns into the vaginal part. Cicatricial deformation of the cervix can lead to many diseases: infectious, severe inflammatory processes, which can be aggravated by purulent rashes, hardening of the endometrium, cervical erosion and even the formation of cancer cells. For women who are trying to get pregnant or carry a child to term, cervical scarring can be a significant cause for concern.

Very often, cicatricial deformation of the cervix does not manifest itself in any way, although obvious signs of this pathology may be: disruptions in the menstrual cycle, as well as profuse discharge during the cycle itself, unpleasant pain in the lower abdomen, painful sexual intercourse, white discharge that 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 using mirrors, a colposcopy, cytology of smears will be prescribed, and you will also need to take some tests. If, nevertheless, you have been diagnosed with 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, original 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 experience 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 severe changes in the cervix, or rather, its inversion into the vaginal part, a woman can develop: keratinization of the tissues of the cervical canal, death of the epithelium, endometritis, cervicitis, erosion, inflammatory processes and even cervical cancer. Therefore, you should not delay timely treatment for long, which can prevent many health problems in the future.

Cervical deformity: treatment

When choosing treatment for cervical deformity, many factors are taken into account: what caused the development of the disease, the degree of tissue damage, the patient’s age, concomitant infections and inflammatory processes. Most often, cervical deformity is treated through surgery or destructive methods. If the changes are minor, the tissues are not deeply affected, then laser plastic surgery, cryodestruction or diathermocoagulation are 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 the woman will be able to become pregnant and bear an absolutely healthy baby.

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