Funnel-shaped expansion of the internal pharynx. What is the cervical canal? Interpretation of research results

When expanding internal pharynx at ultrasound examination a “funnel-shaped” change in its shape is detected. This change can be considered as a sign of the beginning of smoothing of the cervix. Depending on the echographic picture, two types of expansion are distinguished: V- and U-shaped. At V-type the membranes prolapse into cervical canal with the formation of a “funnel” triangular shape. With the U-shaped type, the pole of the prolapsed membranes has a rounded shape.

M. Zilianti et al., using transperineal echography, described the sequence of changes in morphology upper sections cervixes occurring during physiological, timely labor, and coined the acronym “TYVU” to describe them. However, given that the study was performed in preterm labor, it remains to be determined whether the cervix changes similarly in preterm labor.

It is calculated according to the following formula: the sum obtained by adding the depth of the section of the V-shaped expansion of the internal os and 1 is divided by the length of the preserved part of the cervical canal. This parameter was developed to take into account the lengths of both the preserved and expanded sections of the internal os of the cervix, since they both characterize parts of the cervical canal that existed before the onset of cervical effacement processes.

According to a number of authors, it was revealed that cervical index value and the type of change in the shape of the internal os are convincing prognostic factors indicating the risk of premature birth in patients, regardless of the presence or absence of threatened miscarriage. Some researchers prefer to characterize the depth of the V-shaped expansion of the internal os as a percentage of the length of the cervical canal, which is similar in essence to the concept when calculating the cervical index.

So, for example, identifying up to 30 weeks in female patients from the group high risk values ​​constituting 40-50% or more of the total length of the channel indicate increased risk premature birth (42%).

Taking part in a special research possibility of predicting premature birth (Pretern Predictive Study), J.D. lams et al. reported that the value of V-shaped dilatation of the internal os (defined as 3 mm wide) as a predictor of preterm birth is similar to the value of measuring cervical length, but the results of other clinical centers differed significantly from these data.

Thus, they found that the value of the relative risk the onset of premature birth before 35 weeks of pregnancy in the presence of changes in the shape of the internal os is 5.0 when detected at 24 weeks and 4.78 at 28 weeks. Interestingly, according to the results of P. Taipale and V. Hiilesmaa, expansion of the internal os up to 5 mm or more was a more accurate predictor of the onset of preterm birth before 35 weeks of pregnancy compared to the assessment of cervical length. They examined 3694 patients over a period of 18 to 22 weeks.

According to them, with the expansion of internal pharynx relative risk of occurrence Preterm birth before 35 weeks was 28, while cervical shortening (defined as cervical length less than 30 mm) was only 8. Analysis using multiple logistic regression showed that the adjusted odds ratios were 20 and 6.5 respectively. Most likely, it can be assumed that the greater information content of the indicator associated with the state of the internal pharynx in this study, is determined by the fact that the boundary value of the neck length chosen to assess its shortening was 30 mm.

It is known that, according to the majority works, this neck length had low values prognostic significance positive test. The results might have been different if comparative analysis cutoff values ​​of 15 or 20 mm were used.

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Before pregnancy, many women do not even think about how complex their body is, for example, what the cervical canal is, where it is located and what functions it performs. But upcoming motherhood forces us to pay closer attention to own body and its features. The cervical canal plays an important role during pregnancy, so all expectant mothers should learn more about it.

The outcome of pregnancy largely depends on the condition of the cervix and the canal located inside it. When labor begins, how it will proceed, whether there is a threat of the baby being born prematurely - all this can be suggested by the doctor during a gynecological examination.

The cervical canal is the internal portion of the cervix, which connects the cavity of the reproductive organ and the vagina. In medicine, it is usually called the pharynx, since it is an opening. During menstruation, it is removed into the vagina through this pharynx. menstrual blood, and in the process of unprotected sexual intercourse, the male sex cells - sperm - penetrate into it.

The diameter of the external and internal pharynx, located in the cervical canal, averages 2-3 mm. At gynecological examination The external pharynx of a nulliparous woman looks like a point. After childbirth and abortion, the pharynx looks like a specific gap.

The length of the cervical canal is approximately 4 cm for nulliparous women and 7-8 cm for those who already have a history of childbirth or abortion. The mucous membrane lining the walls of the pharynx of the cervix is ​​called the endocervix.

