Pregnancy is a special period in every woman's life. Unfortunately, things don't always go smoothly. Many expectant mothers face various complications during childbearing. Their list includes such a pathology as isthmic-cervical insufficiency.
It should be noted right away that such a complication is dangerous. In the absence of timely assistance, spontaneous abortion is possible. That is why many patients seek additional information. Why does cervical insufficiency develop during pregnancy? Symptoms, risk factors, methods of correction - these are important information that should be thoroughly studied.
What is pathology?
Isthmic-cervical insufficiency (ICD assigned code O34.3 to this condition) is a pathology that is accompanied by the opening of the internal os of the uterus under pressure. According to statistics, in different countries withbetween 1 and 9% of pregnant women face a similar problem.
As you know, the uterus consists of a body (it is a kind of muscular bag, in the cavity of which the development of the fetus takes place) and a neck. The cervix is a small tube that contains the cervical canal. The bulk of the muscles are concentrated in the upper part of the cervix - this is where the internal pharynx is located. The muscles of the pharynx are compressed into a ring, thereby preventing the premature exit of the fetus.
Isthmic-cervical insufficiency is characterized by muscle weakness. As a result, the pharynx begins to open, resulting in possible descent of the membranes into the vagina, miscarriage or premature birth.
Traumatic form of insufficiency
Such a pathology can develop under the influence of various factors. However, failure is often the result of trauma to the cervix. Almost any procedure that involves the expansion of the cervical canal can lead to this. In particular, risk factors include abortion, diagnostic and therapeutic curettage. In addition, trauma can be obtained during childbirth, as well as IVF procedures. The fact is that connective scar tissue is formed at the site of damage. It is not elastic and is not able to stretch, which in the future leads to the development of insufficiency.
Functional form of pathology
Functional form of isthmic-cervical insufficiency, as a rule, is associated with hormonal disorders. The weakening of the muscle tissues of the uterus can be associated, for example, withprogesterone deficiency or increased androgen levels.
Symptoms of this form of pathology, as a rule, begin to appear in the early stages (from 11 weeks). Fortunately, this type of deficiency usually responds well to hormonal drug therapy.
Other deficiencies. Are there risk factors?
Of course, there are other causes and risk factors that should not be ignored. Isthmic-cervical insufficiency often develops in women with congenital anomalies related to the structure of the uterus (for example, a saddle or bicornuate uterus). By the way, such pathologies can be detected even at the stage of pregnancy planning - you just need to see a doctor and undergo the necessary examinations.
Isthmic-cervical insufficiency sometimes develops as pressure on the uterus increases. Risk factors include multiple pregnancies, having one very large fetus, and too much amniotic fluid.
The risk group includes patients with a history of previous miscarriages or preterm births.
Isthmic-cervical insufficiency during pregnancy: symptoms
What signs should I look out for? What disorders are accompanied by isthmic-cervical insufficiency? Sometimes there are no symptoms at all. Deficiency is already diagnosedexamination time after miscarriage or premature birth.
But there are a number of quite characteristic signs that accompany isthmic-cervical insufficiency during pregnancy:
- Vaginal discharge is one of the symptoms. They tend to be copious, slimy, and sometimes streaked with blood.
- Some women complain of discomfort in the suprapubic region, pulling back pain.
- Often there are unpleasant pains in the lower abdomen, which often spread to the lumbar and sacrum.
- Sometimes patients note the appearance of a bursting sensation in the vagina. Some women describe it as a feeling of pressure, fullness. There may be sharp, stabbing pains.
When such violations appear, you need to urgently consult a doctor. Under no circumstances should such symptoms be ignored.
How dangerous is this condition?
Isthmic-cervical insufficiency during pregnancy is a very serious problem that should never be ignored. The result of such a pathology, as a rule, is miscarriage of the fetus - pregnancy either ends in spontaneous miscarriage in the early stages, or premature birth, which, in turn, is dangerous for the fetus (a child born too early needs medical care and appropriate care, the risk of death of the baby is high).
In addition, due to increasing pressure and weakness of the cervix, there is a high risk of penetration of pathogenic microorganisms andinfection of the membranes of the fetal bladder. Partial damage to the membranes is also possible, which is also fraught with a host of dangerous complications.
What does the diagnostic process look like?
If there are suspicions of any violations, a woman should definitely contact an obstetrician-gynecologist leading the pregnancy.
- To begin with, an anamnesis is being collected. It is important to familiarize yourself with all the complaints of the patient, to determine exactly when the problems began. You also need to study the woman's medical record, which may contain information about previous gynecological diseases, abortions, miscarriages, etc.
