How many cm should the cervix be? What can happen due to a short cervix? Short cervix: what to do

Screening for the first trimester of pregnancy is over, time passes, the belly grows, and new worries arise.
Have you heard or read somewhere about isthmic-cervical insufficiency (ICI), premature birth, Ultrasound of the cervix and now you don’t know whether this threatens you and whether you need such a study, and if necessary, when?
In this article I will try to talk about such a pathology as ICI, modern methods of diagnosing it, the formation of a high-risk group for preterm birth and methods of treatment.

Premature birth is defined as birth that occurs during pregnancy from 22 to 37 weeks (259 days), starting from the first day of the last normal menstruation with a regular menstrual cycle, and the fetal body weight ranges from 500 to 2500 g.

The frequency of premature births in the world in recent years is 5–10% and, despite the emergence of new technologies, is not decreasing. And in developed countries it is increasing, primarily as a result of the use of new reproductive technologies.

Approximately 15% of pregnant women are at high risk for premature birth even at the stage of collecting anamnesis. These are women who have a history of late miscarriages or spontaneous premature births. There are about 3% of such pregnant women in the population. In these women, the risk of recurrence is inversely related to the gestational age of the previous preterm birth, i.e. The earlier the premature birth occurred in the previous pregnancy, the higher the risk of recurrence. In addition, this group can include women with uterine anomalies, such as a unicornuate uterus, a septum in the uterine cavity, or trauma, surgical treatment of the cervix.

The problem is that 85% of preterm births occur in 97% of women in the population for whom this is their first pregnancy, or whose previous pregnancies resulted in full-term births. Therefore, any strategy aimed at reducing the rate of preterm birth that targets only a group of women with a history of preterm birth will have very little impact on the overall rate of preterm birth.

The cervix plays a very important role in maintaining pregnancy and the normal course of labor. Its main task is to serve as a barrier that protects the fetus from being pushed out of the uterine cavity. In addition, the glands of the endocervix secrete special mucus, which, when accumulated, forms a mucus plug - a reliable biochemical barrier to microorganisms.

“Cervical ripening” is a term used to describe the rather complex changes that occur in the cervix related to the properties of the extracellular matrix and the amount of collagen. The result of these changes is the softening of the cervix, its shortening to the point of smoothing, and the expansion of the cervical canal.

All these processes are normal during full-term pregnancy and are necessary for the normal course of labor. For some pregnant women, due to various reasons, “cervical ripening” occurs ahead of time. The barrier function of the cervix is ​​sharply reduced, which can lead to premature birth.

It is worth noting that this process has no clinical manifestations and is not accompanied by pain or bleeding from the genital tract.

What is ICN?
Various authors have proposed a number of definitions for this condition. The most common is this: ICI is an insufficiency of the isthmus and cervix, leading to premature birth in the second or third trimester of pregnancy. or something like that
: ICI is a painless dilatation of the cervix in the absence of
uterine contractions, leading to spontaneous interruption

pregnancy.
But the diagnosis must be made even before the termination of pregnancy occurs, and we don’t know whether it will happen. Moreover, most pregnant women diagnosed with ICI will deliver at term.

In my opinion, ICI is a condition of the cervix in which the risk of preterm birth in a given pregnant woman is higher than the general population. In modern medicine, the most reliable way to assess the cervix is.

transvaginal ultrasound with cervicometry - measuring the length of the closed part of the cervix

Who is indicated for cervical ultrasound and how many times?
Here are the recommendations from https://www.fetalmedicine.org/ The Fetal Medicine Foundation:
If a pregnant woman is among those 15% with a high risk of preterm birth, then such women are shown an ultrasound of the cervix every 2 weeks from the 14th to the 24th week of pregnancy.

For all other pregnant women, a single ultrasound of the cervix is ​​recommended at 20-24 weeks of pregnancy.

The woman empties her bladder and lies on her back with her knees bent (lithotomy position).
The ultrasound probe is carefully inserted into the vagina towards the anterior fornix so as not to place excessive pressure on the cervix, which could artificially increase the length.
A sagittal view of the cervix is ​​obtained. The mucous membrane of the endocervix (which can be either increased or decreased echogenicity compared to the cervix) serves as a good guide to determine the true position of the internal os and helps to avoid confusion with the lower segment of the uterus.
The closed part of the cervix is ​​measured from the external os to the V-shaped notch of the internal os.
The cervix is ​​often curved and in these cases the length of the cervix, considered as a straight line between the internal and external os, is inevitably shorter than the measurement taken along the cervical canal. From a clinical point of view, the measurement method is not important, because when the cervix is ​​short, it is always straight.