How the cervical canal changes during pregnancy

When pregnancy occurs, the cervical canal acquires a characteristic bluish tint instead of the usual pink. Often, it is precisely by this sign that the doctor determines that a woman is pregnant.

After conception, a dense tissue forms inside the cervical canal, which becomes protection for the baby for the next 9 months. Mucus is actively produced by the endocervix. The traffic jam becomes a reliable obstacle on the way pathogenic bacteria and viruses threatening from outside.

Just before the start labor activity the plug comes away, thereby freeing the birth canal. This event can occur either 2 hours before birth or 2 weeks - the exact timing is difficult to predict. The loose plug looks yellow or clear mucus streaked with blood. Not all women notice its departure, since most often it leaves the womb of the expectant mother in parts, in the form of small mucous discharge.

Normal cervical canal during pregnancy

Normally, the external os of the cervical canal and the cervix itself are closed into a tight ring during pregnancy. This allows the woman's body to keep the fetus inside the uterus throughout the entire gestation period.

When the female body begins to prepare for childbirth, a gradual softening and smoothing of the cervix occurs, aimed at facilitating the passage of the baby through the birth canal. At the same time, the expansion of the cervical canal begins, which remained tightly closed during pregnancy. With the onset of contractions, the cervical canal opens gradually from 1-2 to 10 cm.

Depending on the degree of opening of the cervical canal, doctors determine the expected time of labor and the woman’s anatomical readiness for it. When the width of the cervical canal reaches 10 cm, a single birth canal is formed, consisting of the uterus, cervical canal and vagina.

If the cervical canal is dilated

An ultrasound of the cervical canal during pregnancy may reveal that it is dilating earlier due date. Sometimes pathology is discovered during a routine visit antenatal clinic.

During an examination on the chair, the gynecologist may notice that the pregnant woman has a slit-like cervical canal and has begun to dilate (the cervix allows the doctor’s finger to pass through). It means that premature birth can start at any time. Usually similar situation occurs after the 20th week.

Why does this condition occur? Firstly, the reason may be a hormonal imbalance - the presence in the body higher level male sex hormones that stimulate cervical ripening.

Secondly, we can talk about, in connection with which serious pressure is created on the neck of the reproductive organ. Thirdly, the causes may be injuries and pathologies of the development of the cervical canal itself.

If you do not see a doctor, you may lose your pregnancy. Treatment is carried out in a hospital. When providing timely assistance, the prognosis for carrying the fetus to term remains favorable.

Pathologies

The main function of the cervical canal is to maintain pregnancy. If for some reason the body does not cope with the set goal, pathologies may arise that threaten the expectant mother with a premature onset of labor.

Isthmic-cervical insufficiency

If the cervical os is dilated, and there is still a lot of time before the expected birth, we are talking about. In this case, the reproductive organ cannot perform its functions and hold the fetus. Many women encounter this diagnosis at 18-20 weeks of pregnancy, it is at this time that the child begins to rapidly gain weight.

Normally, the length of the cervical canal during pregnancy at 20 weeks is 5-7 cm, and the diameter is no more than 6 mm. If these indicators do not meet normal criteria, for example, the cervical canal is shortened to 2-3 cm, the doctor threatens miscarriage or premature birth.

The causes of the pathology are hormonal disorders, multiple pregnancy, cervical canal abnormalities. To prevent a miscarriage, the woman is prescribed medications aimed at strengthening the cervix and a uterus is installed. If these methods are ineffective, the doctor will place surgical sutures around the cervical canal. Removal of sutures is practiced before labor begins.

Pharynx polyp

A polyp of the cervical canal during pregnancy, discovered during an examination, can be frightening expectant mother. But first you need to find out the nature of the disease in order to find out which polyp we're talking about- true or decidual. To do this, the gynecologist prescribes a colposcopy for the expectant mother, as well as histological and cytological examinations.

A decidual polyp, in fact, is a pseudopolyp or polyp-like formation that appears exclusively during pregnancy and disappears on its own after childbirth.

Decidual pseudopolyp results hormonal imbalance in organism. It does not require surgical removal, they try not to touch it at all, only treatment with antiseptics is possible. The pseudopolyp itself disappears after the birth of the child or begins the reverse process of development in the first days after birth.

