Having a healthy baby is every woman's dream. But its implementation is under threat if difficulties arise during pregnancy. A change in the length of the uterine neck (downward) during gestation is one of these complications. When diagnosing a deviation in the early stages, prolongation of pregnancy is carried out successfully. However, the problem is widespread.

A short cervix during pregnancy - a reliable solution to the problem exists

Most women do not suspect that the cervix is \u200b\u200bnot long enough. This serious pathology affects women's health. Its symptoms are especially dangerous during the period of bearing a baby. The diagnosis is known directly during pregnancy. For this, a number of studies are carried out using ultrasound and medical equipment.

Length before pregnancy

The cervix is \u200b\u200ba dense muscle ring. It is located between the uterus and the vagina. For a woman before pregnancy, the norm is a length of 30 mm, the throat is closed. Its standard length is defined as 1/3 of the total size of the uterus.

What should be the length of the cervix during pregnancy

During gestation, there are deviations in length, consistency of the uterine cervix, and also - the opening of the throat changes. In the early stages, the length should not be less than 35-40 mm (12-37 weeks). Shortening of the cervix Only by 38 weeks of gestation, the cervix should be shortened - this is considered normal. A significant change in length occurs shortly before the onset of labor - up to 15 - 10 mm.

During this period, the neck occupies a central position in the small pelvis. If there is a shortening of the cervix within 30 mm, then special attention is needed. A woman whose length has decreased to 15-20 mm is better under constant supervision in a hospital.

If the cervix is \u200b\u200bshort, is it dangerous?

If such a diagnosis is made, then its consequences are very serious - a woman has a 50% risk of childbirth in the next 2 weeks. The threat of miscarriage, premature birth is provoked by a shortened neck. In this state, she may not perform an important function - to keep the uterus together with the constantly growing fetus.

A big threat is the infection of the bearing fetus as a result of the lack of full protection. A pregnant woman is in danger of the rapid development of childbirth. The result of which often becomes rupture of the vagina, cervix, perineum. Diagnosing a problem at an early stage of pregnancy allows you to correctly determine the method of treating pathology.

Reasons for shortening

The reasons why the uterine cervix undergoes a decrease are different. The following factors are common:

1. Natural anomaly in the structure of the uterus (underdeveloped cervical canal; defects that have arisen during the development of the uterus; the presence of genital infantilism).
2. Hyperandrogenism (the presence of an excess amount of androgens - sex hormones characteristic of men).
3. Hormonal disorders arising during pregnancy (no symptoms). Damage caused by previous childbirth.
4. Injuries that have occurred during surgery, abortion.
5. Organ pathology caused by connective tissue dysplasia.

Symptoms in the second trimester

Detection of pathological manifestations of the cervix is \u200b\u200bpossible during the second trimester using ultrasound or gynecological examination. Usually, vaginal examination of pregnant women is rarely performed, but it is mandatory if a woman complains.

When carrying a fetus, a woman should be alerted to symptoms such as:

1. The appearance of a tingling pain in the vagina.
2. The occurrence of cramping pains in the lower abdomen, in the lower back.
3. The presence of unusual secretions - thick mucus, bloody, watery secretions with a specific smell.

The appearance of the latter (liquid, with a characteristic odor) indicates that amniotic fluid is flowing out. The development of such symptoms is observed from 22 weeks. If any of these signs appear, you should immediately contact your gynecologist.

What threatens a decrease in length

Pathology threatens spontaneous miscarriage, premature birth. This is due to the pressure of the growing baby, and the neck may open prematurely. A weakening of the protection of the fetus against infections is provoked. If childbirth occurred in a timely manner, then this state of the organ causes a rapid course of events. It may be accompanied by ruptures not only of the cervix, but also of the perineum.

Deformation of the uterine cervix is \u200b\u200bone of the signs of ICI (cervical-cervical insufficiency). In this condition, there is a risk of pregnancy failure due to physiological problems associated with keeping the fetus within the uterus. The neck and isthmus are under constant pressure from the developing baby.

If a pregnant woman regularly visits a gynecologist, undergoes scheduled ultrasound examinations, then in the presence of pathology, she will be definitely detected by a doctor. Timely measures taken will help prolong the pregnancy.

If narrow and short

The most correct solution would be a systematic observation by a gynecologist if it was found that the length of the neck was reduced. Be sure to stay calm, take good care of yourself and follow the advice of a specialist. It is necessary to pay attention to the tone, which affects the early maturation of the cervix, affects the reduction of its length, disclosure.

Physical activity is limited. It is recommended to wear a bandage. If this pathology is detected, the woman will be offered corrective treatment. The doctor chooses the tactics, it depends on the period, the reasons for the violation. The most common mistake women make is fear of undergoing procedures.

How to lengthen or heal

From the clinical picture and the period of bearing the fetus, a method of treating pathology is chosen. It can be prophylactic, conservative, or surgical. If necessary, the method used is adjusted.

If the critical length of the neck (30 mm) is fixed at 20 weeks, then this is a reason to take the woman under mandatory control. In this situation, she will have to visit a gynecologist on a special schedule. To lengthen the organ, a non-surgical cerclage is prescribed - supporting obstetric pessaries are used, which have various designs. The place of their installation is the cervix.

If by the end of the second trimester the cervix has become shorter - up to 20 mm, then surgical intervention is used. For these purposes, they can:

• strengthen the muscles of the walls using a mechanical method;
• the closure of the external pharynx is carried out by stitching it;
• narrowing the inside of the throat using a mechanical option.

The surgical method can be used starting from the 1st trimester. If a problem is identified at an early stage (week 7), you can operate. A woman needs to be calmer, reduce her activity, it is possible to use bed rest. Medications are used to reduce the tone of the uterus.

Each of these 3 methods helps a pregnant woman give birth to a full-term baby.

Treatment of the shortened cervix helps eliminate the threat of premature birth, makes it possible to calmly endure and successfully give birth to an excellent baby at the right time.

Forecast

Correctly performed treatment has a positive prognosis. This is facilitated by the use of effective methods aimed at reducing tone, reliable retention of the fetus in the uterine cavity. The most common methods are the placement of an obstetric pessary and suture.

