Very short neck. The influence of cervical length on pregnancy

No woman wants her pregnancy to be overshadowed 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?

Cervix- 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 the so-called. This condition is characterized by the physiological inability of the cervix to hold 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 A deformed and shortened cervix not only cannot hold the baby in the cavity, but is also unable to protect him from infections. And during childbirth, it can cause rapid progress, and as a result, cause ruptures of the perineum and vagina.

Causes

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

Examination and diagnosis

An obstetrician-gynecologist may suspect that the cervix is ​​shortened already during the first vaginal examination of a woman. But usually such a diagnosis is made after a transvaginal ultrasound examination or during a second one at 18-22 weeks of pregnancy.

What to do if the cervix turns out to be short 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 monitoring by a specialist, maintaining peace and caring attitude towards yourself.

If shortening of the cervix is ​​detected during pregnancy, that is, the cause is hormonal disorders, then depending on the gestational age and whether there is an opening, the woman is offered corrective treatment for this condition.

Actually, there are two treatment methods: surgical- suturing (up to 27 weeks) and conservative– use of an obstetric pessary (when there is no significant shortening, but there is a threat of 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 treatment for a shortened cervix is ​​not just reinsurance - it is a necessity that will eliminate the threat of premature birth and help you carry and give birth to a healthy baby on time.

No woman wants her pregnancy to be overshadowed 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 hold 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 A deformed and shortened cervix not only cannot hold the baby in the cavity, but is also unable to protect him from infections. And during childbirth, it can cause rapid progress, and as a result, cause ruptures of the perineum and vagina.

Causes

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

Examination and diagnosis

An obstetrician-gynecologist may suspect that the cervix is ​​shortened already during the first vaginal examination of a woman. But usually such a diagnosis is made after a transvaginal ultrasound examination or during a second planned ultrasound examination at 18-22 weeks of pregnancy.

What to do if the cervix turns out to be short 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 monitoring by a specialist, maintaining peace and caring attitude towards yourself.

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

If shortening of the cervix is ​​detected during pregnancy, that is, the cause is hormonal disorders, then depending on the gestational age and whether there is an opening, the woman is offered corrective treatment for this condition.

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

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 treatment for a shortened cervix is ​​not just reinsurance - it is a necessity that will eliminate the threat of premature birth and help you carry and give birth to a healthy baby on time.

Short cervix during pregnancy

Causes, prevention and treatment of short cervix during pregnancy

A short cervix during pregnancy is a fairly common pathology. It is dangerous because it can cause miscarriage or premature birth, since the cervix is ​​not able to hold the baby inside the uterus, it opens under his 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 pregnancy.

Why the cervix opens prematurely and diagnosis of pathology

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

There are many reasons for this pathology. These include various injuries resulting from cervical ruptures during childbirth, during medical abortion, during conization, application of obstetric 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 poor medical history (miscarriages in the second trimester of pregnancy) are under especially careful medical supervision.

Methods of prevention and treatment

Early prevention includes reliable contraception, which will help avoid abortions. In second place is a regular, at least once a year, visit to the gynecologist. Preventive medical examinations will help to identify cervical pathology in time and treat it conservatively. And finally, planning a pregnancy. This is especially true for those women who have had pregnancies in the past with an unfavorable outcome, and the loss of pregnancy occurred at a longer period.

If a short cervix is ​​detected during pregnancy, treatment is prescribed depending on whether there is dilation, as well as directly on the gestational age. Let us remind you that a short one is less than 2.5-3 cm. Actually, there are 2 treatment methods: suturing and an obstetric ring pessary. Sutures are placed before 27 weeks, and the sooner, the more effective the measure will be. Stitches will help even if the cervix is ​​slightly open. Meanwhile, as a conservative method - a ring, it is put on rather for prophylactic purposes, when there is no significant shortening, but the doctor suspects ICI in the patient.

