When the internal os opens. The maturity of the cervix is ​​determined using a special scale. Sizes and condition during pregnancy

The period of waiting for a child brings numerous changes to a woman's body. One of these is oscillatory and periodic dilation of the cervical pharynx. The normal state of this part of the female body looks like pale pink, loose tissue; after hormonal changes due to conception, it acquires bluish tint, associated with increased blood flow in this area. The appearance of the cervix is ​​a very informative indicator for the gynecologist during interesting situation pregnant. The functionality of the internal pharynx is aimed at protecting healthy development baby from infection from outside. The general course of the baby's waiting period can be assessed by location, density and color muscle tissue, as well as by normal indicators canal duct.

If any changes are detected, such as softening of the mucous membrane or opening of the canal, the doctor usually prescribes diagnostic procedures and subsequent treatment in case of urgent need. According to generally accepted medical indications Cervical examinations are performed at specific times, corresponding to approximately 20, 28, 32 and 36 weeks. If more frequent examination procedures are required, then there are some problems, even minor ones, that force you to listen to the doctor’s recommendations and follow all his prescriptions. The most dangerous deadlines The first trimester is considered to open the uterus, when the fetus is still very small and the possibility of miscarriage is quite high. Insufficient closure of the lower part of the cervix is ​​not always accompanied by hormonal changes inherent in pregnancy; sometimes the cause may be congenital pathological disorders uterine structure, causing isthmic-cervical insufficiency.

Symptoms preceding the opening of the isthmus

Signs of dilatation of the lower part of the cervix differ in their manifestations depending on the duration of pregnancy. Very often this process is not accompanied by any painful sensations, nor any other signals, which is extremely dangerous because it increases the risk of fetal loss significantly. Sometimes in the first trimester, cramping pain in the lower abdomen may appear, indicating increased tone of the uterus. Loose closure of the pharynx due to isthmic-cervical insufficiency (ICI) is characterized by periodic but intense pain syndrome in the vaginal area.

With ICI, the isthmus that holds the fetus inside the uterine cavity softens and relaxes so much that it loses its functional ability under the weight amniotic fluid. Clarification of the presence of this type of insufficiency is carried out using the transvaginal method. ultrasound diagnostics. Since the way to measure duration uterine cervix, which should be in within normal limits 2-2.5 cm, not entirely effective.

Isthmic cervical insufficiency, as the most dangerous messenger of a possible opening of the internal os of the cervix. Except congenital pathology uterine tracts, ICN has two types of origin: functional, which occurs when hormonal changes, in particular increasing male androgens, and post-traumatic. The latter type develops after unsuccessful or frequent abortions, as well as due to birth injuries and ruptures. On early stages the occurrence of this diagnosis increases the risk of miscarriage no less than in the middle or at the end of the period. At the beginning of the journey of expecting a baby, the risk of losing the fetus comes down to its small size and weakness of the isthmus muscles. But, starting from the second trimester and until the end of the entire pregnancy, isthmic-cervical insufficiency can provoke a miscarriage in another way. Due to partial dilatation of the cervix, infection of the amniotic fluid may occur with the development inflammatory process, which will inevitably lead to the threat of interruption or damage to the formation of certain functions or organs in the child himself.

Possible methods of prevention and treatment when there is a threat of spontaneous abortion due to the opening of the internal pharynx.

Prevention and treatment

From preventive measures The main precautions are those that exclude an increase in the muscle tone of the uterus:

• Sexual rest with exception sexual relations until the end of the baby's waiting period.
• Anti-caffeine diet with limited chocolate consumption.
• Limiting your stay in warm and stuffy rooms, as well as observing the sunbathing regime.
• Avoiding overheating of the entire body in saunas, steam rooms and even hot baths.

