Examination of the state of the cervix is an important diagnostic tool for an obstetrician-gynecologist. The state of this part of the main reproductive female organ can speak of the well-being or dysfunction of the developing pregnancy, the timing of gestation, and makes it possible to make predictions about the upcoming birth. About what should be the cervix during pregnancy, and why deviations may occur, we will tell in this material.
What it is
Cervix uteri is the Latin name for the cervix, the lower part of the main reproductive organ in women. The cervical canal passes inside the cervix, the lower part of the cervix extends into the vagina, and the upper one communicates with the uterine cavity.
Nature has assigned important functions to this cylindrical part of the uterus.
Before pregnancy, the cervix acts as a "gatekeeper" tightly closing the entrance for infection, germs and even sperm, if they don't arrive on time. The mucus completely closes the cervical canal.
Once a month, the shake holds an "open door" - it happens before ovulationwhen, under the influence of hormones, mucus becomes liquid, freeing the passage into the cervical canal for male germ cells.
If pregnancy occurs, the cervix again "seals" the passage with a mucous plug, reliably protecting the developing embryo, and subsequently the fetus, from microbes, fungi, destructive microflora and everything that can harm.
In addition, the cervix is responsible for keeping the baby in the uterine cavity until delivery. If she is weak and unable to cope with this task, there is a real threat of termination of pregnancy.
During childbirth, the small cervix does a great job - it opens up to such a size that the baby's head can pass through it. It is through the cervical canal that the baby leaves the mother's womb after 9 months to start an independent life in this world.
Anatomically, the cervix is quite complex. She has a vaginal part - it is something that doctors study during a routine examination with a mirror. The deeper structures are the vaginal vaults, which connect the cervix to the uterine cavity. To examine them, one gynecological mirror will not be enough, a special colposcope device is needed, and the examination procedure will be called colposcopy.
How and why is the measurement
The parameters of the cervix are measured in two ways - on the gynecological chair using a mirror and colposcope and on ultrasound diagnostics.
With a manual examination, the physician can determine the condition of the external os, cervical tightness and the closure or opening of the cervical canal.
Ultrasound measures the length, and also obtains a more accurate idea of the state of the internal pharynx (the junction with the uterine cavity), which cannot be examined in other ways.
When registering, the doctor conducts a manual examination, while smears of the vaginal flora are taken for analysis. In the first trimester, a woman also undergoes colposcopy, it gives more information than a conventional examination with a mirror
Measuring the length of the cervix is advisable only after the 20th week of pregnancy, when the baby begins to actively grow, and the load and pressure on the cervix increases.
Up to 20 weeks, the length of the cervix is different for different pregnant women, much depends on the individual values. However, by week 20, the dimensions of the lower part of the uterus in different women come to the same average values, and the length becomes diagnostically important.
In the middle of pregnancy, ultrasound is usually done transabdominallypositioning the scanner sensor on the pregnant woman's abdomen, examining through the anterior abdominal wall. If there is a suspicion of lengthening or shortening of the cervix, as well as other abnormalities, the doctor uses an intravaginal ultrasound method, in which the sensor is inserted into the vagina. Through the thinner vaginal wall, the cervix is clearly visible.
Control over the size and other parameters of the cervix is necessary in order to make sure that the child is not in danger of premature birth, that there is no threat of intrauterine infection, which also becomes possible if the cervical canal opens or opens completely
For the entire period of bearing a baby, healthy the woman undergoes cervical examinations four times. If there is reason for concern, then the diagnosis will be prescribed more often, as many times as necessary.
Changes during pregnancy
In a non-pregnant woman, the length of the cervix is approximately 3-4 cm and a width of 2.5 cm. These values are not absolute, there may be certain individual variations.
If a woman is not pregnant, but is just planning to conceive a baby, her cervix is pink, smooth, and when examined with a mirror, it looks somewhat shiny.
In the early stages
When pregnancy occurs, the cervix undergoes major internal and external changes. Due to the increased blood supply, the delicate pink color is replaced by purple, bluish, cyanotic.
The process of "maturation" begins, which will last all nine months, because the small neck will have to thicken, grow, become thicker and more elastic in order to ensure the passage of the baby in the birth process.
In the first trimester, doctors can judge the condition of the cervix about the possibility of spontaneous abortion, miscarriage... If the neck is loose, during examination it misses the finger of the gynecologist, then such adverse events are very likely.
Normally, in the early stages, the neck should deviate slightly towards the anus, be tightly closed.
A loosely closed cervical canal creates not only the threat of miscarriage, but also the threat of penetration of pathogenic microbes, fungi, viruses into the uterine cavity, which can damage the membranes and lead to fetal death.