The timely start of therapy and strict adherence to all medical recommendations is of great importance. Therapy makes it possible to eliminate the appearance of complications and prolong the pregnancy. Measures aimed at prolonging pregnancy must be taken on time. This is possible only on condition that the woman must attend all the necessary examinations. The diagnosis can be made by ultrasound, which is performed at 15-17 weeks.

Shortening of the cervix during pregnancy is a common problem. It is important to follow all the doctor's recommendations - give up an overly active life, wear a bandage. Undergo treatment if necessary. Then, with this diagnosis, a woman will be able to carry a baby and give birth to him on her own. An absolutely healthy child will be born.

Useful video

The joyful anticipation of the birth of a child can be overshadowed by complications that often occur during pregnancy. In the body of the expectant mother, a colossal hormonal shift occurs, which sometimes leads to the appearance of pathologies in the genital organs. The course of pregnancy and childbirth can be affected by the consequences of previous injuries, abortions and operations on the uterus. The cause of miscarriage is often a violation of the size of the uterus. The short neck cannot withstand fetal pressure. As a result, the pregnancy is terminated.

Content:

What does the shortening of the cervix mean?

During pregnancy, when a fetus develops in the uterus, the size of the organ increases significantly. This is due to the elasticity of the muscle walls. The cervix is \u200b\u200ba narrow canal at its end. The length and thickness of the cervical canal are normally such that the fetus is kept in the uterine cavity until the very moment of delivery.

A neck length of 3-5 cm is considered normal. If it is found that it is shortened to 2 cm or even less, then the woman is diagnosed with a short neck. Such an anomaly is dangerous for both the expectant mother and the fetus she is carrying.

Changing the size of the cervix during pregnancy is not always a pathology. It may get a little shorter if the woman is doing physically demanding work. But after rest, the size is restored. Physiological changes in its length occur at different stages of pregnancy.

Normally, the cervical canal should shorten and widen before delivery. If this does not happen, after the expiration of the prescribed period, the neck for some reason remains narrow and long, this leads to fetal overburden. Artificial induction of labor will be required. They can last longer, accompanied by tears in the birth canal.

Signs of pathology

Most often, women do not suspect the existence of such an anomaly, since there is no discomfort and painful sensations. As a rule, signs by which it can be assumed that the neck is short are noticed during a planned ultrasound scan in the 2nd trimester of pregnancy. The appearance of liquid bloody discharge and cramping pain in the lower abdomen suggests that there is a threat of miscarriage.

The shortening of the cervical canal occurs due to the fact that under the influence of hormones during pregnancy, the epithelium grows inside it, which leads to a decrease in the elasticity of the neck, an increase in the muscle tone of the walls of the entire organ.

Note: Signs of increased tone are the occurrence of pain in the uterus, a feeling of strong tension in the abdomen, the appearance of bloody discharge, as well as nausea and dizziness. A pregnant woman should see a doctor and be treated with progesterone drugs.

When the anomaly is especially dangerous

The most intensive process of shortening the cervix occurs starting from the 20th week. If the cervix is \u200b\u200btoo short, it is during this period that there is an increased likelihood that it will not support the weight of the fetus, a miscarriage will occur.

After 30 weeks, this condition can lead to premature birth. At the same time, the fetus is already quite viable, prematurity often becomes the reason for the child's developmental delay and the occurrence of various diseases in him. The risk of premature birth is especially high if the pregnancy is multiple.

Effects

The consequences of the fact that the cervix is \u200b\u200btoo short during pregnancy are:

1. Isthmic-cervical insufficiency. This condition, in which the neck of the organ cannot bear the weight of the growing fetus, opens ahead of time. In this case, the pregnancy is interrupted or premature birth begins.
2. Too rapid course of labor, which leads to trauma to the vagina and perineum, the formation of vaginal-intestinal fistulas. Due to the too fast passage of the child through the short neck, he may receive birth trauma, leading to the development of physical disabilities or damage to the central nervous system.
3. During pregnancy, the risk of infection entering the uterus increases due to the short and dilated cervical canal.

It is possible that an inflammatory process occurs in the mucous membrane of the uterus (endometritis), as well as the spread of infection to the membrane of the ovum and to the amniotic fluid surrounding the embryo.

Causes of the shortening of the neck

The immediate causes of shortening are malformations of the genital organs, hormonal disorders, distension of the uterus and fetal pressure on the cervix during pregnancy.

A short cervix can be a hereditary trait that manifests itself in female relatives for several generations. At the same time, they have a tendency to the occurrence of the same pathologies in the organs of the reproductive system.

Underdevelopment of the cervix in a girl may be congenital, associated with a complicated course of pregnancy in her mother, or acquired due to the exposure of a pregnant woman to harmful factors (some drugs, chemicals, infections).

The shortening of the cervix during pregnancy is caused by:

• a woman lifting weights;
• traumatic injury to the cervix during previous operations (such as curettage, cauterization of erosion), as well as during previous childbirth and abortion;
• polyhydramnios, carrying a large baby or several at once;
• placenta previa (too close location of the fetus and placenta to the internal os of the cervix);
• the presence of scars in the uterus and cervix formed after the transferred inflammatory and infectious diseases.

After conceiving a child, a woman has a natural physiological decrease in immunity. Thanks to this, there is no rejection of the fetus. A decrease in immune defenses increases the body's susceptibility to infections, so the risk of infection in a pregnant woman increases.

Video: Shortening of the cervix and hypertonicity

Diagnosis of pathology

It is better to detect such an anomaly as a short cervix in advance, even during pregnancy planning. It may be possible to eliminate the pathology or take measures to ensure that the bearing of the child is successful. It is impossible to determine independently the presence of a deviation in the size of the cervix due to the absence of any external manifestations of the anomaly.

Gynecological examination of the cervix in mirrors reveals that it is too short by the increase in the diameter of its outer os. The channel width corresponds to the thickness of the finger. The fetal membrane can be seen through a very short neck.

Cervicometry (transvaginal ultrasound of the cervical canal). A similar diagnostic procedure can be performed up to 22 weeks of pregnancy. Using this method, determine the length of the neck, the diameter of its external and internal os. If necessary, the study is carried out repeatedly.