Each test should be completed within 2-3 minutes. In about 1% of cases, the length of the cervix may change depending on uterine contractions. In such cases, the lowest values ​​should be recorded. In addition, the length of the cervix in the second trimester may vary depending on the position of the fetus - closer to the fundus of the uterus or in the lower segment, in a transverse position.

It is possible to assess the cervix transabdominally (through the abdomen), but this is a visual assessment, not cervicometry. The length of the cervix with transabdominal and transvaginal access differs significantly by more than 0.5 cm, both up and down.

Interpretation of research results

If the length of the cervix is ​​more than 30 mm, then the risk of premature birth is less than 1% and does not exceed the general population. Such women are not indicated for hospitalization, even in the presence of subjective clinical data: pain in the uterus and minor changes in the cervix, heavy vaginal discharge.

• If a shortening of the cervix of less than 15 mm is detected in a singleton pregnancy or 25 mm in a multiple pregnancy, urgent hospitalization and further management of the pregnancy in a hospital with the possibility of intensive care for newborns are indicated. The probability of delivery within 7 days in this case is 30%, and the probability of premature birth before 32 weeks of pregnancy is 50%.

• Shortening of the cervix to 30-25 mm during a singleton pregnancy is an indication for consultation with an obstetrician-gynecologist and weekly ultrasound control.

• If the length of the cervix is ​​less than 25 mm, a conclusion is issued: “ECHO signs of ICI” in the 2nd trimester, or: “Given the length of the closed part of the cervix, the risk of premature birth is high” in the 3rd trimester, and a consultation with an obstetrician-gynecologist is recommended for deciding whether to prescribe micronized progesterone, perform cervical cerclage or install an obstetric pessary.

A few words about the opening and shape of the internal pharynx. When performing an ultrasound of the cervix, you can find various forms of the internal os: T, U, V, Y - shaped, moreover, it changes in the same woman throughout pregnancy.
With ICI, along with shortening and softening of the cervix, its dilatation occurs, i.e. expansion of the cervical canal, opening and changing the shape of the internal os is one process.
A large multicenter study conducted by FMF showed that the shape of the internal os itself, without shortening the cervix, does not statistically increase the likelihood of preterm birth.

Treatment methods

Two methods of preventing premature birth have been proven effective:

• Cervical cerclage (suturing the cervix) reduces the risk of labor before 34 weeks by about 25% in women with a history of preterm labor. There are two approaches to treating patients with previous preterm birth. The first is to perform cerclage on all such women shortly after 11-13 weeks. The second is to measure the length of the cervix every two weeks from 14 to 24 weeks, and apply sutures only if the length of the cervix becomes less than 25 mm. The overall rate of preterm birth is similar with both approaches, but the second approach is preferred because it reduces the need for cerclage by approximately 50%.

• Prescribing Progesterone from 20 to 34 weeks reduces the risk of childbirth before 34 weeks by approximately 25% in women with a history of premature birth, and by 45% in women with an uncomplicated history, but identified shortening of the cervix to 15 mm. A study was recently completed that showed that the only progesterone that can be used for a short cervix is ​​micronized vaginal progesterone at a dose of 200 mg per day.

• Multicenter studies of the effectiveness of using a vaginal pessary are currently ongoing. A pessary, which consists of flexible silicone, is used to support the cervix and change its direction towards the sacrum. This reduces the load on the cervix due to reduced pressure from the fertilized egg. You can read more about the obstetric pessary, as well as the results of the latest research in this area

After suturing the cervix or with an obstetric pessary in place, ultrasound of the cervix is ​​not advisable.

See you in two weeks!

The female body is truly unique. While carrying a child, it is able to constantly change and adapt to new conditions. Not every woman knows that during pregnancy the cervical canal performs very important functions. Do you want to thoroughly prepare for childbirth? Then be sure to study the structure, location and purpose of the cervical canal. You will find all useful information on this topic in this article.

The cervical canal is a pharynx located in the inner part of the cervix. It is necessary to connect this reproductive organ with the vagina. The cervical canal itself is an opening, or in medical terms, a pharynx. Through it, blood is released every month, and seminal fluid penetrates for fertilization.

The onset of labor mainly depends on the condition of the cervix and the length of the cervical canal. A gynecologist can assess the size of the pharynx and the degree of its opening during a simple examination.