Sutures are removed if the amniotic fluid has broken, labor or bleeding has begun. If everything is in order, then the stitches are routinely removed at 38 weeks. If a caesarean section is planned, in most cases the stitches will not be removed at all.

Know that isthmic-cervical insufficiency is not a death sentence if you take timely measures to prevent further dilatation of the cervix 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 news about pathologies and abnormalities of bearing a child. Firstly, modern medicine has enormous capabilities and treatment methods, and secondly, excessive nervousness can only harm the condition of the woman and the fetus. So, let's talk about shortening the cervix during pregnancy. Why it occurs, what it threatens and what doctors usually do in such a situation.

Cervix and pregnancy

When doctors talk about a short cervix during pregnancy, with the diagnosis confirmed by research results, this may be a symptom of isthmic-cervical insufficiency (ICI). This, in turn, is the cause of self-abortions and premature births. The diagnosis of “isthmic-cervical insufficiency” means that the cervix and isthmus cannot cope with the constantly increasing load of fetal pressure and amniotic fluid. This phenomenon leads to premature dilatation of the cervix. Let us remember that the cervix and isthmus are part of a woman’s birth canal. Sometimes the neck is naturally short. And often shortening of a woman’s cervix occurs as a result of various types of intrauterine interventions associated with its dilation. This could 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 shortens.

Read also Dilatation of the cervix

Why does the cervix shorten during pregnancy?

Shortening of the cervix during pregnancy can be caused by hormonal imbalances. As a rule, this occurs between 11 and 27 weeks of pregnancy, and most often from the 16th week. 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 be aware that she is developing ICI. After all, the tone of the uterus may be normal.

Typically, ICI is diagnosed by a doctor during an examination of a woman in a gynecological chair. The diagnosis is confirmed using vaginal ultrasound. When the length of the cervix is ​​less than 2 cm, and the diameter of the internal os is more than 1 cm, then signs of ICI can be stated.

If the cervix shortens during pregnancy, this is a reason for close monitoring by a gynecologist. When this problem is caused by excess androgens, treatment with the drug dexamethasone is usually prescribed. Also used for treatment are drugs that relax the smooth muscles of the uterus, sedatives, and vitamins. Usually, after several weeks of such therapy, the condition of the cervix stabilizes. Otherwise, surgical correction is performed. This means that stitches are placed in the neck. As a rule, 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 fetal fluid on the cervix. This treatment option is acceptable after 28 weeks of pregnancy.

Why is a short cervix dangerous during childbirth?

If shortening of the cervix occurs immediately 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 shortening of the cervix during pregnancy may be the norm for women who are not having their first birth.

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 the gynecologist within the specified time frame.

Especially for beremennost.net Elena TOLOCHIK

Short cervix: causes of pathology and its elimination

The greatest danger facing a woman during pregnancy is the threat of miscarriage or premature birth. From both the physiological and psychological sides, this problem for a woman becomes one of the most significant.

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

If this pathology is present, 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% muscle. The muscles of the cervix are located closer to the body of the uterus and form the so-called sphincter - a muscle ring that keeps the cervix closed, and during childbirth it opens, which becomes the beginning of the last phase of labor. The normal cervix with all its sections is approximately 40 mm long.

Towards the end of pregnancy, as the body prepares for childbirth, the cervix shortens, its internal os widens and childbirth occurs. For various reasons, this process may begin earlier. In this case, ICI occurs - isthmic-cervical insufficiency. This condition is characterized by premature shortening of the cervix and softening of the sphincter, which can result in opening of the first section of the birth canal and premature birth.

If the cervix shortens to 20-30 mm in the first or second trimesters of pregnancy, 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 individual characteristics of the body structure, as well as genetic predisposition.

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

However, even in the absence of congenital pathology, the cervix can shorten even before pregnancy. The reason for this may be previous births complicated by ruptures, spontaneous and medical abortions, surgical interventions in the uterine cavity, diagnostic curettage, conization and many other factors, one way or another related to the dilation or injury of the cervix.