Blood test. If there are no prerequisites indicating the congenital or genetic nature of the anomaly, while the woman does not have genital trauma, then an assumption is made about its hormonal origin. For clarification, a blood test for androgens and progesterone is performed. An increased content of male sex hormones in a woman's body can be the cause of impaired uterine development. Lack of progesterone contributes to the termination of pregnancy due to detachment of the ovum.

After consultation with an endocrinologist, as well as specialists in immune disorders and infectious diseases, additional studies may be prescribed (smear analysis for the microflora of the cervical canal, blood test for antibodies to infectious agents, and others).

Video: How and why cervicometry is performed

Treatment

During pregnancy, if the cervix is \u200b\u200bshortened and there is a threat of miscarriage, conservative or surgical treatment of the woman is performed. The choice of technique depends on the degree of shortening, the duration of pregnancy. The presence of previous pregnancies and their outcome are also taken into account.

Conservative treatment

In order to prevent spontaneous abortion, drug therapy or mechanical devices are prescribed to help keep the fetus in the uterus.

Drug therapy

Prescribed drugs to relax the uterine muscles, reduce muscle tone (tocolytics - Fenoterol, Ritodrin), as well as antispasmodic drugs (Drotaverin, Papaverine). Elimination of muscle spasms helps to improve the blood supply to the fetus, helps to get rid of the pain that occurs due to hypertonicity. A woman is recommended to take sedatives (tinctures of valerian, mint, motherwort), which help relieve nervous tension.

If a blood test shows that the progesterone level is below normal, Utrozhestan or Duphaston (its synthetic analogues) are prescribed. At the beginning of pregnancy, progesterone prevents the rejection of the fetus, promotes its fixation in the uterine wall. Such drugs are taken in the 1st and 2nd trimester, when the likelihood of miscarriage is especially high.

Warning: Hormonal drugs can only be taken as prescribed by a doctor, in strictly individual doses, which are calculated taking into account the age and body weight of the patient. Self-medication leads to hormonal imbalance and the development of severe complications during childbirth. Taking any other medications must also be agreed with the doctor, as they can have side effects that are dangerous for the child.

In the 3rd trimester, a decrease in the level of progesterone in the blood is a natural physiological process necessary for the normal dilation of the cervix and increase its tone during childbirth. During this period, the progestogen drugs are stopped.

Ways to help keep the fetus in the uterus

In order to reduce fetal pressure on the short cervix, a woman is advised to wear a bandage.

In the 2-3 trimester, if the neck is not very shortened and is not more than 1 finger open, a mechanical device is used to prevent fetal loss - a pessary. It is a smooth latex ring. The doctor puts it on the cervix, thereby narrowing it. The device is removed no earlier than 38 weeks, since labor usually begins in the coming days after its removal. In order to prevent the development of the inflammatory process, after installing the pessary, it is necessary to analyze the smear for microflora once every 2 weeks. It is recommended to avoid sexual intercourse.

Surgery

If the likelihood of isthmic-cervical insufficiency is high, temporary sutures are applied to tighten the cervix (cervical cerclage). Typically, this operation is performed at 16-25 weeks. The procedure is performed under general anesthesia.

Sutures are usually removed after 38 weeks or a little earlier if the amniotic fluid has departed or spotting appears.

It is better to detect and eliminate gynecological pathologies in advance. But if a woman did not visit a doctor before pregnancy, she should register as early as possible. This will help to take urgent measures if complications arise, or to carry out preventive treatment if pathologies of the structure of the uterus are detected.

The shortening of the cervix is \u200b\u200bnot a contraindication or an obstacle to the onset of pregnancy, but it requires close monitoring and compliance with all doctor's prescriptions. Pregnant women with such pathologies are advised to abandon swimming, as well as sports exercises that require stress or sudden movements.

For many women, pregnancy seems to be a magical stage in which you can enjoy a peaceful, calm flow of life. In practice, the gestation process is accompanied by risks and complications, a woman regularly visits a doctor, takes planned and additional tests to control the condition. One of these deviations is a short cervix during pregnancy, which is dangerous for the onset of premature birth.

It is a natural process to reduce its size and soften shortly before birth. If this happens much earlier than the planned date, there is a threat of miscarriage, or the baby will be born prematurely.

Diagnostics of the short cervix

The cervix has a conical shape, the special structure of muscle fibers allows you to keep the fetus together with the placenta until the very moment of childbirth. Readings of 35 mm are normal, dimensions of 25 mm are deviations. Also, the length depends on the term, closer to childbirth it begins to soften, decrease. The norm is considered to be 35-45 mm for a period of 22-28 weeks, after this period - 30-35 mm. If this is a congenital feature of a woman, and she regularly visits a gynecologist, before conception, it is necessary to go through the planning stage.

Diagnostics of the cervix is \u200b\u200balso carried out when the expectant mother registers, this usually happens in the first trimester, up to 12 weeks. A routine examination by a doctor is enough to suspect a pathology; during palpation, the gynecologist assesses the length, patency and condition of the cervical canal.

Additional studies to confirm the diagnosis:

• inspection with mirrors;
• ultrasound (transvaginal) allows you to further monitor the state of the cervix.

To determine the pathology of the cervix, a doctor's examination is sufficient. A comprehensive examination is necessary for making a diagnosis, tracking the effect on the state of gestation.

Main reasons

Any deviations in the organs of the reproductive system pose risks to pregnancy. A short neck is especially dangerous in case of multiple gestation, polyhydramnios or the development of a large child.

Causes of pathology:

• the factor of heredity, abnormal structure or insufficient development of organs due to genetic characteristics;
• changes in hormonal levels that occurred after conception;
• dysplasia of the uterus occurs at the onset of early sexual activity, deficiency of important elements, harmful addictions, the presence of sexually transmitted infections;
• diseases of the endocrine system, signs are increased greasiness of the scalp, face, acne, changes in the structure of the ovaries;
• violation of the integrity of the uterus during operations, abortions, during childbirth.

If the expectant mother monitors health indicators, eats right and regularly visits a gynecologist, the risks of pathology are reduced. Besides genetic reasons, a woman's lifestyle is of great importance.

Symptoms

The pathology begins to remind of itself after the formation of the placenta, from the 16th week of pregnancy. During this period, the size of the fetus increases, which means that the pressure on the pharynx of the uterus increases. A woman cannot independently detect this, it turns out during a routine examination by a gynecologist.