From medical procedures, due to inexpediency preventive measures, common:

• Surgical intervention. If the diagnosis is established with absolute accuracy and there really is a risk of miscarriage, the only way out The isthmus will be sutured to avoid further stretching due to softening. Sutures are applied with non-absorbable material for a period from one and a half months to the end of the term, or more precisely until reaching 38 weeks. Unfortunately, in in some cases and this way of preserving the fetus may not work due to various kinds reasons: from maternal diseases to pregnancy pathologies.
• Installation of the pessary ring. A mechanical effect that maintains the opening of the pharynx by strengthening a ring structure made of plastic or silicone called the “Meyer ring” on the cervix. The treatment period lasts from 20 to 38 weeks of pregnancy. The disadvantage of this method is the organic rejection of the part female body And increased risk infection of the fetus due to foreign material.
• Drug treatment, expressed in intravenous drip injections, is prescribed in the form of hormonal therapy, as well as medicines with a concentration of magnesium, vitamins and antispasmodics.

As it turns out, the question of cervical dilatation, the timing and size of the opening in centimeters or transverse fingers and how to interpret this worries all pregnant women. However, many do not know a clear answer. We will try to illuminate as much as possible this topic and let's start with the anatomical features.

The uterus is important body reproductive system women and consists of the body of the uterus and the cervix. The cervix is ​​a muscular tubular formation that starts from the body of the uterus and opens into the vagina. The part of the cervix that is visible when examined in speculums is called the vaginal part. The internal os is the transition of the cervix into the uterine cavity, and the external os is the border between the cervix and the vagina. In these places the muscle part is more pronounced.

During pregnancy, some of the muscle fibers in the cervix are replaced by connective tissue. Newly formed “young” collagen fibers are stretchable and elastic; when they are formed excessively, the cervix shortens and the internal os begins to expand.

Normally, throughout pregnancy, the cervix is ​​long (about 35 - 45 mm), and the internal os is closed. This position helps prevent spontaneous miscarriage and also protects against infection entering the uterine cavity.

Only a few weeks before the expected date of birth (EDD), the cervix changes its structure, gradually becoming softer and shorter. If shortening, softening of the cervix and expansion of the internal os occurs during pregnancy, then this condition threatens termination of pregnancy or premature birth.

Causes of premature shortening of the cervix:

A burdened obstetric history (abortions, miscarriages at different stages, premature birth history, especially very early preterm birth before 28 weeks)

Aggravated gynecological history (infertility, polycystic ovary syndrome and other gynecological diseases)

Cervical injuries (surgeries, ruptures in previous births, large fetus births)

Norms for the cervix by timing

Up to 32 weeks: the cervix is ​​preserved (length 40 mm or more), dense, the internal os is closed (according to ultrasound results). On vaginal examination, the cervix is ​​firm, deviated posteriorly from the pelvic axis, and the external os is closed.

The wire axis of the pelvis is a line connecting the midpoints of all direct dimensions of the pelvis. Since the sacrum has a bend, and then the birth canal is represented by the muscular-fascial part, the wire axis of the pelvis is represented by a curved line, reminiscent of a fishhook in shape.

32–36 weeks: the cervix begins to soften peripheral parts, but the area of ​​the internal pharynx is dense. The length of the cervix is ​​approximately 30 mm or more, the internal os is closed (according to ultrasound). During a vaginal examination, the cervix is ​​described as “tight” or “unevenly softened” (closer to 36 weeks), deviated posteriorly or located along the wire axis of the pelvis; cervical canal.

From 37 weeks: the cervix is ​​“mature” or “ripening”, that is, soft, shortened to 25 mm or less, the pharynx begins to expand (cervical length funnel-shaped expansion uterine pharynx is described by ultrasound). On vaginal examination, the external os may allow 1 or 2 fingers to pass through, the cervix is ​​described as “softened” or “unevenly softened”, located along the wire axis of the pelvis. At this time, the fetus begins to lower its head into the pelvis and puts more pressure on the neck, which contributes to its ripening.

To assess the cervix as “mature” or “immature”, a special table (Bishop scale) is used, where the parameters of the cervix are assessed in points. Nowadays, the modified Bishop scale (simplified) is most often used.

Interpretation:

0 – 2 points - the cervix is ​​“immature”;
3 – 4 points - the cervix is ​​“not mature enough”
5 – 8 points - the cervix is ​​“mature”

The ripening of the cervix begins in the area of ​​the internal os. For primiparous and multiparous women, the process occurs slightly differently.