Sometimes intrauterine infection turns into anomalies and malformations of the baby, congenital diseases.
The first changes in the neck begin at about 4 weeks pregnant, when the growing fertilized egg begins to protrude somewhat the wall of the uterus to which it is attached. This creates a slight asymmetry.
The cervix changes its position in space, if during ovulation it rose higher in order to increase the chances of sperm penetration, now the main task is not to miss the ovum, for this the lower segment of the uterus has to go down and lean back.
Many women who want to quickly find out whether a pregnancy has occurred are interested in what the neck should be to the touch, because it is no secret that many planning a pregnancy carry out palpation at home on their own. Approximately 8-10 days after conception, under the influence of the hormone progesterone, the cervix becomes softer. The cervical canal, on the other hand, closes more tightly.
A stiff cervix in the early stages may indicate a threat associated with an increased tone of the uterus itself. This can happen, for example, with autoimmune diseases or with a lack of progesterone.
At a later date
In the third trimester, according to the state of the cervix, doctors judge the timing of the approaching birth. This part of the uterus becomes softer. The length of the neck is gradually reduced by about half, on an ultrasound you can see how the internal pharynx expands, preparing for the upcoming birth.
This process is slow, gradual, taking several months. Changes occur under the influence of hormones - estrogens.
At 38 to 39 weeks, your doctor may start checking your cervix for labor... This readiness can be judged by the ability of the cervical canal to pass the examining doctor's finger through itself.
It is strictly forbidden to carry out such palpation on your own, and, fortunately, it is quite difficult to do it technically.
Sometimes a week or several days before childbirth, a woman may notice the discharge of a mucous plug, the same one that served as an obstacle to pathogenic microbes throughout the pregnancy. The neck gradually smoothes out, begins to expand. For some women, such preparation of the cervix "starts" only at 40 weeks, and for some - even later.
If a woman gives birth to her first child, then it is possible that the neck can begin to change in advance, and she will do this rather slowly. In multiparous, preparation begins later and proceeds faster. Their neck "remembers" how to behave in the circumstances.
If the cervix is in no hurry, doctors can prescribe preparatory treatment that will help the cervix to "ripen" faster. The feasibility of such stimulation by modern gynecologists is considered controversial.
Some doctors believe that there is a need for stimulation, others believe that one should wait and trust nature, which knows better than any doctor when it is time for a child to be born.
Length norms by week
If you notice deviations in the state of the cervix in time, then the probability of maintaining a problem pregnancy is almost 95%, because in the arsenal of modern medicine there are many ways to influence the behavior of the cervix - medications, special fixators that are installed directly on the cervix, as well as minor surgical methods (suturing ). That is why it is important to examine expectant mothers at least four times during the gestation period.
Routine examinations, if there is no reason to fear for the health of the mother and child, are carried out at 20 weeks, 28 weeks. Then at 32 and 36 weeks. If the doctor has concerns, a woman complains of pain, discharge, which cannot be considered normal during pregnancy, then the study and measurement of the neck length will be carried out unscheduled for emergency indications.
What are the norms for the length of the cervix for different periods of pregnancy, how this indicator changes by week, you will learn from this table.
Length of the cervix:
As can be seen from the table, in women who are going to give birth for the first time, the length of the neck at the beginning of pregnancy increases more slowly than in multiparous women. In the third trimester, the normal size of the cervix is assessed using a special scale created specifically for this.
Each indicator is assessed in a certain number of points, as a result, a more or less true clinical picture is obtained
You can judge the maturity of the cervix by several criteria:
- Consistency. Dense - 0 points, slightly softened - 1 point, soft - 2 points.
- Length. More than 20 mm - 0 points, 10-20 mm - 1 point, less than 10 mm - 2 points.
- Position in space. The cervix is deflected back - 0 points, deflected forward - 1 point, is located directly in the center perpendicular to the entrance to the vagina - 2 points.
- Opening degree. If the doctor's finger does not pass into the cervical canal - 0 points, if 1 finger passes - 1 point, if 2 or more fingers pass - 2 points.
Possible deviations and their reasons
Measurements and comparisons of results with existing norms raise many questions among women in "position". Deviations can indeed be indicators of trouble. Let's take a look at the most common anomalies and their causes.
Pregnancy in the cervix
If at an early stage the cervix is enlarged above normal, the doctor may suspect a so-called cervical pregnancy. This is a type of ectopic pregnancy in which the ovum is implanted not into the uterine cavity, as nature intended, but into the cervix or isthmus.