Less common is a true polyp of the cervical canal during pregnancy. Typically, such a pathology appears even before conception, and it actively prevents it. If a woman wants to get pregnant, it is recommended surgical removal true polyp, as well as required course drug treatment. Only after this can you plan for a child.

But sometimes a true polyp of the cervical canal develops after conception, already during pregnancy. In this case, they try not to touch him until the baby is born. At the same time, throughout the entire period, careful monitoring is carried out for any changes in the formation to prevent complications.

Only in serious situations should such a polyp be removed while the child is pregnant. This is possible provided that the woman’s life is in danger.

Endocervicitis

This diagnosis means the presence of inflammation in the cervical canal, which is caused by infections. The disease is diagnosed during an examination, and the doctor takes it and sends it to the laboratory.

Depending on the type of pathogen, the specialist selects the necessary course of treatment. For expectant mothers it is preferable to use local drugs - vaginal suppositories or capsules with antimicrobial and anti-inflammatory effects. Medicines are selected taking into account the duration and type infectious disease. To prevent infection of the fetus, it is necessary to treat endocervicitis.

Prevention

To avoid unnecessary worries, it is important for the expectant mother to monitor her well-being and not ignore timely medical examinations at the antenatal clinic. Preparation for pregnancy is of great importance, during which any gynecological and endocrine pathologies, and if necessary, they are treated.

Also, a woman must maintain hygiene intimate area- wash your face daily and change your underwear often. It is prohibited to use the douching method during pregnancy, as external influence on the cervical canal can cause infection or injury to the mucosa. This also applies to overly active sexual relationships - violent sexual intercourse can lead to the same consequences. Read more about dangerous and safe positions for sex during pregnancy →

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Cervicometry - ultrasonography, which allows you to determine the condition of the pharynx (internal and external), cervical (cervical) canal and its length. During gestation, the muscles of the uterus hold the fetus in its cavity; if muscle tone weakens prematurely, this leads to shortening of the cervix and its opening.

The smaller the cervical size, the higher the risk of losing the child. Ultrasound of pregnant women allows gynecologists to promptly identify signs of a threat of failure and prevent it.

Diagnostic standards for cervicometry during pregnancy

The length of the cervical canal, together with the external and internal pharynx, is a variable value. Their sizes depend on the duration of pregnancy and the number of births (primipara or multiparous woman). The longer the gestation period, the correspondingly the size of the cervical canal should be smaller (the canal is shorter). At normal course pregnancy and no threat of miscarriage:

• at 20 weeks, the normal dimensions are within 40 mm;
• at 34 weeks - within 34 mm.

If the length of the cervix is ​​less than 25 mm, then it is assessed as short, and the question of the threat of failure arises. If its dimensions are less than 15 mm. at the end of the second trimester - this is an indicator of a high risk of miscarriage.

Preparing for the study

This type of ultrasound does not require special preparation, diet, use of any medications or discontinuation of prescribed medications. Regular enough hygiene procedures, and having a diaper with you (cover the couch), as well as a medical condom (put on the vaginal sensor/transducer). Before the procedure it is necessary to empty bladder. Ultrasound is performed using an intracavitary transducer. Normally, the procedure is painless; if discomfort occurs, you should immediately inform the doctor performing the procedure.

Cervicometry procedure

There are several ultrasound methods that allow you to determine the size of the cervical canal along with the external and internal os. These methods include:

• transabdominal ultrasound (via abdominal wall), when performing it, the bladder must be full;
• transvaginal ultrasound (the transducer is inserted directly into the vagina).

Although there are two ways, international standards Cervicometry requires that the dimensions of the area of ​​interest on ultrasound be determined correctly, as accurately as possible from the external to the internal pharynx. This can only be done through examination performed through the vagina. Required condition it is carried out by an “empty” bladder, because during transabdominal examination, the bladder may cover the internal os. During the cervicometry procedure, the size of the cervix is ​​assessed first of all - its length, as the main indicator of normality and pathology. Next, they study the expansion of the internal os, the condition of the cervical canal, and establish the presence of prolapse (protrusion) of the membranes in them with the development of ICI (isthmic-cervical insufficiency). If there is a suture in the area of ​​the cervical canal, its location is specified.

There were no cases of any complications occurring during the study, immediately after the procedure or in the distant future. Like any ultrasound examination, transvaginal ultrasound is the safest, non-traumatic, accurate and informative method determining the norm and pathology of the organ under study. The method is safe for both the mother and her baby.