In primigravidas (A), the cervical canal becomes similar to a truncated cone facing wide part up. The fetal head, falling down and moving forward, gradually stretches the external pharynx.

In multiparous women (B), the expansion of the external and internal pharynx occurs simultaneously, therefore repeated births, as a rule, proceed faster.

1 – internal pharynx
2 – external pharynx

Cervix during labor

Everything we described above applies to the condition of the cervix during pregnancy. During pregnancy, the terms “shortening of the cervix”, “dilation of the internal os”, “cervical maturity” are used. The term “dilation” or “opening” (they mean the same thing) begins to be used only with the onset of labor.

By the time of birth, the cervix, gradually shortening, is completely smoothed out. That is, it ceases to exist as an anatomical structure. The long tubular structure is completely smoothed out and only the concept of the “internal os of the cervix” remains. Its opening is calculated in centimeters. As the labor activity the edges of the internal pharynx become thinner, softer, more pliable, which makes it easier for them to be stretched by the fetal head.

Depending on the degree of opening of the internal pharynx, labor is divided into periods I and II:

I stage of labor This is what is called “the period of dilatation of the internal os of the cervix.” The first period is divided into phases.

During the latent (hidden) phase, the internal os gradually opens up to 3–4 cm. Contractions during this period are moderately painful or painless, short, occurring in 6–10 minutes.

Then the active phase of the first stage of labor begins - the rate of opening of the uterine pharynx should be at least 1 cm per hour in primiparous women and at least 2 cm per hour in multiparous women, contractions in this period become more frequent and occur once every 2 to 5 minutes, becoming longer ( 25 – 45 seconds), strong and painful.

The internal os should open to 10 - 12 cm, then this is called “full opening/dilatation” and the second stage of labor begins.

II stage of labor called the period of “expulsion of the fetus.”

At this stage, the uterine os is fully open, and the fetal head begins to move along birth canal to the exit.

The dynamics of the opening of the uterine pharynx is reflected in the partogram, which is maintained from the beginning of the latent phase and is filled out after each obstetric examination.

A partogram is a method of graphically describing childbirth, which reflects in the form of a graph the dilatation of the cervix in centimeters, time in hours, the advancement of the fetus along the pelvic planes, the quality of contractions, the color of the amniotic fluid and the fetal heartbeat. Below is a simplified version of the partogram, which reflects only the parameters that interest us in this topic, that is, the opening of the uterine pharynx over time.

In order to clarify the obstetric situation, the doctor conducts an internal obstetric examination, the frequency of which depends on the period and phase of labor. In the latent phase of the first period, examination is carried out once every 6 hours, in active phase in the first period, 1 time every 2–4 hours, in the second period, 1 time per hour. If any deviation from the physiological course of labor develops, the examination is carried out according to indications over time (the frequency of examinations is determined by the doctor leading the birth, examination by a council of doctors is possible).

Pathologies associated with the process of cervical dilatation:

1) Pathological condition associated with shortening of the cervix and/or expansion of the internal os during pregnancy:

2) Pathology of cervical dilatation in the preliminary period.

The preliminary period is a condition with rare, weak cramping pain in the lower abdomen and lower back, which develops during full-term pregnancy and mature cervix, lasts about 6 – 8 hours and gradually progresses into the first stage of labor. The preliminary period is not observed in all women.

The pathological preliminary period is irregular short painful contractions with a mature cervix, which last more than 8 hours and do not lead to cervical effacement.

3) Pathologies of cervical dilatation during childbirth.

-weakness ancestral forces. Weakness of labor forces is the contractile activity of the uterus that is insufficient in strength, duration and regularity. Weakness of labor is manifested by a slow rate of dilatation of the cervix, rare, short, insufficient contractions that do not lead to the advancement of the fetus. This diagnosis is made based on observation of the pregnant woman, the results of carditocography (CTG) and vaginal examination data. The above figure shows the result of CTG with weak labor forces, as we see contractions here of weak strength and short duration. For comparison with the norm, we provide the figure below.

Primary weakness of labor forces is a condition when contractions initially did not become sufficiently effective.