There the embryo can theoretically live and develop up to about 4-5 weeks, less often up to 6-7 weeks. After that, the conditions become unbearable, and the fetus dies and is rejected, a miscarriage occurs, sometimes accompanied by great blood loss.
The pathology is considered quite rare, it is diagnosed less often than in 0.01% of all pregnancies. The ovum can attach to the walls of the cervical canal for a number of reasons, many of which are not known for certain to medicine today.
Doctors tend to believe that this becomes possible if the conditions for implantation in the uterus do not meet the requirements, the blastocyte simply cannot gain a foothold and, in search of a haven, descends into the neck.
A recent abortion may be the cause, after which the woman neglected the recommendations to protect herself for a certain time. Cervical pregnancy, which a young mother decided after a cesarean section, can become, if less than 3 years have passed since the operation.
Women with previously diagnosed uterine fibroids and adhesions are also at higher risk than others.
Any interventions - surgery, trauma, inflammation of the uterus can be the reason for the subsequent cervical or isthmus pregnancy. There may be no symptoms. The first thing that the doctor will notice at the examination is just too large a cervix with too small the uterine cavity itself. After that, ultrasound and colposcopy are prescribed.
A blood test for the determination of chorionic gonadotropin, a hormone characteristic of all pregnant women from the day of implantation, shows a too low level of hCG, uncharacteristic for the last monthly period declared by the date.
On ultrasound, the doctor will not find the ovum in the uterus, and with a careful examination of the cervical canal, he will find it there. Until a few decades ago, there was no other way to solve this problem, how to remove the uterus completely. Many women with cervical pregnancies have lost the opportunity to have children in the future.
There are now less violent ways to help a woman and keep her chances of motherhood in the future - vacuum aspiration and laser excision of the site of embryo growth into the neck. The risks of complications after such interventions are quite high, but modern medicine is quite successfully coping with this task.
Short neck
A short neck (at the very beginning of pregnancy, less than 25-27 mm), may be an inborn feature of the structure of a woman's reproductive organs, and a consequence of traumatic influences - abortion, for example, or inflammatory processes that caused a shortening of the lower segment of the uterus. In any case, the insufficient length of this part of the reproductive system is fraught with a serious danger to the child and woman.
Normally, the cervix lengthens at the beginning of pregnancy and shortens closer to childbirth. Initially short neck it will be very difficult to cope with the load of keeping the growing baby in the uterine cavity. Miscarriage, premature birth, rapid labor, cervical rupture may occur.
A shortened neck creates an increased risk of intrauterine infection of the fetus, since it cannot serve as reliable protection against pathogenic microorganisms and viruses.
The doctor will be able to detect shortening already at the first appointment, if it took place before pregnancy. However, with the subsequent development of a short neck, for example, against the background of hormonal insufficiency in the first trimester, it will be possible to detect the problem only at the 12th week of pregnancy, when the expectant mother comes for a screening examination.
Symptoms sometimes appear after this period, closer to the fourth month of pregnancy.
The growing baby begins to exert more tangible pressure on the short neck, and the woman may begin to complain that the lower abdomen hurts, and sometimes even slightly bleeds.
At the same time, the discharge is in the nature of bloody or bloody, sometimes with admixtures of mucus. If the shortening is confirmed by the results of a vaginal ultrasound, then the question of how to provide assistance is decided. In some cases, the cervix can get stronger under the influence of drugs, for example, hormones, if they are not enough, but it cannot lengthen under any circumstances.
During pregnancy, such an expectant mother will be more closely watched, hospitalize as neededto provide treatment aimed at maintaining and prolonging pregnancy.
The cervix can be installed pessary - a special ring that will fix it and reduce the load of the growing genital organ on the short neck.
Another method is circus. It is based on the imposition of sutures on the neck, which will mechanically prevent its premature opening. It is reasonable to carry out suturing only in the early stages and before 26-29 weeks of pregnancy, after this period they try not to carry out the circling.
Long neck
A long cervix can be from birth, or it can become after surviving operations, including abortions and curettage, inflammatory diseases of the reproductive system - the uterus, appendages, ovaries. Quite often, the first symptoms of such a pathology appear precisely during pregnancy.
The lengthening of the lower segment of the uterus leads to incorrect proportions of the genital organ, and therefore the risk of pathological attachment of the placenta increases when this temporary organ is located in the center, too low or on the side.
The height of the placenta is of great importance, especially in the second and third trimesters, it depends on how well the baby will be provided with all the necessary nutrients and oxygen.
Women with a pathologically elongated cervix risk in childbirth... The very process of giving birth to a child is protracted, childbirth in primiparas lasts almost 14 hours, and in multiparous ones - 9-12 hours.