As a result, scars may form on its muscle walls, the neck becomes 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 obstetrics, the fetus begins to produce its own hormones, in particular androgens, which are necessary for normal labor.

If by that time androgens are contained in excess in the mother’s body, gradual premature preparation for childbirth occurs: the cervix shortens and the internal os opens, which leads to the risk of premature birth.

How to maintain pregnancy with a short cervix?

A shortening of the cervix may be suspected by a doctor during a gynecological examination and confirmed by an ultrasound specialist during an intravaginal examination. When a pathology is detected, a series of studies are prescribed to determine the cause of its development, one of the mandatory ones being a blood test for hormone levels.

If the cervix shortens due to excess hormones, the condition can often be stabilized by prescribing hormonal therapy. A pregnant woman with a shortened cervix is ​​given rest and bed rest, wearing a prenatal bandage. In some cases, the patient is offered to continue the pregnancy in the hospital.

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

If the condition is critical, that is, the length of the cervix is ​​less than 20 mm and there is an opening of the pharynx of more than 10 mm, the doctor may recommend surgical correction of the cervix - applying a cervical cerclage. The procedure involves placing stitches in specific areas of the cervix. Sutures are placed no later than 27 weeks of pregnancy in a hospital setting using anesthesia and under ultrasound control.

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

The main thing is to detect the 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 short cervix

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

And if it comes to an asymptomatic disease, then representatives of the weaker half of humanity learn about it only when the trouble makes itself felt. A short cervix also falls into 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 little anatomy

In a woman’s body, the organ in which the embryo is formed from the fertilized egg 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. The shape of the neck resembles a truncated cone or cylinder, 3.5 - 4 cm long. Conventionally, it is divided into 2 parts:

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

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

In composition, 1/3 of the cervix consists of muscle tissue. Moreover, the main part of the muscles is “concentrated” in the area of ​​the internal os, and forms a powerful muscle ring (sphincter) there, which allows the fetus to be retained in the uterine cavity throughout pregnancy.

Why is a shortened cervix dangerous?

A short cervix (less than 2.5 cm) is one of the reasons for the development of ICI (isthmic-cervical insufficiency) in a woman. With this pathological condition that occurs during pregnancy, the cervix is ​​not able to hold the unborn child in the uterine cavity. The constantly growing fetus, together with amniotic fluid, puts pressure on the cervix. As a result of this, 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, a shortened cervix is ​​not 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

Symptoms of FCI most often begin to appear during pregnancy between 15 and 27 weeks. And this is no coincidence. It is from this period that the fetus intensively increases in size and, gaining weight, begins to put more pressure 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, a short cervix is ​​manifested by bloody discharge or profuse watery discharge from the vagina, pain in the lower abdomen. If these symptoms are present, in order to finally confirm the diagnosis, the doctor sends the patient for an ultrasound examination.

Causes

Why is such a pathology suddenly discovered 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 shortening of the cervix during pregnancy include:

1. Congenital anomalies of the structure of the uterus. Rarely encountered and usually inherited
2. Mechanical injuries to the cervix with subsequent deformation resulting from operations (for example, when applying medical forceps, during conization), abortions, diagnostic curettages. In this case, the muscular sphincter loses its elasticity, i.e. ability to stretch.
3. Hormonal imbalances during pregnancy. They begin at 11-12 weeks of pregnancy, when the fetus’s adrenal glands begin to actively function. They secrete hormones, including androgens, under the influence of which (with an increased level of a woman’s “own” androgens), the cervix becomes soft and shortens. This helps to open it up. In this case, the woman is not even aware of the threatening danger, since there is no increase in the tone of the uterus (and, accordingly, certain symptoms).
4. Damage to the cervix during previous births. 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 a 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 in a gynecological chair. During this study, a specialist can visually assess the condition of the cervix and its size.

The woman is also obliged to inform the doctor that she has a history of pregnancy that ended in miscarriage. In this case, the patient will be under special control, in which monitoring of the condition of the cervix is ​​mandatory every week (or once every two weeks) (from 12-16 weeks of pregnancy).