There is a danger of symptoms of miscarriage. A pregnant woman has pain in the lower abdomen, passing into the lumbar region. From the genital tract, mucous masses interspersed with blood are released. If signs occur, the woman is sent for an ultrasound, this may be a signal of the threat of interruption of gestation or the onset of premature birth.

The most unfavorable prognosis for isthmic-cervical insufficiency, a dangerous failure of gestation. With a cervical length less than 25 mm, the uterus cannot support the growing fetus, which leads to the opening of the pharynx. This condition is asymptomatic and can only be detected during a vaginal examination.

What is the dangerous short cervix:

• the onset of premature birth, failure of gestation;
• childbirth proceeds rapidly, often accompanied by breaks;
• insufficient barrier can lead to fetal infection.

The diagnosis of ischemic-cervical insufficiency is not an obstacle to motherhood. Timely diagnostics and treatment therapy allows a woman to maintain pregnancy and give birth to a healthy child.

Treatment and therapy

It is impossible to increase the length of the cervix, the doctor's actions are aimed at preserving gestation, preventing the onset of premature birth. Pregnancy of women with a history of miscarriages and ICI diagnosed is under close supervision.

With a slight deviation of the cervix, an obstetric pessary is used. This device allows the cervix, rectum and bladder to be fixed in the correct position. Made from hypoallergenic materials, does not cause body reactions. Has different sizes, the ability to pick up for both large and small circumference of the uterus. Stirred after 20 weeks, and removed before childbirth at 38 weeks.

The edges of the pessary are lubricated for painless passage along the vaginal walls. The method allows to maintain multiple pregnancy, reduces the risk of onset of labor.

After installing an obstetric pessary, a pregnant woman needs:

• give up intimate life;
• limit physical activity;
• to prevent inflammatory processes, conduct a microflora study every 20 days.

In case of pathological shortening of the cervix, opening of the throat, a procedure for suturing the uterus is performed. This mechanical method allows you to restrain the erection until the moment of delivery. The operation is performed from an early date (up to 17 weeks), but no later than 30 weeks. During suturing, the pregnant woman is under short-term, local anesthesia, anesthesia that is safe for the development of the baby must be selected.

The stitches are removed by a gynecologist in the following cases:

• after 38 weeks, when the pregnancy is considered full-term;
• with stable labor, regardless of gestational age;
• with leakage or complete discharge of amniotic fluid;
• if there is a discharge with blood clots.

Prevention

The basics of sex education will help prevent possible pregnancy pathologies. In addition to the genetic causes of a short cervix, the rest are the result of irresponsible attitude towards reproductive health.

Preventive measures:

• selection of contraceptives to prevent unwanted pregnancy, sexually transmitted diseases;
• a planned visit to a gynecologist will allow you to identify abnormalities in the early stages and carry out successful treatment;
• the planning stage is mandatory for women who have undergone pelvic surgery, abortions, ectopic pregnancies in the past;
• a healthy intimate life includes having one partner, no casual relationships, and protected intercourse.

Carrying out therapeutic actions for such a pathology as a shortened cervix will preserve the pregnancy, prevent the onset of premature birth. The expectant mother is also advised to follow the regimen, exclude sexual intercourse, and devote more time to rest.

No woman wants her pregnancy to be clouded by the occurrence of any complications, especially the threat of termination of pregnancy or premature birth. But, unfortunately, this happens, and many different reasons can contribute to this. One of these reasons may be a short cervix.

Why is a short cervix dangerous?

- This is the lower, narrowed, rounded part of the uterus that connects to the vagina. Normally, its length is about one third of the total length of the uterus, approximately 3 to 4 cm. But in some cases it can be short, reaching only 2, or even less, centimeters.

A short cervix can cause the development of so-called isthmic-cervical insufficiency (ICI). This condition is characterized by the physiological inability of the cervix to keep the constantly growing fetus in the cavity. Under pressure from the baby, the cervix begins to shorten and open even more, which can lead to miscarriage or premature birth.

Information The deformed and shortened cervix not only cannot keep the baby in the cavity, but is also unable to protect him from infections. And during childbirth, it can serve as their rapid course, and as a result, cause ruptures of the perineum and vagina.

The reasons

1. , a short cervix can be congenital, genetically determined by a feature of the anatomical structure of the genitals;
2. , it can be shortened against the background of hormonal changes in the body during pregnancy (this becomes especially noticeable in the second trimester of pregnancy);
3. , deformities and shortening of the cervix are facilitated by previously performed abortions, curettage of the uterine cavity and childbirth.

Examination and diagnostics

The fact that the cervix is \u200b\u200bshortened, an obstetrician-gynecologist may suspect already at the first vaginal examination of a woman. But usually such a diagnosis is made after a transvaginal ultrasound scan or during the second planned ultrasound scan at 18-22 weeks of pregnancy.

What to do if the cervix is \u200b\u200bshort during pregnancy?

Additionally If you knew about this problem from the very beginning, that is, you have a congenital feature or this has already happened in previous pregnancies, then the most correct solution would be constant supervision by a specialist, respect for peace and respect for yourself.

It is recommended to observe that the uterus is not in good shape during pregnancy, as this provokes the maturation of the cervix, its shortening and disclosure. It is best to limit physical activity and resort to wearing a bandage.

If a shortening of the cervix is \u200b\u200bdetected during pregnancy, that is, hormonal disorders become the cause, then, depending on the gestational age and whether there is a discovery, the woman is offered corrective treatment for this condition.

Actually, there are two methods of treatment: - suturing (applied up to 27 weeks) and - the use of an obstetric pessary (when there is no significant shortening, but there is a threat of ICI development).

One of the most common mistakes women make is fear of these procedures, unwillingness to play it safe and mistrust of the doctor. If you have any doubts and want to visit another specialist, then it is better to do so. But remember that the treatment of a shortened cervix is \u200b\u200bnot just a reinsurance - it is a necessity that will eliminate the threat of premature birth, help to bear and give birth to a healthy baby just in time.

Short cervix during pregnancy

Causes, prevention and treatment of a short cervix during pregnancy

A short cervix during pregnancy is a fairly common pathology. It is dangerous because it can cause a miscarriage or premature birth, since the cervix is \u200b\u200bnot able to keep the baby inside the uterus, it opens under its weight. But if a woman regularly visits a gynecologist and undergoes ultrasound examinations, the doctor will definitely notice this cervical pathology and take measures to prolong the pregnancy.