Secondary weakness of labor forces is a condition in which the developed regular and effective labor activity fades away and becomes ineffective.

- discoordination of labor. Discoordination of labor is pathological condition, in which there is no consistency between abbreviations different departments uterus, contractions are uncoordinated and can be very painful due to their non-productivity (the fetal head does not move along the birth canal). For example, the fundus of the uterus is actively contracting, but the cervix (uterine pharynx) is not opening sufficiently, or the cervix is ​​opening, but the fundus of the uterus is not contracting effectively enough. The figure below shows the result of CTG during discoordinated labor, contractions have different strength and frequency.

A form of incoordination of labor, in which the body of the uterus actively contracts, and the cervix does not have sufficient dilatation due to scar changes (consequences of abortion, old ruptures, cauterization of erosion) or an undiagnosed condition (there is no indication of pathology or trauma to the cervix in the history) is called dystocia cervix. This form of pathology is characterized by painful nonproductive contractions and pain in the sacral area. With internal obstetric study the doctor sees a spasm of the uterine pharynx during contractions and rigidity of the edges of the internal pharynx of the cervix (tightness, inflexibility).

- rapid and rapid birth. Normal duration birth process is 9 – 12 hours, for multiparous women it may be less, approximately 7 – 10 hours.

Primiparas give birth quick labor Labor is considered to be less than 6 hours, and rapid labor is considered to be less than 4 hours.

In multiparous women, rapid labor is considered to be labor of less than 4 hours, and rapid labor is considered to be less than 2 hours.

Fast and rapid labor is characterized by an accelerated rate of opening of the cervix and expulsion of the fetus. In some cases, this is a blessing, since delay can lead to complications (pathologies of the umbilical cord, placenta, and others). But often, due to the rapid pace of labor, the child does not have time to correctly go through all stages of the biomechanism of childbirth (adaptation soft bones the child’s skull to all bends of the mother’s pelvic bones, timely rotations of the body and head, flexion and extension of the head), and an increased risk birth trauma(both mother and newborn).

Treatment for premature cervical dilatation:

1) Isthmic - cervical insufficiency treated by placing circular sutures on the cervix (from 20 weeks) or installing obstetric pessary(from about 15-18 weeks).

2) Pathological preliminary period. After the observation period has expired (8 hours) and there is no dynamics during a repeated vaginal examination, an amniotomy is performed (opening amniotic sac). If the cervix remains shortened, but does not smooth out, then oxytocin may be administered to stimulate labor. If the cervix has smoothed out, but there is no regular labor, then they talk about the transition of the pathological preliminary period into primary weakness of labor.

3) Weakness of generic forces. Amniotomy is performed as the first therapeutic measure with weak labor activity. After amniotomy, dynamic monitoring of the woman in labor, counting of contractions, CTG monitoring of the fetal condition and obstetric examination after 2 hours are indicated. If there is no effect, drug treatment is indicated.

With primary weakness, labor is induced, with secondary weakness, labor is intensified. In both cases, the drug oxytocin is used, the difference is in the initial dose and the rate of delivery of the drug through the infusion pump (drip dosage administration). If there is no effect of treatment, delivery by cesarean section is indicated.

4) Discoordination of labor (cervical dystocia). When discoordinated labor develops, the woman in labor must undergo labor anesthesia using narcotic analgesics (promedol intravenously in an individual dose under CTG control) or therapeutic epidural anesthesia (single injection of anesthetic or prolonged anesthesia with periodic administration of the drug). The type of anesthesia is selected individually after a joint examination by an obstetrician-gynecologist and an anesthesiologist-resuscitator. If there is no effect of treatment, delivery by cesarean section is indicated.