Ultrasound is another research method that is widely used in diagnosing cervical pathologies. This can be done in two ways:

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

By ultrasound, isthmic-cervical insufficiency is determined when the diameter of the internal pharynx is > 1 cm and the length of the cervix< 2 см.

Prevention

After diagnostic measures, the doctor prescribes the necessary treatment aimed at maintaining the pregnancy. However, a short cervix is ​​a problem, the unpleasant consequences of which can be avoided by carrying out 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 in time.
• Using reliable methods of contraception to avoid unwanted pregnancy and its consequences - abortion.
• Pregnancy planning. This is especially important for those women who have a history of problematic 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 of the structure), then she needs to be constantly observed by a gynecologist, not to be nervous, and to rest more. In addition, care should be taken to ensure 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.

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

If the cause of a 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 ​​assessed. If there is no improvement, as well as if the shortened neck has arisen as a result of exposure to a traumatic factor, surgical correction is performed - cervical cerclage. In this procedure, which takes place under anesthesia (epidural or intravenous), stitches are placed on the cervix. This helps keep the fetus in the uterine cavity.

Sutures are placed within 17-21 weeks. After the operation, the woman remains in the hospital for 7-20 days. All this time, in order to avoid increasing the tone of the uterus, therapy is carried out with antispasmodic drugs (Papaverine, No-shpa, etc.). In case of infection or when pathogenic microflora is detected, antibacterial drugs are prescribed. After discharge from the hospital, a woman should visit a gynecologist once every two weeks, who will monitor the condition of the cervix. Also, 1-2 times a month, the patient takes a bacteriological culture and a smear for flora. Prenatal hospitalization occurs at 37 weeks. At this time, the stitches are removed.

Important!!! If amniotic fluid has leaked or labor has begun, the sutures are removed regardless of the stage of pregnancy. If this is not done, during contractions the stretched threads will injure the cervix.

Traumatic damage to tissue by threads occurs if this operation was performed on an “inflamed neck.”

For a shortened neck, a 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 to avoid infection of the fetus and injury to the amniotic sac. A pessary is a kind of bandage that not only reduces pressure on the cervix, but also reduces the likelihood of infection of the fetus by preserving the cerumen plug.

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

A short cervix or isthmic-cervical insufficiency (ICI) is diagnosed in pregnant women at various stages. This is a pathological condition that is unsafe for the growing fetus, as it can cause spontaneous abortion or premature birth. Women whose cervical tumor thickness does not correspond to the gestational age should be regularly examined and, if necessary, admitted to hospital. All physical activity and sudden movements are excluded - all this can cause the discharge of amniotic fluid through the slightly open cervical canal and the onset of labor.

Normally, before pregnancy, the cervix is ​​the passage between the vagina and the uterus. The length of the tube is about 4 cm and the diameter is 2.5 cm. The color of the fabric is pink and plain. The inner surface is smooth and velvety, the uterine os is slightly open. When pregnancy occurs, the normal indicators change - due to the growing blood vessels, the cervix changes color to a darker one, the tissues and the cervical canal become denser. The organ gradually increases in size, causing the cervix to stretch and shorten. For each period, there are size standards that the doctor uses to determine how safe it is to bear a child. If the sizes do not match, this poses a threat to the health of the mother and fetus, so measures are taken to preserve the pregnancy.

How dangerous is shortening of the cervix during pregnancy?

Shortening of the cervix is ​​a normal process during pregnancy, but it is more common during the third trimester, when a woman’s reproductive system is preparing for childbirth. Of greater importance is the period at which this occurs and the size of the organ. If shortening is noticed ahead of schedule - between 15 and 26 weeks, then premature birth is the most likely outcome of pregnancy. The greater the shortening, the more premature the baby will be born. Your doctor may recommend taking special medications to help prepare your child's lungs for breathing.