In a healthy woman, the diameter of the canal in the cervix is ​​2-3 mm. If a representative of the fair sex has not yet given birth to children, then upon examination such a pharynx will resemble a small dark dot. After labor, the hole enlarges and visually resembles a gap. According to medical standards, the length of the cervical canal in those who have not given birth is 4 cm, in those who have given birth - about 7-8 cm. The walls of this opening are covered with mucous tissue by the endocervix.

In normal condition, the cervical canal is pink. When a woman is pregnant, the throat takes on a bluish tint. If the gynecologist discovers a change in the color of this hole during the examination, pregnancy can be confirmed with complete confidence.

To protect the fetus from infection from the outside, the cervical canal is filled with a special mucus plug. It persists throughout the entire 9 months of pregnancy. Mucus for blocking the pharynx is produced directly by the endocervix.

When the cervical canal opens during pregnancy, the plug comes off on its own. This process begins immediately before birth, and allows you to clear the way for the baby to come into the world. In some patients, the mucus plug comes out before the onset of contractions, in others it takes several weeks. The patient may not even notice that the plug has come off.

Norm

The length of the cervix varies depending on the stage of pregnancy. During standard diagnostics, the doctor assesses the size of this organ and sets the timing of conception. In order for the diagnosis to be confirmed, the patient needs to additionally undergo an ultrasound and pass all the necessary tests. This will allow the doctor to assess the condition of the patient and fetus as objectively as possible.

During an ultrasound scan of a pregnant woman, it is important to accurately determine the parameters of the embryo. However, an equally important parameter is the length of the cervical canal during pregnancy. If its size is not normal, the patient may have a miscarriage.

The normal width of the cervical pharynx during pregnancy is 3.5-4 cm. The opening before birth is tightly compressed and protected by a mucus plug. This will keep the fetus securely inside the female body throughout pregnancy.

When the time of contractions approaches, the cervix begins to actively soften and gradually smoothes out. This greatly simplifies the birth process for the baby. By the end of the 9th month, the pharynx also begins to expand. If before contractions the pharynx has a diameter of 3-4 cm, then by the beginning of pushing it increases to 10 cm.

The approximate time of birth can be determined by how much the pregnant woman's cervix is ​​open. This indicator also characterizes the patient’s readiness for labor. After the opening has expanded to 10 cm, all reproductive organs will unite into a single birth canal.

Ultrasound

At 24 weeks of pregnancy, a physician must conduct an ultrasound examination of the patient to determine the length of the cervix and the size of the cervical canal. According to the data obtained, it is possible to draw objective conclusions about the presence of a threat of premature birth.

If the gynecologist determines that the cervix is ​​too short, transvaginal diagnosis may be additionally needed. This type of examination allows you to get more accurate results.

If carrying a child is not accompanied by any pathologies, at the 24th week the size of the cervix is ​​3.5 cm. As the length of this organ decreases, the risk of miscarriage increases. The longer the period, the shorter the cervix becomes.

This is understandable, because the female body is gradually rebuilt for active labor. The length of the cervical canal during pregnancy - the weekly norm depends on the size of the cervix.

• From 16 to 20 weeks of pregnancy, the cervical size is 4 - 4.5 cm;
• From 24 to 28 weeks – 4 – 3.5 cm;
• From 32 to 36 weeks – 3.5 – 3 cm.

If the patient's indicators differ significantly from the norm, additional treatment and hospitalization may be necessary. IN last weeks During pregnancy, the cervix begins to rapidly decrease in size, and by birth its length is no more than 1 cm.

If your cervix bleeds after an examination during pregnancy, you should definitely inform your doctor about it. The patient may need additional examination. Such discharge may signal the onset of premature labor.

Pathology

One of the most important functions of the cervical canal is to maintain pregnancy. If there are any pathologies of such a pharynx in the body of a pregnant woman, there is a high probability of miscarriage or premature birth. To prevent this from happening, you need to regularly visit a gynecologist during pregnancy and monitor the size of the cervical canal.

ICN

One of the most common pathologies of the pharynx is isthmic cervical insufficiency. With this disorder, the opening in the cervix expands ahead of schedule. In this case, the fetus may not be able to stay in the uterus, and premature birth will begin. Most often, this pathology is detected in pregnant women at 19-20 weeks of gestation. During this period, the fetus actively grows and develops, which means it gains weight.

If the cervical canal is enlarged during pregnancy, you should definitely seek help from a doctor. This condition is detected during ultrasound diagnostics or routine examination. The pharynx should not increase in size ahead of schedule.