5) Rapid and rapid birth. In this case, the most important thing is to end up in a maternity facility. It is impossible to stop labor, but it is necessary to monitor the condition of the mother and fetus as carefully as possible. Cardiotocography is performed (the main thing is to clarify the condition of the fetus, whether there is hypoxia), if necessary ultrasonography(suspecting placental abruption). When rapid labor There must be a neonatologist (micropediatrician) in the delivery room and there must be conditions for providing resuscitation care newborn. C-section indicated in the event of an emergency clinical situation (placental abruption, acute hypoxia or incipient fetal asphyxia)

After reading the article, you realized what an important and unique formation the cervix is. Pathologies of the cervix and in particular pathologies of cervical dilatation, unfortunately, do and will continue to occur, but any deviations from the norm can be treated the more successfully the sooner you see a doctor. And then the chances of maintaining your health and timely birth healthy baby increase significantly. Take care of yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

From the beginning of pregnancy, colossal changes occur in a woman’s body to preserve and develop the unborn baby. Key work This is done by the uterus, a muscular sac with an epithelial layer, thanks to which the baby can develop in safety from external infections. Bottom part The uterus is a muscular ring that connects it to the vagina. This ring is called the cervix. It performs the main function of protection against premature birth. Anatomically, the cervix consists of an external os, which is located on the border with the vagina, and an internal os, on the border with the uterus. The length of the cervix in a non-pregnant woman is 25 mm.

The cervix is ​​a dynamic organ; it changes throughout monthly cycle in a non-pregnant woman, the cervix opens during ovulation and menstruation; at the beginning of a new cycle, the cervix closes and rises. If fertilization occurs, the first thing that changes is appearance and the location of the cervix: it lengthens and acquires a bluish tint due to increased blood circulation, becoming dense and tight. During the examination, the doctor can accurately determine whether there is a threat of miscarriage; if the cervix is ​​tightly closed, does not allow a finger to pass through, and is also slightly deviated, there is no threat. But if the cervix is ​​partially dilated or loose, hospitalization is necessary to avoid premature birth.

Normally, the cervix changes during the entire period of pregnancy in the following parameters:

• up to 14 weeks pregnancy length is 35-36 mm;
• 10-14 weeks – up to 39 mm;
• 20-24 weeks – 40 mm;
• 25-29 weeks – 42 mm;
• from 30 to 34 weeks it decreases to 37 mm;
• from 35 weeks the length is 29 mm.

A closed internal os of the cervix is ​​important for the correct and safe development of the child, since it:

• promotes retention of the fetus in the uterus until timely birth;
• protects the fetal bladder from infection;
• prevents infection.

During normal functioning of the body, the cervix begins to shorten and expand, and also changes its structure to loose and soft. This allows the fetus to descend in preparation for birth.

If the pregnancy proceeds without complications, the internal pharynx of the cervix should be closed, but there are cases when the pharynx is partially opened, which can cause miscarriage, infection or premature birth. There may be several reasons why the cervix does not close:

All this develops isthmic-cervical insufficiency (ICI) - premature expansion of the internal pharynx, in connection with this the fetus descends into lower cavity of the uterus, further dilatation and premature birth occur under pressure.

If a pregnant woman experiences symptoms such as heaviness in the lower abdomen; feeling of fullness in the vagina, copious discharge, the doctor conducts gynecological examination using a speculum and prescribes a transvaginal ultrasound, which will accurately examine the cervix and determine that the internal os is closed.

How to close the cervix

When the cervix is ​​shortened and partial dilatation is observed, doctors carry out procedures to help close the pharynx. There are several methods to:

• therapeutic;
• conservative;
• surgical.

Therapy consists of taking hormonal drugs based on progesterone, which help stabilize the condition and possible closure of the cervical canal. Such drugs include Duphaston, Utrozhestan. Two weeks after prescribing the drug, it is necessary to diagnose the cervical canal to determine the effectiveness of this method; if all is well, the drug is prescribed for long-term use.

Can be helpful for drug therapy if ICI progresses or independently.

This method includes the installation of a pessary. An oval ring is placed on the cervix so that it rests against the walls of the vagina. This will remove the main load from the internal pharynx.

This method allows you to close the cervix and:

• carried out at any stage of pregnancy;
• does not require the use of anesthesia and hospital observation;
• used for multiple pregnancies.

Use the ring only for early stage ICN, when the cervical canal is completely closed.

An obstetric pessary is foreign body in a woman’s body, therefore it is important to carry out preventive cleaning of the ring itself and sanitization of the vagina in order to avoid the development of vaginal dysbiosis.