Table of the relationship between the length of the cervix between 15 and 24 weeks and the expected due date.

At 16–20 weeks, the norm is a length of 4–4.5 cm. Indicators that are less than these values ​​are a signal for the doctor and the woman.

Expulsion of the fetus at 20–22 weeks is considered a late miscarriage and can have the following consequences for the mother:

• Heavy bleeding that can lead to hemorrhagic shock;
• As a result of decay of particles of the fertilized egg, an inflammatory process develops that can cause the death of a woman;
• Subsequent infertility due to purulent endometritis. Getting pregnant after a late miscarriage is more difficult.

To reduce the risk of consequences, if cervical insufficiency is detected, you should follow all doctor’s recommendations to maintain pregnancy.

Insufficiency in the area of ​​the uterus and isthmus is prone to progression, so spontaneous improvement of the situation in most cases is not observed. However, there are exceptions, judging by the reviews of women who have a similar problem. Cases have been described in which the cervix, under the influence of hormones, either shortened or lengthened. As a result, the pregnancy was carried to term and the birth occurred on time. The functional processes have not been fully studied, and each case is considered to be purely individual, but if pathology is present, it should be observed in order to avoid late miscarriage. In the hospital, women are observed whose length of the cervix is ​​less than 2 cm and there are organic pathologies. If the length is 2.5 cm and there are functional abnormalities associated with pregnancy, doctors monitor pregnant women as usual.

In the second trimester, the risk of late miscarriage is highest, which has serious consequences, so reducing the length of the cervix to 25 - 28 mm is considered a risk. This requires a woman to be careful and pay attention to her feelings. The fact is that the symptoms of isthmic-cervical insufficiency are weak and it is not always possible to suspect a problem based on sensations.

Shortening of the cervix is ​​dangerous if, in addition, it is accompanied by the opening of the uterine pharynx. The degree of disclosure can be different, from 1 to 3 cm.

During pregnancy with twins, a decrease in the length of the cervix is ​​associated with greater pressure on the pelvic floor muscles. At this time, the woman needs to reduce the load as much as possible and stay more in a horizontal position.

Reasons for shortening the CMM

The reasons that lead to this situation are divided into organic and functional. Organic pathologies are structural features of the organ, congenital changes in the shape of the uterus. Sometimes organic lesions lead to:

• Postpartum injuries, when there were ruptures and sutures were placed on the cervix.
• Consequences of abortion. To carry out curettage, the organ is further expanded with special instruments. During pregnancy, even in the early stages, the cervix is ​​tight and difficult to dilate. Forced actions can disrupt the tissue structure and lead to scarring, cracks, and fiber tears. Such problems affect subsequent pregnancies because the uterus cannot fully open and contract.
• Miscarriages followed by cleansing. The same procedures and similar consequences if cleaning is not done professionally.
• Surgical operations - cauterization of erosion, conization, excision, removal of polyps or fibroids. The muscle layer is damaged under the influence of thermal devices, which weakens it and makes it vulnerable during pregnancy.

Functional cervical insufficiency is hormonal imbalances, an impaired muscle response to hormonal stimulation. As sensitivity decreases, the muscles soften and become loose long before the expected due date. Under the influence of gravity, the uterus gradually opens or is in a slightly open state, which at any moment can trigger the onset of labor. In addition, this is also fraught with infection in the amniotic fluid.

Premature shortening of the cervix can be provoked by an inflammatory process, genital tract infections and bleeding.

Diagnosis during pregnancy

The first thing a woman is prescribed to confirm the diagnosis is an ultrasound examination with a transvaginal sensor. An ultrasound is prescribed more often if a woman’s condition is alarming and threatens miscarriage. Weekly chairside examinations with speculums and visual examination of the pelvic floor are usually recommended. A sign of approaching labor is considered to be a shortening of up to 1 cm and dilatation of up to 3 cm. All measurements begin to be taken from the 20th week, because it is after this period that it becomes clear how high the probability of premature birth is.