When the cervical canal of a pregnant woman is so open that the gynecologist’s finger can easily pass through, the patient needs urgent hospitalization. This condition at the 20th week of pregnancy can cause premature birth.

There are several reasons for the premature increase in the size of the cervical canal and cervix. These include:

• Hormonal imbalance in the body of the expectant mother. If the male hormone testosterone increases in the blood, the cervix begins to ripen faster.
• The patient has a multiple pregnancy and there is increased pressure on the cervical canal.
• Congenital pathologies or mechanical trauma of the cervical canal.

If the length of the cervix during pregnancy does not correspond to the norm by week, the patient is prescribed treatment in a hospital setting. Only qualified medical assistance will save the baby’s life and prevent premature birth.

The main thing is to seek help in a timely manner. The most commonly prescribed therapy is medications, install the pessary. In extreme cases, the doctor decides on the need for a surgical operation, during which the cervix and cervical canal are sutured. This procedure is carried out under anesthesia, and is quite dangerous for the baby’s health, as there is a risk of infection.

Polyp

During a gynecological examination, a physician may discover a cervical canal polyp in a pregnant woman. Such a diagnosis, as a rule, frightens the fair sex, but there is no need to panic ahead of time. The polyp can be true or decidual. To determine the nature of the neoplasm, it is enough to do a colposcopy and send the sample for cytological laboratory testing.

Pseudopolyp develops only in pregnant women. Such a growth does not in any way affect the health of the mother and child, and resolves immediately after childbirth. Such neoplasms appear due to hormonal changes in the body. There is no need to remove it surgically. A simple treatment with an antiseptic is enough. The decidual polyp will soon disappear on its own or begin to decrease in size until it completely disappears.

A true polyp of the cervical canal can cause difficulties in conceiving a child. If you are diagnosed with such a growth and you are planning a pregnancy, it is better to immediately remove it surgically. After surgery, the patient must undergo an additional course of drug therapy to prevent the appearance of new tumors on the cervix.

If a true polyp was discovered during pregnancy, it should not be touched until the baby is born. In this case, it is necessary to carefully monitor the condition of the growth in order to be able to prevent the development of any complications in time. In the most severe situations, surgical removal of the polyp is prescribed, despite pregnancy. However, such an operation is performed only if there is a threat to the life of the expectant mother.

Endocervicitis

When an infection enters the cervical canal, inflammation may begin. During a gynecological examination of a pregnant woman, a physician may diagnose endocervicitis. To determine the most appropriate treatment method, you need to take a smear and examine it in a laboratory.

The first step is to identify the type of causative agent of the inflammatory disease, and only after that effective medications are prescribed. Pregnant women are usually recommended to use topical medications. These can be suppositories or capsules with a medicinal antimicrobial substance. Only an experienced doctor can prescribe therapy. In this case, it is necessary to take into account not only the type of infection, but also the duration of pregnancy. If you want to protect the fetus from infection, be sure to pay due attention to the treatment of endocervitis.

Prevention

If you want your pregnancy to pass without any worries, be sure to carefully monitor your health and regularly visit your doctor for a routine gynecological examination. Proper preparation for conceiving a child involves preliminary treatment of any gynecological diseases and endocrine pathologies. If you find any abnormality, do not ignore it. Consult your doctor to find out the best ways to solve the problem.

In addition, in the prevention of diseases of the cervix and cervical canal, it is important to pay due attention to daily intimate hygiene. You need to wash yourself twice a day and change your underwear once a day. If you are pregnant, avoid douching. Such external influence on the pharynx can negatively affect its functioning, and there is a danger of infection of the fetus or causing microtrauma to the mucous membrane of the cervical canal. The same consequences can occur after rough sex, so moderate your passion for a while.

The uterus is the main organ necessary for carrying a pregnancy. It consists of a bottom, body and neck. The latter looks like a tube connecting the uterus to the vagina. The successful course of pregnancy and natural childbirth directly depends on its condition. The cervix changes significantly before childbirth, although for the woman herself these changes are practically unnoticeable, since this process is not accompanied by any special symptoms.

What happens in the prenatal period and why is special attention paid to the cervix?

How is cervical maturity assessed?

Starting from 38 weeks of pregnancy, during an examination with a gynecologist at a antenatal clinic or in a maternity hospital, the doctor conducts a vaginal examination to assess the condition of the cervix. It is also mandatory to examine the cervix before childbirth, as well as during labor. This is necessary to understand how quickly the process of maturation occurs.