Why does the cervix open ahead of time and diagnosis of pathology

This pathology is medically called isthmic-cervical insufficiency (ICI). Its signs are: premature shortening, softening and opening of the neck. These signs are most often diagnosed at 15-20 weeks, when a rapid weight gain in the fetus begins, and the cervix during pregnancy experiences great stress. A doctor can notice violations during a gynecological examination, as well as on an ultrasound scan. The expectant mother herself may notice profuse watery or bloody discharge. But in most cases, there are no symptoms.

There are many reasons for this pathology. These are various injuries resulting from ruptures of the cervix during childbirth, during medical abortion, during conization, the imposition of forceps, etc. The situation is aggravated by multiple pregnancies, polyhydramnios, and a large fetus.

ICI can also be congenital and caused by hormonal disorders, due to which the length of the cervix during pregnancy begins to decrease long before the date of birth.

All women with cervical injuries, as well as with a bad history (miscarriages in the second trimester of pregnancy) are under especially close supervision of a doctor.

Prevention and treatment methods

Early prevention can include reliable contraception to avoid abortion. In second place is a regular, at least once a year, visits to the gynecologist. Preventive medical examinations will help to identify the pathology of the cervix in time and cure it in a conservative way. And finally, pregnancy planning. This is especially true for those women who had pregnancies with an unfavorable outcome in the past, and the loss of pregnancy occurred at a long time.

If a short cervix is \u200b\u200bfound during pregnancy, treatment is prescribed depending on whether there is an erection, as well as directly from the gestational age. Recall that the short one is less than 2.5-3 cm. Actually, there are 2 methods of treatment: suture and an obstetric ring pessary. Sutures are applied up to 27 weeks, and the earlier, the more effective the measure. Sutures will help even if the neck is ajar. Meanwhile, as a conservative method - a ring, it is put on rather for a preventive purpose, when there is no significant shortening, but the doctor suspects an ICI in the patient.

The stitches are removed if the amniotic fluid has departed, labor or bleeding has begun. If everything is in order, then as planned, the stitches are removed at 38 weeks. If a cesarean section is planned, the stitches are not removed in most cases.

Know that isthmic-cervical insufficiency is not a sentence if you take timely measures to prevent further cervical dilatation and follow the doctor's recommendations.

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Shortening of the cervix during pregnancy

A pregnant woman in our time should calmly perceive the news about pathologies and deviations of bearing a child. Firstly, modern medicine has tremendous possibilities and methods of treatment, and secondly, excessive nervousness can only harm the condition of a woman and a fetus. So, let's talk about shortening the cervix during pregnancy. Why does it arise, how it threatens and what doctors usually do in such a situation.

Cervix and pregnancy

When doctors talk about a short cervix during pregnancy, with confirmation of the diagnosis by research results, this may be a symptom of isthmic-cervical insufficiency (ICI). She, in turn, is the cause of self-abortion and premature birth. The diagnosis of isthmic-cervical insufficiency means that the cervix and the isthmus cannot cope with the constantly increasing pressure of the fetus and amniotic fluid. This phenomenon leads to early disclosure of the cervix. Recall that the neck and isthmus are part of a woman's birth canal. Sometimes the neck is naturally short. And often the shortening of the cervix in a woman occurs as a result of various types of intrauterine interventions associated with its expansion. This can be abortion, curettage, previous childbirth with trauma to the muscle ring of the cervix. Scars appear at the site of the injury, the ability of the muscles to stretch and contract is impaired, and the neck is shortened.

Read also Dilation of the cervix

Why is the cervix shortened during pregnancy?

The shortening of the cervix during pregnancy can be caused by hormonal disorders. Typically, this occurs between 11 and 27 weeks of pregnancy, and most often from 16 weeks. At this time, the child develops adrenal activity. They secrete androgens - hormones that provoke the development of shortening of the cervix. Under their influence, the cervix softens, shortens and opens. The pregnant woman herself may not suspect that she is developing an ICI. After all, the tone of the uterus may be normal.

Typically, ICI is diagnosed by a doctor during the examination of a woman in a gynecological chair. Confirm the diagnosis with a vaginal ultrasound. When the length of the cervix is \u200b\u200bless than 2 cm, and the diameter of the internal os is more than 1 cm, then signs of ICI can be ascertained.

If during pregnancy the cervix is \u200b\u200bshortened, then this is a reason for close monitoring by a gynecologist. When this problem is caused by an excess of androgens, it is usually treated with dexamethasone. Also for treatment, drugs are used that relax the smooth muscles of the uterus, sedatives, vitamins. Usually, after several weeks of this therapy, the cervix will stabilize. Otherwise, surgical correction is made. This means that sutures are applied to the neck. Typically, this procedure is done before 28 weeks of pregnancy. Another option for correcting the problem is an obstetric pessary, that is, a special device that holds the uterus in the correct position and reduces the pressure of the fetal fluid on the cervix. This treatment option is acceptable after 28 weeks of pregnancy.

What is the danger of a short cervix during childbirth?

If the shortening of the cervix occurs just before childbirth, then this is considered a normal preparatory process. At the same time, a short cervix during childbirth can become a factor in the onset of rapid labor. They, in turn, are fraught with ruptures of the cervix and vagina.

Medical statistics suggest that cervical shortening during pregnancy may be the norm for women who are not in labor for the first time.

In order to avoid the negative impact of cervical shortening on childbirth, a pregnant woman must constantly and strictly follow the doctor's prescriptions, undergo medical examinations on time and visit a gynecologist at the time specified for her.

Especially for beremennost.net Elena TOLOCHIK

Short cervix: causes of pathology and its elimination

The greatest danger that lies in wait for a woman during pregnancy is the threat of her termination or premature birth. Both from the physiological and from the psychological side, this problem for a woman is becoming one of the most significant.

That is why any pregnancy should take place under the strict supervision of a doctor who is able to suspect a threat of miscarriage or premature birth, and, if necessary, take measures to preserve the pregnancy. One of the most common causes of miscarriage or rapid premature birth is a short cervix.