Important! If a woman has had a late miscarriage in the past, she is at risk.

The degree of risk is determined by the number of points based on the examination results and the presence of a history of late miscarriages. When summing up the points, the doctor draws up a correction plan and tells you how many times a month you need to come for examination.

A woman receives 0 points if at 20 weeks:

• the neck is tilted back;
• closed uterine os;
• cervical length up to 3 cm;
• According to the analysis, there is no hyperandrogenism;
• there were no previous miscarriages.

A woman receives 1 point if, at 20 weeks of pregnancy:

• The CMM is slightly tilted back;
• length from 2 to 3 cm, that is, shorter than normal;
• internal pharynx expanded to 9 mm;
• male hormones are not increased;
• I had one late miscarriage in the past.

A pregnant woman gets 2 points:

• the short cervix during pregnancy is in the center;
• length is small – up to 2 cm;
• the pharynx is expanded more than 9 mm;
• male hormones are higher than normal;
• there were 2 late miscarriages.

If the score is 5 or more, hormonal treatment or corrective procedures are required.

What to do if the cervix is ​​shortened during pregnancy?

To maintain pregnancy as long as possible, the woman is prescribed tocolytic therapy. Tocolytic drugs can extend gestation for several days. Medicines are prescribed strictly according to indications, as they have a large number of side effects.

The main thing with ICI is to reduce the tone of the uterus and prevent premature dilatation. Three drugs are used - magnesia, nifedipine and indomethacin.

If there is a lack of progesterone, take utrozhestan or three times a day. They are designed to suppress male hormones androgens and normalize hormonal levels. Discontinuation of drugs should occur gradually, since sudden cessation of use can cause miscarriage.

Sometimes suturing the pharynx with a circular suture is used to reduce the risk of infection and leave drainage in the form of an open cervical canal. After 37 weeks, the sutures are removed.

Installation of a pessary on the cervical area. The size depends on the type of birth, taking into account the diameter of the uterus and the width of the cervix. The ring reduces the load and pressure on the cervix, usually installed after 20 weeks. The ring is removed after 37 weeks, when the degree of maturity of the uterus begins to change and the body prepares for childbirth.

conclusions

ICI is a condition that requires an individual approach when managing pregnant women. The degree of risk is not always high; in some cases, you can do without taking medications that have a negative effect on the fetus.

Video: ICN, my recumbent pregnancy

Video: Discharged! ICN. Pessary. When to give birth?

A short cervix is ​​a pathological condition in which its softening and decrease in length are detected. In a normal pregnancy, the cervix should be at least 4 cm long, this helps to keep the fetus in the uterine cavity.

If the cervix is ​​short according to ultrasound during pregnancy, then the woman needs to immediately solve this problem. This pathological condition can provoke the opening of the cervical canal, which leads to the premature birth of the baby.

Cervix during pregnancy

During the period of bearing a child, every pregnant woman undergoes a periodic examination in a gynecological chair, during which the doctor assesses the condition and degree of closure of the cervical canal.

If necessary, the doctor may prescribe additional examination methods to determine the degree of development of this pathological condition.

During pregnancy, the entire female body undergoes significant changes, especially the reproductive system. During this period, there is an increase in blood flow in the pelvic organs, as a result of which the epithelial tissue lining the cervical canal grows and begins to produce special mucus in larger quantities.

The muscle layer of the organ also changes, while the cervix increases in volume and size. All this is an obstacle to the penetration of infection into the uterine cavity to the fetus, and also contributes to a favorable course of pregnancy.

However, under the influence of certain factors, protective processes may fail. In this case, the cervical canal may begin to open and the cervix can no longer hold the fetus.

In this regard, women diagnosed with a short cervix are subject to enhanced monitoring and are at risk for miscarriage.

Why does the cervix shorten?

Signs of cervical shortening are most often detected when examining a pregnant woman between 15 and 20 weeks. Just at this time, the load on the structural parts of the perineum increases. This is due to increased fetal growth.