There are four main parameters, by assessing which an obstetrician-gynecologist can conclude that the cervix is ​​ready for childbirth. Its maturity is determined by a special Bishop scale, according to which each of the parameters is assessed on a three-point system (from 0 to 2 points). If this scale is rated 5, then we can talk about readiness for natural childbirth.

The cervix begins to prepare for the birth of a child from 32 to 34 weeks of pregnancy. First, its edges soften, leaving a dense area of ​​tissue along the cervical canal. Closer to childbirth, the uterus more often comes to tone, due to which its lower segment softens and becomes thinner. The upper myometrium, on the contrary, becomes denser.

Due to this, the fetus begins to gradually descend and put its weight on the neck, provoking its further opening.

Dilatation of the cervix before childbirth does not occur equally in women who give birth for the first time and in multiparous women. In the first, it begins with the opening of the internal pharynx.

In the latter, the process of opening the internal and external pharynx occurs simultaneously, since by the end of pregnancy their external pharynx usually already allows one finger through. As it opens, the neck thus becomes shorter. A couple of days before the onset of labor itself, the process of its maturation accelerates significantly. Gradually it completely smoothes out and easily lets through 2 fingers or more.

Based on the Bishop scale above, on the eve of childbirth the cervix should meet certain parameters.

A soft cervix is ​​ideal for childbirth. Her softness is evidenced by the fact that she freely passes 2 or more fingers of the doctor. During this period, a woman may notice the release of the mucus plug. This is one of the harbingers of the upcoming birth, indicating the imminent onset of contractions. As for the length of the cervix, during pregnancy a length of 3 cm is considered normal. In this case, both ends of the cervical canal must be closed. Closer to childbirth, it shortens. The length of the cervix before childbirth should not exceed 1 cm, gradually smoothing out completely.

As for its location, it was tilted back throughout the entire pregnancy. This further helps keep the fetus inside. Gradually, due to the softening of the lower segment of the uterus, it begins to unfold forward. When the time comes for childbirth, it should be located exactly in the center of the small pelvis.

If the cervix is ​​not ready for childbirth

A soft, shortened cervix, which is located in the center and slightly open, indicates the approach of labor. However, it also happens that the due date has already approached, but the maturity of the cervix has not yet occurred.

An immature cervix can lead to complications during labor, so if it is not ripe by the expected date of birth, the doctor may decide to induce stimulation.

Pregnancy after 40 weeks is post-term and dangerous for the baby. At this point, the placenta ceases to fully perform its functions. Therefore, if the cervix does not mature by this time, then its stimulation is mandatory.

In addition to postterm pregnancy, indications for stimulation are:

• The mother has a disease in which further pregnancy threatens her health.
• Development of hypoxia in the fetus.
• Large fetus or multiple pregnancy.
• The cessation or weakening of contractions during labor.
• Premature placental abruption.

In all other cases, the question of the need for stimulation is decided individually. There are various methods to prepare the cervix for childbirth.

Medical methods include the following:

There are other - non-medical methods that allow you to prepare the body for natural childbirth. Unlike the first ones, they can be used at home, but subject to full-term pregnancy, satisfactory health of the woman and baby, and only after consultation with a doctor.

Otherwise, such stimulation can be dangerous. Non-medical stimulation methods include:

If the cervix opens prematurely The opposite situation also happens, when the cervix begins to open and prepare for childbirth ahead of schedule. This is usually associated with a pathology of the cervical canal called isthmic-cervical insufficiency.

It lies in the inability of the cervix to properly contain the fetus. It shortens and opens early, which often leads to spontaneous abortion.

The presence of this pathology is indicated by the length of the cervical canal at 20–30 weeks of less than 25 mm.
Isthmic-cervical insufficiency can develop due to trauma to the cervix, hormonal disorders, or excessive load on the cervix during pregnancy.

In this situation, measures should be taken aimed at maximizing the prolongation of pregnancy:

In addition, treatment is carried out to promote the rapid maturation of the fetal lungs in case labor begins prematurely. Before childbirth, the cervix changes so much that it allows the baby to be born unhindered.

Therefore, visits to the gynecologist in the third trimester should be regular and accompanied by a vaginal examination, which allows you to assess the degree of readiness of the body for childbirth. This is especially true for those women who already feel other warning signs. If the due date has already approached, but cervical maturity has not yet arrived, then there is no need to be afraid of stimulation. Sometimes delay can cost the lives of both mother and child.

The most important female organ during pregnancy is the uterus, where the fetus grows. At the same time, during gynecological examinations, close attention is paid to her cervix, which holds the fetus and, being tightly closed until the end of the term, prevents the penetration of infections. But sometimes the cervix during pregnancy, for various reasons, does not perform its functions, and in such cases there is a threat of miscarriage.