In the presence of this pathology, a woman may be unable to bear a fetus and give birth to a child without medical intervention.

Short neck. Physiological side of the issue

The isthmus and cervix are the first section of the birth canal. The neck has the shape of a truncated cone or cylinder, 70% consists of connective tissue, and 30% of muscles. The musculature of the cervix is \u200b\u200blocated closer to the body of the uterus and forms the so-called sphincter - a muscle ring that holds the cervix closed, and opens during childbirth, which becomes the beginning of the last phase of labor. The normal cervix with all its parts is approximately 40 mm long.

By the end of pregnancy, when preparing the body for childbirth, the neck is shortened, its internal pharynx expands and childbirth occurs. For various reasons, this process can start earlier. In this case, there is an ICI - isthmic-cervical insufficiency. This condition is characterized by premature shortening of the cervix and softening of the sphincter, as a result of which the opening of the first section of the birth canal and premature birth can occur.

If the cervix in the first or second trimesters of pregnancy is shortened to 20-30 mm, this is a signal of the presence of ICI - a condition in which the risk of miscarriage increases many times over.

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Short cervix: causes of pathology

Isthmic-cervical insufficiency can be congenital or acquired. In the first case, the pathological condition is associated with the individual characteristics of the structure of the body, as well as a genetic predisposition.

The congenital form can be found during a gynecological examination or ultrasound of the pelvic organs of a woman before the first pregnancy. If it is present, pregnancy can be complicated, therefore, while carrying a child, a woman needs to carefully monitor her well-being, exclude the maximum possible amount of physical activity and ensure peace, and also regularly visit a doctor.

However, even in the absence of congenital pathology, the cervix can be shortened even before pregnancy. The reason for this may be previous childbirth complicated by ruptures, spontaneous and medical abortions, surgical interventions into the uterine cavity, diagnostic curettage, conization and many other factors, one way or another associated with the expansion or injury of the cervix.

As a result, scars can form on its muscle walls, the neck is deformed, becomes incapable of normal stretching and shortens. There is also a completely physiological reason for the shortening of the cervix during pregnancy. At 10-21 weeks of obstetric period, the fetus begins to produce its own hormones, in particular androgens, which are necessary for normal labor.

If, by that time, androgens are in excess in the maternal body, there is a gradual premature preparation for childbirth: shortening of the cervix and opening of the internal pharynx, which leads to the risk of premature birth.

How to maintain a pregnancy with a short cervix?

The shortening of the cervix may be suspected by the doctor during a gynecological examination and confirmed by an ultrasound specialist during an intravaginal examination. When a pathology is detected, a number of studies are assigned in order to determine the cause of its development, one of the mandatory among which is a blood test for hormones.

If the neck is shortened against the background of an excess of hormones, then often the condition can be stabilized by the appointment of hormone therapy. A pregnant woman with a shortened cervix is \u200b\u200ballowed to rest and bed rest, wearing a prenatal bandage. In some cases, the patient is offered to maintain the pregnancy in the hospital.

Progressive shortening of the cervix despite bed rest and lack of physical activity requires measures to maintain pregnancy. In this case, it can be recommended to install an obstetric pessary on the cervix - a special polymer device like a ring that maintains the uterus in a physiologically normal position, reduces fetal pressure on the cervix and prevents further shortening and opening of the cervix.

If the condition is critical, that is, the length of the cervix is \u200b\u200bless than 20 mm and there is an opening of the throat by more than 10 mm, the doctor may recommend a surgical correction of the cervix - to apply a cervical cerclage. The procedure involves suturing certain areas of the cervix. Sutures are applied no later than 27 weeks of pregnancy in a stationary mode using anesthesia and under ultrasound control.

Cervical cerclage is removed at the beginning of labor: with contractions, drainage of water, or beginning labor bleeding. If labor does not begin before 38 weeks, the stitches are removed as planned, and with a planned caesarean section, they may not be removed at all. A shortened cervix is \u200b\u200bnot a sentence for a pregnant woman. In most cases, the situation is fixable, thanks to which a woman can safely bear and give birth to a child without any special consequences for her body.

The main thing is to detect pathology in time and take action, as well as lead a calm lifestyle, rest more often, reduce physical activity and wear a prenatal bandage, which reduces the pressure of the amniotic sac on the internal os of the cervix.

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Diagnosis and treatment of a shortened cervix

Today, with such a fast paced life, many women simply do not have time for their health.

And if it comes to a disease that is asymptomatic, then the representatives of the weaker half of humanity learn about it only when the trouble makes itself felt. The short cervix also belongs to this category of pathologies.

This disease is not "exotic", as it occurs quite often. However, the danger is that in the normal state of a woman, the disease does not manifest itself in any way. And only during pregnancy it suddenly turns out that the patient has a short cervix.

A bit of anatomy

In a woman's body, the organ in which the embryo is formed from the ovum, and then the fetus develops, is the uterus. It has two parts: the body, where the unborn child is located, and the cervix, which subsequently, during labor, performs the function of the birth canal. In shape, the neck resembles a truncated cone or cylinder, 3.5 - 4 cm long.It is conventionally divided into 2 parts:

• vaginal (clearly visible during a gynecological examination);
• vaginal (not a view on examination).

The part of the cervix adjacent to the body of the uterus is called the internal pharynx. The part that passes into the vagina is the external pharynx.

In terms of composition, 1/3 of the cervix consists of muscle tissue. Moreover, the main part of the muscles is "concentrated" in the area of \u200b\u200bthe internal pharynx, and forms there a powerful muscle ring (sphincter), which allows the fetus to be kept in the uterine cavity throughout pregnancy.

Why is the shortened cervix dangerous?

A short cervix (less than 2.5 cm) is one of the reasons for the development of ICI in a woman (isthmic-cervical insufficiency). With this pathological condition that occurs during pregnancy, the cervix is \u200b\u200bnot able to hold the unborn child in the uterine cavity. The constantly growing fetus, together with the amniotic fluid, exerts pressure on the neck. As a result, it becomes even shorter and opens, leading to premature or accelerated labor (with ruptures of the vagina and even the uterus), and in the early stages - to miscarriage.

In addition, the shortened cervix is \u200b\u200bnot able to fully protect the fetus from the effects of infectious agents, since it does not perform a barrier function, becoming permeable to various microorganisms.