Timing of cervicometry

A control (screening) study is prescribed to all pregnant women, regardless of the fertility of the pregnancy and its primacy. The timing of cervicometry coincides with a screening study of fetal anatomy. If a woman has had problems with pregnancy in the past (self-abortion in late dates, premature delivery), or with established multiple pregnancies, this examination needs to be done at an earlier date. Between weeks 11 and 14, during the first screening test for genetic developmental abnormalities. If there is a threat of premature termination of pregnancy, ultrasound monitoring diagnostics may be prescribed at intervals of 14 days, and in some cases even 7 days.

Indications for cervicometry. Risk group

If you have a history of self-abortion or early interruption pregnancy, the risk of fetal loss during the current pregnancy increases (with one case of miscarriage, this risk is increased by 5-10%; if there have been several cases of self-abortion, the risk increases to 20%). With multiple births, the risk of miscarriage in the third trimester increases significantly. When carrying one fetus, the risk of miscarriage is up to 1%; when carrying dichorionic twins, the risk is already about 5%; when carrying monochorionic twins, the risk increases by an order of magnitude and is 10%.

For the same reason, when undergoing an ultrasound scan of the fetus at any stage of gestation, a woman should inform the doctor about a history of premature birth/self-abortion, surgical interventions on the cervical canal, i.e. that she is at risk.

Risk group that requires close monitoring of the gestation process:

• the presence of self-abortion in the later stages or premature delivery of previous pregnancies;
• suspicion of ICN;
• multiple births;
• surgical interventions and sutures on the cervical canal.

Shortening of the cervix (SCI)

One of the most common pathologies is isthmic-cervical insufficiency (ICI), shortening of the isthmus and cervix. The condition of ICI is diagnosed when the size of the organ does not exceed 25 mm. Reasons causing shortening of the cervix:

1. Large or multiple pregnancies, as well as polyhydramnios in women who have suffered traumatic exposure to the cervical canal.
2. Hereditary abnormalities of the structure of the uterus. This pathology is very rare.
3. Violation of hormonal status during pregnancy. This is due to the activation of the fetal adrenal glands (in the third month of gestation). If a woman’s blood level of androgens is normal, this is not critical, but if it is elevated, then the additional amount of these hormones secreted by the fetal adrenal glands leads to a decrease in the size of the cervical canal. This happens asymptomatically, because is not accompanied by an increase in muscle tone of the entire organ.
4. Mechanical injuries to the cervix with subsequent deformation (for example, when applying medical forceps) due to abortion, diagnostic curettage and so on.

The development of ICI can be indicated by the opening of the internal pharynx in the form of a funnel, revealed by ultrasound examination. IN in good condition it is closed. Additional reasons ICN can be:

• excision of the cervical canal during the treatment of certain types of pathologies;
• trauma to the cervical canal during previous births;
• his injuries as a result of self- or medical abortions.

Such a pathology requires hospitalization and, in the future, if the condition does not return to normal, possible intervention. For this purpose it is recommended bed rest, either a suture is placed (cervical cerclage) on the neck, or special mechanical devices are installed. These devices are used to support the uterus and are called an obstetric pessary.

Shortening the cervical canal is not a death sentence. This is only a signal that the risk of miscarriage has increased and the intensity needs to be reduced. physical activity, and, if necessary, carry out preventive measures in a timely manner.

Immaturity of the cervix during ultrasound examination

There is also the opposite problem - the cervix is ​​not ready for the process of delivery (immaturity), despite the pregnancy being full-term. The reason for this may be psychological problems(fear of the process of childbirth), anatomical anomalies in the development of the organ or operations, as a result of which the walls of the cervical canal lose their elasticity. Readiness is assessed on a 3 or 4 level scale. 3-level scales are more often used. The main signs of the uterus being ready for delivery (maturity) are:

• its structure, which is usually described as consistency;
• patency of the cervical canal;
• length of the vaginal part;
• deviation from the wire pelvic axis.

The degree of maturity of the cervix is ​​assessed in points:

The degree of its maturity according to a 3-level system is assessed in points from 0 to 10. From 0 to 3 points - immature, from 4 to 6 - maturing and from 7 to 10 - mature. Normally, after 37 weeks, the transition from an immature to a mature state occurs. If the uterus is immature or poorly mature, problems arise during delivery. An operation - caesarean section - may be indicated.