During pregnancy, the cervix holds the fetus and prevents infections

The cervix is ​​a kind of tube connecting the uterus and vagina, with a diameter of about 2.5 centimeters and a length of 3-4 cm. Its lower part is the vaginal part, the upper part is the supravaginal part. The cervical canal is located inside the cervix; on the outside it is normally pink and smooth, on the inside it is loose and velvety to the touch.

During pregnancy, the cervix changes. The criteria for its normal state, determined at , are as follows:

• dense to the touch;
• bluish tint due to the proliferation of blood vessels;
• increased in length and volume compared to the state before pregnancy;
• slightly deviated relative to the pelvic axis;
• with overgrown epithelium producing thick mucus;
• closed, a finger does not fit into the canal.

The doctor can determine the threat of miscarriage by the loose structure and open cervical canal. If there are suspicions of deviations from the norm, the doctor will prescribe an ultrasound, which will determine the structure and condition of the cervical canal.

Length by week

One of the main criteria that the doctor pays attention to during the patient’s pregnancy is the length of the cervix. If it is less than the values ​​​​necessary to hold the fetus until birth, there is a risk of miscarriage. Cervical shortening can be detected in two ways:

1. During a gynecological examination.
2. When performing a vaginal ultrasound, which is recommended to be done in several positions - standing, lying down, coughing.

Moreover, before pregnancy, it is possible to estimate the length of the cervix only if it decreases as a result of injury and is accompanied by gross, visible anatomical disorders. Reasons There are several reasons why the cervix may be shortened:

1. Congenital anatomical changes, deficiency of connective fibers, which is rare.
2. Hormonal changes, especially characteristic for the period of 15-28 weeks, when the fetus’s adrenal glands, which synthesize androgens, are activated.
3. Consequences of injuries to the muscle ring, operations, abortions, difficult births (for example, with a large fetus or in a breech presentation). During healing, scars form in damaged areas, which impair the ability of muscles to contract and stretch.

Normally, the length should change as the fetus grows and shorten before birth. Dimensions (in millimeters) and other criteria considered normal are shown in the table (in mm).

If an ultrasound examination reveals a shortened cervical cervix in combination with an enlarged pharynx, a diagnosis is made: isthmic-cervical insufficiency" However, it is worth keeping in mind that during the first pregnancy, shortening by early stages(up to twenty weeks) is very difficult, so an additional examination with a vaginal ultrasound is usually prescribed at 20-22 weeks.

Short cervix: what to do

First of all, a short neck is a reason for constant monitoring, so the number of visits to the gynecologist for women with this pathology is much higher.

According to statistics, it is this pathology that becomes the most common cause of miscarriages occurring in the 2nd trimester, and with habitual abortions it is detected in approximately 20% of cases.

The degree of development of isthmic-cervical insufficiency and, accordingly, the threat to pregnancy is determined by the sum of various criteria.

The scores obtained from the survey are summed up. If their sum is 5 or more, a correction is indicated.

The patient may be prescribed the following treatment methods:

• Tocolytic therapy.

Drug treatment aimed at reducing uterine tone and muscle relaxation. To achieve this goal, the following drugs may be prescribed:

1. Droppers with magnesium sulfate.
2. Magne B6 up to six times a day.
3. Beta-agonists, for example, Partusisten.

• Hormonal therapy.

Functional shortening of the uterus can occur with changes in hormonal levels, primarily with an increase in androgen levels and a lack of progesterone. The following drugs may be prescribed:

1. Progesterone up to 25 mg per day.
2. Utrozhestan orally or intravaginally twice a day until 27 weeks.
3. Duphaston tablet up to 3 times a day.

Important conditions for hormonal therapy are constant monitoring of hormone levels in the blood and gradual withdrawal of drugs, since abruptly stopping their use can provoke a miscarriage.

The suture is placed in the place where the anterior vaginal vault meets the cervix. This operation can be performed in several ways:

1. The external pharynx (posterior and anterior lips of the neck) is sutured. The disadvantage of this method is that the sutured cervix creates conditions for the development of infections in a confined space.
2. Narrowing of the internal pharynx by applying a circular suture. In this case, a hole remains for drainage, so this method is considered more favorable.

The operation is considered simple, but it is performed only in a hospital setting. The optimal period for the operation is 14-20 weeks, but in any case no later than 27 weeks, since later, with noticeable growth of the fetus, there is a high risk of postoperative complications. Anesthesia, as a rule, is administered epidurally and does not harm the health of the fetus. Stitches from the cervix are usually removed at 37 weeks in preparation for childbirth.