There are contraindications for installing a pessary:

• partial opening of the internal pharynx;
• non-developing pregnancy;
• protrusion of the membranes through the internal os;
• the presence of infectious and inflammatory sexual diseases;
• periodic bloody issues.

The ring is removed at 37–38 weeks of pregnancy or at the beginning of labor.

It consists of suturing the cervix and thereby compressing the cervical canal. This method is used if there is a real threat of miscarriage and other methods are not effective.

Held this operation in early pregnancy and no later than 28 weeks. It is important that the amniotic membranes are not broken and do not prolapse into the cervix, otherwise infection is possible.

Contraindications for suturing:

• present infectious diseases genitourinary system;
• placenta previa;
• pathologies of fetal development;
• severe maternal illness.

Before the procedure, it is necessary to carry out therapy aimed at reducing the tone of the uterus, as well as an ultrasound examination that will determine the condition of the fetus and the location of the placenta. Since suturing is a surgical procedure using anesthesia, inpatient preparation before surgery and observation after surgery are required. It is necessary to undergo a weekly examination by a doctor and periodically sanitize the vagina. Because it can provoke increased tone uterus, the use of drugs such as Ginipral and Magnesia and the antispasmodic Papaverine is recommended. Sutures are removed at 38 weeks in the gynecologist’s office. This procedure will allow the fetus to descend for further delivery.

Closing the internal pharynx in this way can lead to complications:

• thread cutting through muscle tissue due to stress;
• intrauterine infection;
• bleeding;
• hypertonicity of the uterus.

Prevention

It is impossible to prevent the opening of the internal pharynx 100%, but a number of measures can be taken that will to some extent help in solving this problem even at the planning stage of the child:

• perform cervical plastic surgery if ICI was observed during the first birth;
• normalize hormonal levels;
• do not have abortions;
• cure existing gynecological diseases.

If pregnancy has already occurred, it is necessary to register in the early stages of pregnancy and limit yourself from physical and psycho-emotional stress. At timely diagnosis opening of the internal pharynx can be avoided disastrous consequences, the main thing is to follow the doctor’s recommendations and some rules:

• sexual rest throughout pregnancy;
• following a diet limiting sugar and caffeine intake;
• avoiding stuffy rooms, as well as baths and saunas.

In most cases, the therapy carried out makes it possible to prolong the pregnancy and give birth to a healthy baby, the only exception being those cases when attempts to intensify pregnancy pose a threat to the life of not only the child, but also the mother.

Video: Structure of the cervix

During pregnancy, a woman becomes most vulnerable, as her body works for two. If there are several fruits, then the load increases. In this regard, ICI may develop - a dangerous pathology that leads to the loss of the baby. How to determine the onset of the disease and avoid it negative consequences, learn from our article.

How to give birth to a healthy baby with ICN?

Carrying a child, except positive points has a lot of negative risks and threats to the health of the woman and the baby itself. One of dangerous pathologies is isthmic-cervical insufficiency. What is it? What are the symptoms and treatment?

What is isthmic-cervical insufficiency (ICI)

Isthmic-cervical insufficiency is a pathology of the cervix, which consists in the inability of the organ to hold the fetus. As a result, spontaneous miscarriage or premature birth occurs. Distinctive feature– absence of symptoms, and pathology can only be detected using ultrasound and not earlier than the second trimester.

There are two types of ICN:

1. Traumatic – caused by injury to the cervix.
2. Functional - the range of causes is wider, most often a lack of progesterone or against the background of hyperandrogenism.

Symptoms

The disease occurs without significant symptoms.

Rare manifestations of pathology:

• slight bleeding;
• nagging pain in the lower abdomen;
• pressure in the upper uterus;
• feeling of vaginal distension from the inside.

The danger of ICN is that it is impossible to independently determine the presence of pathology. Even with constant visits to the gynecologist, it is not always possible to identify pathology.

Causes

The uterine sphincter keeps the uterus in good shape, and during the period of bearing a child, it controls that dilatation does not occur before the due time. With ICN, the process is disrupted.

The main reason is cervical injury.

• with a history of abortions or fetal-destroying operations;
• having internal breaks;
• who have undergone operative childbirth when applying obstetric forceps or in breech presentation;
• after surgical intervention on the cervix.