Symptoms

ICV symptoms most often begin to appear during pregnancy at 15-27 weeks. And this is no coincidence. It is from this period that the fetus intensively increases in size and, gaining weight, begins to press harder on the muscular sphincter of the internal os of the cervix.

The doctor detects changes in the size of the cervix during the next gynecological examination. In this case, the woman usually does not make any complaints. Only in some cases, the short cervix is \u200b\u200bmanifested by bloody discharge or profuse watery discharge from the vagina, pain in the lower abdomen. In the presence of these symptoms, in order to finally confirm the diagnosis, the doctor sends the patient for an ultrasound examination.

The reasons

Why is such a pathology suddenly revealed during pregnancy?

In some women, for example, a short cervix can be detected during the second pregnancy, even if its length during the first pregnancy was within the normal range.

The main reasons leading to the shortening of the cervix during pregnancy include:

1. Congenital anomalies of the structure of the uterus. Rare and usually inherited
2. Mechanical trauma to the cervix with subsequent deformation arising from operations (for example, when applying forceps, during conization), abortion, diagnostic curettage. In this case, the muscular sphincter loses its elasticity, i.e. the ability to stretch.
3. Hormonal disruptions during pregnancy. They begin from 11-12 weeks of pregnancy, when the adrenal glands begin to function actively in the fetus. They secrete hormones, including androgens, under the influence of which (with an increased level of a woman's “own” androgens as well), the neck becomes soft and shortens. This contributes to its disclosure. At the same time, the woman does not even know about the threatening danger, since an increase in the tone of the uterus (and, accordingly, certain symptoms) is not observed.
4. Damage to the cervix during previous birth. In this case, the risk of injury increases in the presence of so-called aggravating factors, which include:

• multiple pregnancy,
• polyhydramnios.

Diagnostics

In order for the short cervix to be detected in the early stages of pregnancy, a woman needs to visit a gynecologist as soon as she learns about her "interesting" position. The first thing the doctor will do is examine the patient on the gynecological chair. During this study, a specialist can visually assess the condition of the cervix, its size.

A woman is also obliged to inform the doctor about the fact that she has a history of pregnancy, which ended in miscarriage. In this case, the patient will be under special control, in which every week (or once every two weeks) it is necessary to monitor the state of the cervix (from 12-16 weeks of pregnancy).

Ultrasound is another research method that is widely used in the diagnosis of pathologies of the cervix. It can be done in two ways:

• transabdominal (through the stomach);
• transvaginal (using a vaginal probe through the vagina).

With ultrasound, isthmic-cervical insufficiency is determined when the diameter of the internal os\u003e 1 cm and the length of the neck< 2 см.

Prevention

After diagnostic measures, the doctor prescribes the necessary treatment aimed at maintaining the pregnancy. However, a short cervix refers to a problem, the unpleasant consequences of which can be avoided by early prevention of the disease, which includes the following measures:

• Timely visit to the gynecologist. It is during the examination that the doctor can see the problem and begin the necessary treatment on time.
• Use of reliable contraceptive methods to avoid unwanted pregnancy and its consequences - abortion.
• Pregnancy planning. This is especially important for those women who have a history of problem pregnancies.

Treatment

If a woman knows about the structural features of her cervix (there were similar problems in previous pregnancies or there are congenital anomalies in the structure), then she needs to be constantly monitored by a gynecologist, not to get nervous, to rest more. In addition, it should be monitored so that the tone of the uterus does not increase, as in this case there is a risk of miscarriage. It is recommended to limit any physical activity as much as possible and wear a bandage.

With minor changes in the neck, the doctor resorts to conservative therapy. A woman is prescribed drugs that relieve the tone of the uterus and contribute to the return of the cervix to a physiological state. For these purposes, intravenous drip administration of Magnesia, Ginipral is indicated (can also be used in tablets).

If the reason for the short neck is an excess of androgens, glucocorticoid drugs (for example, dexamethasone) are prescribed to correct the condition. After the course of treatment, the condition of the cervix is \u200b\u200bassessed. If there is no improvement, as well as if the shortened neck has arisen as a result of exposure to a traumatic factor, a surgical correction is performed - cervical cerclage. In this procedure, under anesthesia (epidural or intravenous), stitches are placed on the neck. This helps to keep the fetus in the uterine cavity.

Suturing is carried out in the period of 17-21 weeks. At the end of the operation, the woman is in the hospital for 7-20 days. All this time, in order to avoid an increase in the tone of the uterus, therapy with antispasmodic drugs (Papaverine, No-shpa, etc.) is carried out. In the case of an infection or when a pathogenic microflora is detected, antibacterial drugs are prescribed. After discharge from the hospital, a woman must visit a gynecologist every two weeks, who will monitor the condition of the cervix. Also, 1-2 times a month, a bacteriological culture and a smear on the flora are taken from the patient. Antenatal hospitalization is performed at 37 weeks. At this time, the seams are removed.

Important!!! If there is an outpouring of amniotic fluid, or labor has begun, the stitches are removed regardless of the gestational age. If this is not done, the stretched threads injure the neck during contractions.

Traumatic tissue damage by threads occurs if this operation was performed on the "inflamed neck".

With a shortened neck, the so-called non-surgical cerclage is performed. The essence of this method is that a special ring is put on the neck - an obstetric pessary. This design can be used in the second half of pregnancy (at 25 weeks), when suturing is contraindicated in order to avoid infection of the fetus and injury to the fetal bladder. The pessary is a kind of bandage that not only reduces the pressure on the cervix, but also reduces the likelihood of fetal infection, keeping the sulfur plug.

In order to prevent infectious complications, the installed pessary, as well as the vagina, is processed by a doctor every 15-20 days. The construction is removed during pregnancy for a period of 37-38 weeks.

Sometimes, even during a safely proceeding pregnancy, unpleasant surprises occur. Such diagnoses include shortening of the cervix.

A woman may not be aware of the existing pathology either before pregnancy or with its onset.

The problem will manifest itself only after 15 weeks, when the active growth of the fetus begins and its pressure on the cervix increases. The diagnosis of "shortening of the cervix" is directly related to isthmic-cervical insufficiency - a dangerous condition that threatens to terminate pregnancy.