• Placement of the pessary.

A pessary is a silicone or plastic ring that is placed to relieve the cervix and relieve pressure on the uterus. There are several types of obstetric pessaries; the choice is made depending on the nature of the birth, the diameter of the cervix and the size of the upper part of the vagina.

Installation of the ring is usually painless: the doctor lubricates it with silicone, inserts it into the vagina and places it on the uterus. The optimal timing of the procedure is after 20 weeks, and the pessary is removed at 37-38 weeks. If the ring is displaced, inflammation may develop, so to prevent complications, tests are scheduled every two weeks.

How does an obstetric pessary work?

Maturity indicators

At approximately 37 weeks, the cervix begins to change and prepare for childbirth. These changes are manifested by shortening, softening and smoothing, as well as by the fact that the cervix moves to a central position and begins to open. In gynecology, the term “degree of maturity” is used, which refers to the level of readiness for childbirth. The degree of maturity is expressed in points, which are determined according to the following criteria:

The points received are summed up and the result is evaluated:

1. Up to 3 points – the neck is immature.
2. 4-6 points – the neck is ripening, not mature enough.
3. 7-10 points – maturity.

If after 37 weeks the cervix does not enter a mature state, we are talking about a pathology opposite to isthmic-cervical insufficiency. It also requires correction, and in some cases, the choice of cesarean section as a method of delivery.

If during early pregnancy the doctor suspects a shortening of the uterus, a gentle regimen is recommended, which involves avoiding physical activity, lifting heavy objects, and exercising caution during sexual relations. At the same time, doctors advise avoiding strict bed rest, since it does not help maintain pregnancy, but can lead to the formation of blood clots.

Sources:

1. Baskakov P. N., Torsuev A. N., Tarkhan M. O., Tatarinov L. A. Correction of isthmic-cervical insufficiency with an obstetric unloading pessary // Protection of motherhood and childhood. — 2013. — No. 1
2. Obstetrics - National Guide. Ed. E.K. Ailamazyan, V.I. Kulakova, V.E. Radzinsky, G.M. Savelyeva. Moscow, 2009.

When registering for pregnancy, a woman must undergo a series of diagnostic procedures to determine her health status and ability to bear and give birth to a baby. The greatest importance is attached to the examination of the internal genital organs, especially the condition of the cervix.

What it is?

The cervix is ​​the most important part of the female organ, associated with the process of childbirth, affecting both the course of pregnancy and the birth process. It is a small tube, approximately 4 cm by 2.5 cm, connecting the uterus and vagina. The cervix is ​​divided into the upper - supravaginal part, located above the vagina, and the lower - vaginal part, which protrudes into the vaginal cavity.

Additionally In the center of the lower part, the cervical canal opens in the form of an internal pharynx (entrance to the uterine cavity). The surface of a healthy cervix is ​​pale pink, shiny, smooth and elastic, and from the inside of the cervical canal the color becomes more intense, and the surface is loose and velvety.

What should the cervix be like during pregnancy?

With the onset of pregnancy, like the entire female body, the cervix undergoes significant changes. Due to a sharp change in hormonal levels and increased blood supply, within a few days after fertilization it becomes cyanotic, and the glands that are abundant in its thickness significantly expand and grow. The muscle fibers lining the cervix are replaced by connective tissue during pregnancy.

Information The newly formed collagen structure, highly extensible and elastic, promotes, in its excessive formation, stretching of the uterus and, accordingly, leads to shortening of the cervix during pregnancy and the creation of conditions for the opening of the internal pharynx.

This type of organ persists throughout pregnancy, and by the end of pregnancy, the doctor notes softening of the tissues, which indicates the maturation of the cervix and readiness for the birth process. Just before childbirth, the cervix tends to sharply shorten to 1-2 cm, fixing strictly in the center of the small pelvis. Further, periodic examination is required so as not to miss the onset of labor, which is signaled by the expansion of the internal os and the first contractions.

Cervical length during pregnancy by week

The cervix gradually becomes shorter according to the duration of pregnancy, reaching its shortest length in the longitudinal dimension towards the end of pregnancy. This dependence is presented in the table:

Inspection

The pregnancy period requires a woman to visit a doctor for a general examination and, in particular, to examine the condition of the cervix, quite often - at least once a month. This regularity is indicated for completely healthy women who do not have serious health problems. If the pregnancy is aggravated by serious diagnoses, or there is a high risk of miscarriage, the doctor establishes a more frequent schedule of visits to the gynecological office.