Methods for preventing premature pregnancy

In modern obstetric practice, the most effective methods are considered drug prophylaxis and surgery (suturing the cervix). Suturing (cervical cerclage) – considered effective way preventing premature birth. There are two options for this intervention. In the first case, sutures are placed at the end of the first trimester. In the second case, monitoring ultrasound diagnostics is performed. Its duration is from 14 to 24 weeks with an interval of 14 days. Surgical intervention in this case, it is considered justified if the neck length is reduced to 25 mm or less. The second approach reduces the need for surgical intervention up to 50%. However, this operation is risky for multiple pregnancies and may increase the risk of premature delivery.

As medications progesterone preparations are used to prevent early delivery. Also, placement of a vaginal pessary is used as an experimental technique. After using mechanical or surgical means to prevent early delivery, transvaginal ultrasound is not performed.

Often during an examination or ultrasound, a pregnant woman hears about a closed uterine pharynx or its opening. As a rule, the gynecologist voices the condition of the external pharynx, and on ultrasound they describe the internal pharynx. What do these concepts mean? What is their significance during pregnancy? What is the opening of the internal pharynx?

Description of the internal os of the uterus during pregnancy

The uterine cavity is connected to the vagina by the cervix, inner part which is called the cervical canal. This narrow canal has two openings: one before the entrance to the uterus, the second at the entrance to the vagina. The opening that serves as a transition from the cervix directly to the reproductive organ is called the internal os.

The uterine os cannot be seen or felt during a gynecological examination. This opening is closed most of the time by the walls of the cervical canal, opening the entrance to the uterus only during menstruation. During pregnancy, the internal os is always closed. It opens immediately before the birth of the child.

The functions of the extreme space of the cervical canal are to protect the uterus from penetration into it pathogenic microorganisms, retention of the fetus in the uterine cavity, protection amniotic sac from infection. With the onset of pregnancy, the canal ring located at the entrance to the uterus becomes dense, and the exit to the cervix is ​​completely fenced off.

Closer to the due date, the cervix begins to soften, the cervical canal shortens, and the pharynx gradually opens. Normally, this process occurs at 36-38 weeks.

External os: what is it?

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The external os is the opening located between the vagina and the cervix. It is the entrance to the cervical canal from the vagina. In the area of ​​the external pharynx, cells of different epithelia are in close contact: cylindrical and flat.

In good condition this combination provides the hole with the ability to stretch and recover. However, if internal processes are disrupted, this place becomes the epicenter of cell degeneration into a malignant tumor.

The external pharynx can be felt during a gynecological examination. In nulliparous women, it has the shape of a closed ring. After the baby is born, the hole takes the form of a flattened slit. The external or external os should be closed.

During pregnancy, its expansion begins during the preparation of the cervix for the birth process. By its diameter, doctors determine the readiness of the uterus for childbirth. The most intense opening of the external entrance to the cervical canal begins after the lumen of the internal pharynx increases due to fetal pressure on the cervix.

What should a normal pharynx be like during pregnancy?

After fertilization of the egg, hormones increase blood flow to the genitals and change the structure and density of the tissues of the cervical canal. The cervix becomes denser, and the tissues of the internal and external pharynx become immobile.

Mucus forms between the vagina and the uterus, which creates additional protection for the uterus from the penetration of pathogenic microflora. Normally, both entrances to the cervical canal should be closed until the 36th week. The diameter of the external and internal pharynx can reach 2-4 mm (after numerous births, 6 mm is allowed). The condition of the uterine lumen is checked during an ultrasound at 11-14, 20-22, 32-36 weeks.

The external gap is examined by a gynecologist at 20, 28, 32 and 36 weeks. After 36 weeks, the cervix softens. In nulliparous women, the passage into the cervical canal is open by approximately 0.5 cm; in women who have given birth, the opening opens by approximately 1 finger. Full opening is diagnosed after the outer hole reaches a diameter of 10 cm.

Why is jaw opening dangerous?

The need to constantly monitor the condition of the cervical openings is due to the fact that cervical dilatation often occurs without clear symptoms. A woman may feel mild discomfort and periodic contractions of the uterus. However, only a doctor can determine that this is due specifically to the opening of the canal.