These procedures violate muscle fibers, lowering the overall tone.

ICI also occurs with an anomalous structure reproductive organs women. Congenital isthmic-cervical insufficiency is rare and can be diagnosed even in a non-pregnant patient; in this case, cervical dilatation is observed at ovulation of more than 0.8 cm.

Other reasons:

• at increased content male hormones in the body (hyperandrogenism);
• polyhydramnios – there is additional pressure on the cervical canal and it cannot cope;
• large fruit;
• in patients over the age of 30, the risk of ICI increases;
• conception using IVF;
• observed in patients who engage in heavy physical work during pregnancy.

Manifestations and dynamics during pregnancy

ICN does not bother a woman in labor in the first trimester. In the second, in the period from 16-24 weeks, slight spotting may occur, sometimes pulling in the lower abdomen. The child is actively developing, growing and gaining weight. As a result, the cervical canal experiences severe stress, and since the muscle fibers are destroyed and do not have the necessary tone, fetal loss occurs.

A pregnant woman should visit regularly antenatal clinic and undergo a timely ultrasound examination. With its help, it is possible to identify ICN in time and take measures to prevent the development of pathology.

In advanced cases of isthmic-cervical insufficiency, it is used surgical method- stitches are applied. To do this, the internal pharynx is narrowed using silk threads.

How dangerous is it if the internal or external throat is open?

With ICI, an opening of the internal or external pharynx is observed. This poses a threat to the life of the fetus.

In the early stages

In the first trimester, it is not possible to detect ICI because the embryo is small and does not affect the uterus. As you grow, the load will increase, and premature opening of the pharynx occurs. Sometimes, isthmic-cervical insufficiency begins to develop from the 11th week according to the following scheme:

1. The internal pharynx opens.
2. Opening of the external pharynx.
3. Prolapse of membranes in the vagina.
4. Violation of their integrity.
5. Death of the fetus.

In the later stages

Starting from the second trimester, ICI actively develops, increasing the risk of spontaneous miscarriage. Most often this occurs between 18-24 weeks. At the end of the term, the pathology causes premature birth with a great risk to the life of the child.

How is the diagnosis made?

To correctly diagnose isthmic-cervical insufficiency, a set of procedures is required: gynecological examination and ultrasound monitoring.

Analyzes

There is no need to take tests to diagnose ICI, since the condition of the cervix can only be determined using ultrasound. At gynecological examination the doctor makes a presumptive diagnosis.

Ultrasound examination

To determine the pathology, an ultrasound examination using a vaginal sensor is necessary (this method is more effective). During the examination, the specialist assesses the condition of the cervix, the length and presence of opening of the internal os. With ICI, the organ has a V-shaped appearance. To confirm the diagnosis, the patient is asked to cough, or the doctor applies pressure to the uterine fundus to increase the load and check the functioning of the organ.

Normal indicators for the length of the cervical canal: up to the 6th month of pregnancy - 3.5-4.5 cm, at later months 3-3.5 cm.

If a woman has cervical insufficiency, then these values ​​shift downward, which indicates a shortening of the cervix.

How does childbirth go?

Childbirth with ICI occurs rapidly, since the uterine sphincter does not perform its function. Women in labor with this diagnosis are sent to the hospital in advance, where they stop taking medications or the doctor removes the pessary or sutures. Delivery occurs naturally if there are no indicators for cesarean section.

Risks

Isthmic-cervical insufficiency is serious pathology which poses a threat to the life of a child. A woman may experience spontaneous miscarriage or premature birth. Even with proper treatment there is a risk:

• installation of a pessary requires careful and regular sanitation so that germs and bacteria do not enter internal organs and to the child;
• suturing – surgery, which has some contraindications.

The main danger of ICI is the absence of symptoms. Miscarriage often occurs, and only then is it diagnosed this pathology thanks to x-ray fallopian tubes

The interval between pregnancies must be at least two years. If the patient has a history of ICI, then it is necessary to consult a specialist during the period of planning a child to eliminate the risk of developing pathology or take preventive measures.

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