- Gynecological examination with bimanual vaginal examination is mandatory. During palpation, the doctor determines the size of the uterus and ovaries, the condition of the ligamentous apparatus, the presence of pain during certain manipulations. You also need to examine the cervix with the help of mirrors - it is important to determine its size, position, shape, length, assess the condition of the cervical canal, identify areas with cicatricial changes (if any).
- Transvaginal ultrasound is also shown, which will give the specialist more information about the condition of the cervix, the degree of closeness of its internal pharynx.
Isthmic-cervical insufficiency: treatment with medications
The treatment regimen is determined depending on the general condition of the patient, the termpregnancy, degree of cervical insufficiency and some other factors.
- If there is a violation of the hormonal background, then it is brought back to normal by taking hormonal drugs.
- To reduce muscle tension, patients are prescribed tocolytics (such drugs help relax the muscles of the uterus).
- Sometimes women are prescribed vasodilator drugs, low molecular weight dextrans (help improve blood properties), vasoactive agents (enlarge small vessels). Such therapy helps prevent the development of placental insufficiency.
Correct mode for expectant mother
The presence of insufficiency does not mean that the pregnancy will necessarily terminate. With proper treatment, a woman can successfully bear a child. Medical treatment and surgical correction, of course, will help prevent miscarriage. However, a woman must follow certain rules.
Bed rest required. Physical activity, as well as sexual intercourse, is contraindicated, as this can further weaken the cervix. You need to give up lifting weights and housework, get more rest, eat right. It is important to maintain peace of mind, since any stress is accompanied by the release of certain hormones, which affects the functioning of the reproductive system. A woman should maintain a positive attitude, follow all the recommendations of the doctor, take the drugs chosen by the specialist and, of course, not miss scheduled examinations. In some cases, until the endpregnancy, a woman stays in a hospital under the constant supervision of doctors.
What is the installation of a relief pessary?
In addition to drug therapy, a woman is sometimes fitted with a special unloading pessary. The Meyer ring is a special plastic construction that is placed deep into the vagina. This device provides support for the cervix, redistributes the pressure associated with pressure on the tissues of the amniotic fluid and the growing baby.
This is a simple procedure to do in isthmic-cervical insufficiency, multiple pregnancy, polyhydramnios, and in any other situation where you need to prevent premature opening of the uterus. The device can be installed at any stage of pregnancy.
Remove it, as a rule, at 37 weeks or in the presence of labor activity. This is a simple procedure, which, however, is associated with some complications. Despite the fact that the pessary is sterile and made of special materials, there is still a possibility of developing vaginal dysbacteriosis. That is why patients need to regularly do microflora smears.
Surgical correction and its features
If, for one reason or another, drug therapy and the installation of the Meyer ring does not give the desired result, then the correction of isthmic-cervical insufficiency is performed surgically.
In this case, we are talking about the narrowing of the cervix of the uterus, followed by the imposition of strong non-absorbable sutures on it. This is a rather responsible procedure, whichcarried out in a hospital setting. First, the vagina is sanitized, after which sutures are placed on the tissues of the pharynx. The procedure requires short-term anesthesia.
As a rule, such fixation is carried out in the early stages of pregnancy. In any case, the procedure should not be performed after the 28th week of gestation. Stitches are removed in the gynecological office at about 38 weeks. Premature removal of the suture material is carried out if there is an active labor activity, the appearance of bloody discharge, the leakage of amniotic fluid. The patient is also required to take medication to prevent uterine hypertonicity.
Predictions for expectant mothers: what you need to know?
Proper management of pregnancy in isthmic-cervical insufficiency includes regular check-ups, ultrasound monitoring. If it was possible to stabilize the uterus with the help of medications or suturing, then the woman manages to successfully bear the child.
Nevertheless, in most cases, childbirth is very fast and requires certain skills from the doctor. That is why the patient is recommended to go to the hospital a few days or even weeks before the day of the expected birth. The process itself, as a rule, passes without any major deviations.
Prevention of pathology in re-pregnancy
If a woman had isthmic-cervical insufficiency during pregnancy, then the conception of the next child can begin to plan after at least two years. Before fertilization, the patient is recommended to undergo a complete examination to determine if there is a risk of re-development of insufficiency.
During gestation, it is very important that the expectant mother adheres to the correct regimen, monitors the slightest changes in her state of he alth, and regularly visits a gynecologist. The specialist periodically examines the cervix using mirrors and ultrasound equipment.
According to statistics, cervical insufficiency is the most common cause of miscarriage. It is worth noting that with the birth of each subsequent child, the risk of complications increases, so a woman should be attentive to her condition.