Shortening of the cervix during pregnancy can be provoked by the following predisposing factors:

• Genetic features of the structure of the female genitourinary organs: incorrect anatomy of the cervix and malformations of its development;
• Cervical injuries during previous childbirth, during artificial termination of pregnancy and other gynecological operations;
• Hormonal instability of the body - increased amount of male hormones in the blood (androgens);
• Increased content of relaxin in tissues present in the cervical wall.

All these factors can lead to premature opening of the cervical canal. This process is quite aggravated by multiple pregnancies, in which the pressure on the cervix more than doubles. Polyhydramnios and a large fetus predispose to the development of shortened cervical canal.

What is the danger of such a condition?

The main risks with a shortened cervix in length are associated with possible termination of pregnancy at various stages. This pathological condition can lead to the following consequences for the woman and child:

First.

Development of isthmic-cervical insufficiency (ICI). In this condition, the internal and external pharynx begins to open, which leads to the impossibility of holding the fetus in the womb. In the short term, this can lead to late miscarriage, and in the long term, it can lead to premature birth.

Second.

When the cervical canal is open, the risk of infection from the vagina entering the uterine cavity increases significantly. This can threaten intrauterine infection of the fetus, which, in the event of unfavorable concomitant conditions, can provoke its death.

Third.

It should also be noted that a short cervix during labor can contribute to its rapid progress. That is, the birth of a baby occurs in a short time.

In this case, regardless of the weight and size of the child, significant damage to the birth canal can occur: ruptures of the perineum and vagina, the occurrence of hematomas in the walls of the genital organs.

Since a short cervix poses a threat of miscarriage, the uterus, in turn, tries to prevent this process.

In this case, a woman experiences such an unpleasant condition as increased tone, when the pregnant woman feels periodic pain in the lower abdomen, accompanied by tension in the abdominal wall and a feeling of fossilization of the walls of the uterus.

Features of the pathological condition at different stages of pregnancy

A peculiarity of the female body is that the content of hormones at different stages of pregnancy changes significantly. This is necessary for the normal course of pregnancy and the safe entry of a woman into childbirth.

In this regard, cervical length indicators may vary at different periods. Let's consider what features shortening of the cervix has during the most significant periods during pregnancy.

20 weeks

Gestational age 20 weeks is considered the middle of pregnancy. During this period, the load on the cervix increases significantly and an increased increase in abdominal parameters begins. It is at 20 weeks that a woman will undergo a second scheduled ultrasound scan during pregnancy.

In the normal course of bearing a child in the period from 20 to 25 weeks, the cervix should have a length of about 4 cm. According to the results of an ultrasound examination the norm is considered to be within 3 cm. If the length of the cervix is ​​less than this value, then a diagnosis of “short cervix” is made.

A short cervix during pregnancy, detected at 20 weeks, is subject to weekly monitoring and, as it progresses, requires the use of various treatment methods. The main measure to prevent miscarriage in this period is the woman’s complete physical and sexual rest.

30 weeks

At this time The length of the cervical canal should be within 2.5 cm. If this figure is lower according to ultrasound, there is cause for concern. Despite the fact that at 30 weeks the fetus is already viable and can survive if premature birth occurs, it is still better to prevent such a situation.

A good circumstance for a pregnant woman who is diagnosed with a short cervix at 30 weeks is that maternity leave begins right now.

This will allow you to spend more time at rest, without exposing your body to various physical and psychological stress.

32 weeks

During this period, the female body is already beginning to prepare for the upcoming birth. The ratio of hormones in the blood changes, which leads to gradual softening and possible shortening of the cervix. The normal length of the cervical canal at this stage is 2 cm. Measurements are carried out at the third planned ultrasound.

A short cervix detected during pregnancy at 32 weeks can cause premature birth. However, now it will not be as dangerous as before.