The lower part of the uterus is called the cervix. This is a kind of muscle lock that holds the fetus in the mother's abdomen, protecting it from mechanical damage and infections. The part of the cervix facing the vagina is called the external os, and the inner edge is called the internal pharynx.

With the growth of the fetus, the neck is stretched from the side of the internal pharynx and, accordingly, becomes shorter. If the external pharynx is also included in the process, the obturator function of the cervix is \u200b\u200bdisrupted, there is a threat of loss of membranes, infection, miscarriage.

Even in the absence of symptoms of the disease, it is recommended for a period of 24 weeks. The normal value is 3.5 cm. A shortening of the neck to 2.2 cm indicates the possibility of miscarriage in 20% of cases, and shortening to 1.5 cm increases the risk of premature birth by 50%.

Diagnosis: what are the symptoms?

As such, the pathology of shortening of the cervix has no symptoms. The doctor will notice a possible danger during a routine obstetric examination. But to clarify the diagnosis, the woman is sent for an ultrasound scan.

A vaginal probe examination will allow accurate measurements and an assessment of the threat.

If the diagnosis has already been confirmed and there is a risk of termination of pregnancy, an examination is carried out with an external, transabdominal sensor to monitor the state of the cervix.

At the same time, for a period of 16-20 weeks, the cervix of the uterus is considered to be 4-4.5 cm, at 26-28 weeks, the norm will be 3.5-4 cm, but closer to childbirth, the cervix naturally shortens and at 34-36 weeks size 3 , 5-3 cm will be an indicator of the preparation of the birth canal by the time the baby is born.

1-2 weeks before childbirth, the neck decreases to 1 cm, this indicates the opening and smoothing of the wall from the side of the internal pharynx.

The reasons

Several reasons are available to diagnose the pregnancy. Among them:

• congenital anatomical features;
• cervical injury as a result of previous childbirth or abortion;
• scars after a protracted inflammatory process.

Many of these problems are amenable to surgery, so it is important to see a doctor if you are.

But if a woman has undergone a medical examination and no problems in the cervix are found, can she be sure that the problem will not affect her during pregnancy? The doctor cannot give such a guarantee. Some factors that are absent in the usual state and associated specifically with pregnancy can also affect the condition of the cervix.

• Hormones.

It can be a hormonal imbalance in the body of the woman herself, and the endocrine system of a growing fetus that is involved in the work. By about 16-18 weeks, when the adrenal glands are formed, androgen production begins. Under the influence of hormones, the tissues of the cervix become softer, more pliable, and open faster under the load of the fetal bladder.

• or .

The "safety margin" laid down by nature is sufficient for the successful bearing of a normal pregnancy, when one fetus of average standard size develops in the mother's body. But when carrying twins, the pressure on the cervix increases significantly: both due to the additional weight and due to the atypical position of the babies in the womb.

Under pressure, the cervix becomes wider and therefore shorter. The same happens if the future baby is gaining weight too rapidly. In such a situation, isthmic-cervical insufficiency may even develop.

If near the internal pharynx there is not a small head of the child, but the placenta - a larger, wider organ, this leads to excessive stretching of the uterus in the lower part, which will result in a shortening of the cervix.

The shortening of the cervix does not always pose a threat to pregnancy, but it is a condition that requires additional monitoring.

Why is the shortening of the cervix dangerous?

An important role is played not only by the diagnosis of shortening, but also by the gestational age at which it happened.

Shortening in the 2nd trimester

If the pathology is detected at a sufficiently early stage, from 15 to 26 weeks, then the likelihood of premature birth is high. This means that additional monitoring of the development of pregnancy is required.

It may be necessary to prepare the baby's lungs for birth with special medications.

• if at the indicated time the size of the cervix does not exceed 2-2.5 cm - with a high degree of probability the child will be born no later than 36 weeks;
• if the neck is 1.5-2 cm, the baby will appear at 33-34 weeks;
• with a size of less than 1 cm, pregnancy is unlikely to be delivered longer than 32 weeks.

In this case, childbirth will take place in a special hospital, where there are conditions for nursing low birth weight premature babies. The newborn will be admitted to the children's intensive care unit and discharged home after growing up and gaining weight.

Shortening in the 3rd trimester

A shortening diagnosed in the third trimester no longer threatens such an early birth, but development can lead to infection of the amniotic fluid or prolapse of the membranes.

Therefore, a woman should be especially careful about hygiene and rest regime. Visit your doctor regularly to monitor your cervix.

How to maintain a pregnancy?

Measures to preserve pregnancy depend on the reasons for the shortening, the timing of the diagnosis, the development (or absence) of symptoms of isthmic-cervical insufficiency:

• If the cause is in previous injuries or anatomical features and the uterus is shortened even before pregnancy, surgical repair is possible.

Muscle elasticity and size are restored. Pregnancy is possible several months after surgery.

• The shortening of the cervix during pregnancy caused by hormonal imbalance is corrected with appropriate medications, diet, vitamin therapy.
• With a pronounced CI and the threat of early disclosure, or.

Both methods are aimed at mechanically keeping the walls of the cervix closed. The pessary also plays an additional role as a medical band, redistributing pressure to the lower segment of the uterus and preventing the cervix from flattening ahead of time.

Preventive measures

Proper treatment of vaginitis and other inflammatory diseases of the genital organs will preserve the elasticity of the cervix. This applies equally to the pre-pregnancy period and to pregnant women.

Vitamins or hormone therapy prescribed by doctors can normalize the density of muscle tissue and the conduction of impulses, help the cervix in performing its main functions.

The overweight of the woman herself and non-compliance with the diet during pregnancy put additional stress on the organs. It is important to monitor nutrition and weight dynamics during pregnancy.

If shortening is diagnosed, it is necessary to limit physical activity, lifting weights, bending. A woman should be able to lie down 2-3 times during the day and have a full night's rest.

When installing a pessary or suturing, the doctor will tell you about additional features of the regimen. Hospitalization will be required on the eve of the planned birth.

The diagnosis of "shortening of the cervix" delivered during pregnancy means a deviation of the diagnosed size from the norm. But he doesn't always talk about. It is possible to preserve the obturator function of the neck, subject to the regime and fulfillment of the doctor's prescriptions