Causes of throat opening:

• natural preparation birth canal for the birth of a baby;
• high content of male hormones in the body;
• increased pressure on the cervix during multiple pregnancies;
• isthmic-cervical insufficiency;
• congenital pathologies of the genital organs;
• injury to the cervical canal due to abortion or gynecological operations;
• progression of cervical erosion;
• low levels of pregnancy hormone.

Opening of the cervical openings on last weeks pregnancy indicates the imminent onset of labor. This normal process, which does not pose a danger to the woman and the fetus. However, if the process begins long before the expected date of delivery, there is a risk of miscarriage or premature birth.

It is necessary to distinguish between the opening of the external and internal pharynx. A slight enlargement of the opening between the cervix and vagina does not always cause an increase in the entrance to the uterus. However, if the internal entrance to the cervical canal is slightly open, the opening of the external opening will be initiated.

If the doctor diagnoses an increase in space at the exit of the vagina, the expectant mother is sent for an ultrasound. With a normal internal hole there is Great chance favorable pregnancy outcome without the use of radical measures.

Treatment of throat dilatation

Therapy for cervical dilatation is aimed at slowing down the process of dilation of the opening and maintaining pregnancy. The treatment regimen depends on the severity of the process and the period of gestation at which the pathology was detected. The woman is sent to a hospital, where one of the treatment methods is used:

• medicinal;
• application of a supporting structure;
• surgical.

Drug treatment involves taking hormonal drugs, antispasmodics and vitamins. Most Popular hormonal drugs during pregnancy are Utrozhestan and Duphaston. If a threat of miscarriage is detected, the doctor prescribes an increased dose of the medicine.

Minimum admission period large dose is 7-14 days. After this time has passed, an ultrasound is performed. If the cervix does not shorten and the opening process has stopped, the doctor may reduce the dose of the drug. In most cases, hormonal therapy is continued until last month pregnancy. Sometimes hormones are needed until childbirth.

Antispasmodic medications are used to reduce the sensitivity of the uterus and cervix. Spazmalgon, No-shpa, Papaverine relieve tension in the uterus. Medicines are prescribed in the form of injections, droppers, tablets and suppositories. The drugs are discontinued when the uterine tone is eliminated. Vitamin complexes are used as maintenance therapy.

Identification of pathology leads to the fact that the woman begins to experience nervous tension. To eliminate stress, it is recommended to drink sedatives.

Drug therapy is appropriate if a partial opening of the external pharynx is diagnosed. The pathology of the internal opening and a significant increase in the external one require the use of a special design or sutures on the isthmus of the cervical canal. Features of the methods are described in the table.

Regardless of the chosen treatment method, it should be remembered that the internal and external lumens cannot completely close. If the lumen is open, it is impossible to return it back to its original position. However, the use of therapy helps to avoid a situation where the hole opens completely before the fetus becomes viable.

Preventive measures

It is impossible to predict all possible complications during pregnancy. To reduce the risk of premature onset birth process, necessary:

• Plan your pregnancy together with your gynecologist. A woman must pass full examination, cure gynecological pathologies and give up bad habits.
• Avoid abortion. Elimination unwanted pregnancy implies interference with natural physiological process. As a result of abortion, hormonal background and get injured reproductive organs. The risk of miscarriage increases when you first try to carry a child over the age of 25.
• Register with your doctor in a timely manner. Early registration allows for timely identification and elimination of pregnancy pathologies.
• Support normal weight. Overweight when carrying a baby, it leads to an increase in the load on all organs and systems and changes in hormonal balance.
• During pregnancy, avoid visiting saunas.
• Avoid stress.
• Adhere to the schedule of planned visits to the gynecologist and recommendations for undergoing an ultrasound scan.
• If you identify a threat of termination of pregnancy, strictly follow the instructions of your doctor.

If during the first pregnancy a woman was diagnosed with ICI, then with a second gestation there may be a risk of miscarriage. To those who were given this diagnosis, it is recommended to resort to the use of a pessary. During pregnancy, you should completely abstain from sexual intercourse and reduce physical activity.

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 a bluish tint associated with increased blood flow in this area. Appearance 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 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 inappropriateness 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 hormone therapy, and medicines with a concentration of magnesium, vitamins and antispasmodics.