To prevent the birth of a child before the due date, a woman needs medical supervision and constant bed rest. For this purpose, hospital treatment is recommended for pregnant women with a short neck at 32 weeks.

Treatments used for a short cervix

The doctor’s tactics and the choice of treatment method for a short cervix depend on many factors: the length of the cervix, the length of the pregnancy, a history of gynecological operations, the location of the placenta and the presence of uterine tone. In this regard, the following treatment methods are distinguished:

Surgical correction.

This method involves placing special surgical sutures on the cervix under anesthesia. The manipulation is called “cervical cerclage”. This procedure is carried out until 28 weeks.

After applying U-shaped sutures to the cervix, a woman must take antibacterial drugs, as the risk of infectious complications increases. Sutures are removed at 38 weeks.

Non-surgical methods.

They include placing a pessary on the cervix - a special silicone ring that keeps the cervix from dilating. This method of treatment is used for minor shortening of the cervix and for non-progressive pathology.

A pessary is applied on an outpatient basis no earlier than 28 weeks of gestation. After this procedure, the woman must be examined by a gynecologist every two weeks to monitor the installation of the ring and carry out preventive sanitation of the vagina. The pessary is removed before delivery, usually at 38 weeks.

Drug therapy.

If a woman is diagnosed with a hormonal nature of the occurrence of ICI, then she is prescribed progesterone-type drugs: Duphaston or Utrozhestan. The use of these medications significantly reduces the risk of spontaneous abortion.

Synthetic progesterones can reduce the tone of the uterus, thereby reducing the load on the cervix and preventing the opening of the cervical canal. The drugs can be used either orally in the form of tablets or intravaginally in the form of suppositories.

Also, a shortened cervix, diagnosed during pregnancy, requires a woman to observe a special lifestyle: minimizing physical activity, eliminating stressful conditions, sexual rest, bed rest, prevention of genital tract infections.

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

Cervix and pregnancy

When doctors talk about pregnancy, with the diagnosis confirmed by research results, this may be a symptom of isthmic-cervical insufficiency (ICI). This, in turn, is the cause of self-abortions and premature births. The diagnosis of “isthmic-cervical insufficiency” means that the cervix and isthmus cannot cope with the ever-increasing pressure load of the fetus and. This phenomenon leads to premature dilatation of the cervix. Let us remember that the cervix and isthmus are part of a woman’s birth canal. Sometimes the neck is naturally short. And often shortening of a woman’s cervix occurs as a result of various types of intrauterine interventions associated with its dilation. This could be abortion, 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 shortens.

Why does the cervix shorten during pregnancy?

Shortening of the cervix during pregnancy can be caused by hormonal imbalances. As a rule, this occurs between 11 and 27 weeks of pregnancy, and most often from the 16th week. 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 be aware that she is developing ICI. After all, the tone of the uterus may be normal.

Typically, ICI is diagnosed by a doctor during an examination of a woman in a gynecological chair. The diagnosis is confirmed using vaginal ultrasound. When the length of the cervix is ​​less than 2 cm, and the diameter of the internal os is more than 1 cm, then signs of ICI can be stated.

If the cervix shortens during pregnancy, this is a reason for close monitoring by a gynecologist. When this problem is caused by excess androgens, treatment with the drug dexamethasone is usually prescribed. Also used for treatment are drugs that relax the smooth muscles of the uterus, sedatives, and vitamins. Usually, after several weeks of such therapy, the condition of the cervix stabilizes. Otherwise, surgical correction is performed. This means that stitches are placed in the neck. As a rule, 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 fetal fluid on the cervix. This treatment option is acceptable after 28 weeks of pregnancy.

Why is a short cervix dangerous during childbirth?

If shortening of the cervix occurs immediately 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. They, in turn, are fraught with ruptures of the cervix and vagina.

Medical statistics suggest that shortening of the cervix during pregnancy may be the norm for women who are not having their first birth.

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 the gynecologist within the specified time frame.

Especially for Elena TOLOCHIK