Regular examinations of the cervix during pregnancy are of paramount importance to identify pathologies of both mother and child, allowing the necessary treatment to be prescribed in a timely manner. At each visit, the doctor takes material to identify a possible inflammatory process, various infections, and exclude cancer in its incipient stage.

Information During appointments, the doctor pays special attention to the condition of the cervix, monitoring its size, shape, location, and consistency. Careful routine examinations are usually carried out in the first weeks of pregnancy, at 20, 28, 32 and 36 weeks. In case of deviations from the norm, inspection is carried out as necessary. Especially the condition of the cervix at the beginning of pregnancy, when its shortening indicates the onset of pregnancy.

Due to the presence of vaginal discharge, which may also indicate the beginning of the process of interruption, the question arises of excluding this option or taking immediate action.

The cervix feels to the touch during early pregnancy

At the very beginning of pregnancy, when there are no pathologies, the cervix, upon examination, feels quite dense upon palpation and is slightly tilted back in location, which is considered normal. The absence of a threat of spontaneous miscarriage is also indicated by obstruction of the cervical canal (external pharynx) for the finger.

And, on the contrary, if such a threat exists, the doctor will notice this by the softened structure, shortened size and loosely closed cervical canal.

Loose cervix during pregnancy

As pregnancy progresses, the tissue of the cervix, like its entire body, undergoes dramatic changes in structure.

Distinguished by its smoothness at the beginning of pregnancy, due to hormonal and physiological reasons, it becomes more and more loose towards childbirth. The loose nature of the surface of the cervix is ​​considered normal near the cervical canal. However, large, loose areas may indicate an infection causing inflammation.

Sources of trouble can be:

• gonococcus;
• and other serious infections requiring urgent treatment.

In addition to increased looseness, ulcerations, nagging pain in the lower abdomen, and discharge may be observed.

Soft

In a normal pregnancy, the cervix should be a dense area with a closed external os, protecting the inside of the uterus from infections. Only after this period does it begin to soften unevenly, that is, become “ripening” - capable of opening during the birth process, but only along the periphery, and the area of ​​the cervical canal remains closed, as evidenced by ultrasound data.

Cervicometry

Cervicometry is a method that determines the length of the cervix during pregnancy.

The study is carried out both using the usual ultrasound procedure and using a vaginal sensor. Preparation for pregnant women does not include filling the bladder, as in the case of a general examination. The examination procedure itself does not differ from the examination of the uterus, familiar to all women, only the device’s sensor will move across the lower abdomen.

Information The doctor preliminarily lubricates the skin with gel for better operation of the ultrasound equipment.

When examining with a transvaginal probe, it is wrapped in a condom, following hygienic considerations, the gel is also applied and the cervix is ​​examined accordingly. Sometimes an examination with a vaginal probe complements a conventional examination through the abdomen.

The cervix serves as a “gate” that holds the fetus inside the uterus. But if it is weak, it may not be able to withstand the increasing mass of the fetus and open ahead of schedule. In such cases, they resort to applying special sutures in the form of a ring. This method is indicated for a period of 13-24 weeks; after this period, this method is not used, but bed rest is recommended for future mothers.

This is a simple operation that involves suturing the neck with lavsan thread, which does not dissolve. It is performed under anesthesia that is safe for the baby, allowing the woman to fall asleep for a short time. After this, a short course of antibacterial and uterine relaxing drugs is given. After surgery, you may experience bloody issues and nagging pain, which is normal.

Stitches are removed after 37 weeks without pain relief. Even if childbirth occurs immediately after this, major problems can no longer occur, since the child reaches functional maturity by this time. In most cases, after removal of the sutures (cerclage), childbirth occurs in a timely manner.

Cervix during second pregnancy

During a second pregnancy, the cervix looks looser at the beginning of the pregnancy compared to the previous state. If the “nulliparous” cervix has the appearance of a cylindrical tube, then the “gave birth” cervix takes on the appearance of a cone or trapezoid. In addition, its surface is no longer completely smooth, but has scars left by previous births and medical manipulations, which impairs its extensibility and leads to shortening.

There is a risk of shortening the cervix with each subsequent pregnancy, so the doctor should constantly monitor its length, especially if the pregnancy was preceded by any complications in the past.

Information There is a widespread belief that in women who have already given birth, some opening of the external pharynx is allowed, which is gross ignorance. In any pregnancy, cervical closure must be absolute; other options are deviations.