The elongated organ opens longer, slower, more painful.
In a child passing through such a canal, the risk of hypoxia increases, since the head and neck are in the same plane.
The difficulty lies in the fact that it is impossible to determine the pathology on a routine examination by a gynecologist. It is possible to suspect an anomaly only during colposcopy, and to confirm or deny - only with the help of ultrasound diagnostics.
Such a deviation does not require special treatment, because a long neck diagnosed at an early stage can flatten and shrink before childbirth. If this does not happen, then doctors are likely to use one of the methods of stimulating labor.
Massage is recommended for a woman before giving birth, which promotes the outflow of lymph, and also strengthens the muscles of the pelvic organs. Medication is rarely prescribed, mainly in the case of prolonged pregnancy in a hospital setting.
Erosion
Based on the results of the biometrics of this organ, as well as during manual examination, the doctor can report that the length is normal, but there is erosion. More than 60% of pregnant women face this phenomenon. In some, changes in the mucous membrane of the neck were observed before the onset of the "interesting" position, but it is possible that erosion can develop during pregnancy.
The reasons are manifold. The mucous membrane can change under the influence of hormones if a woman has taken oral contraceptives before pregnancy, as well as in the case of a deficiency or excess of certain hormones while carrying a baby. The reason may be previous inflammations, while erosion sometimes can manifest only after pregnancy.
Erosion affects women who previously had a history of sexually transmitted diseases and genital infections, difficult childbirth that injured this organ, multiple abortions. Even the inability to do douching correctly and extra pounds can lead to the development of such a complication.
A woman can feel the symptoms herself. At any stage of pregnancy, when erosion appears, uncomfortable sensations “inside” during intercourse may appear, sometimes expectant mothers complain about the appearance of scanty pink or bloody discharge. More than half of women experience no symptoms.
Erosion is not treated during pregnancy.
The standard methods of dealing with this annoying problem are - moxibustion and laser exposure - expectant mothers are contraindicated because of the danger of a scar, which can cause a lot of problems and pain during childbirth, and can also create an additional threat of organ rupture. Therefore, treatment is postponed until later.
By the way, for many women, erosion after childbirth goes away on its own. This problem has no effect on the fetus and the course of pregnancy.
Dysplasia
Colposcopy can show another problem - cervical dysplasia. This term refers to changes in the epithelium that have precancerous prerequisites. Most often, the disease is found in women aged 25 to 33-35 years. If the disease can be identified in the early stages, dysplasia is considered completely reversible, and negative consequences can be avoided.
Outwardly, with manual examination, dysplasia can be confused with erosion, since the clinical picture is similar, but colposcopy and laboratory tests can establish the main difference. It lies in the fact that during erosion, damage to the epithelium is of a superficial mechanical nature, and with dysplasia it is cellular, that is destruction occurs at a deeper, cellular level.
Most often, the disease is caused by human papillomaviruses of types 16 and 18. They are actively "helped" by other factors that contribute to the development of the disease - smoking, weak immunity or immunodeficiency, chronic inflammatory processes in the reproductive organs that have not been treated for a long time.
During pregnancy, hormonal changes due to natural reasons can affect the development of dysplasia. Having sex too early and giving birth too early are also risk factors.
Modern methods of treatment allow preventing the development of cancer - medical and surgical, as well as constant monitoring of the further state of the organ. However, during pregnancy, the use of medications and even more so the operation is undesirable. Mild dysplasia rarely degenerates into oncological disease, and therefore requires only observation.
A severe form of the disease can present a woman with a choice - to leave the child or have an abortion and agree to an urgent operation.
In each case, the issue is resolved individually.
Medical statistics are not too optimistic - about 30% of expectant mothers who chose pregnancy, in connection with which the gynecological operation was postponed, nevertheless ended up subsequently registered at the oncological center due to the development of cervical cancer.
Ectopia
Ectopia also resembles erosion, it is even called pseudo-erosion. With this pathology, part of the columnar epithelium will mix into the vagina. On examination, the doctor sees a red spot that resembles erosive changes.
A woman may complain of copious yellow, white or greenish discharge with an unpleasant odor. The reasons for this phenomenon can be traumatic, but most often they are infectious. and indicate either the presence of infections, or that infections were transferred in the past.
Earlier abortions, hormonal disruptions, and too early sexual activity can increase the likelihood of ectopia. However, in most cases, doctors are quite optimistic, because ectopia also has physiological reasons.
The changes that the lower segment of the uterus undergoes during the gestation of the baby lead to a change in the tissues of the organ. After delivery, ectopia, which is not caused by pathologies, inflammation or infections, usually goes away without a trace.
Conclusion
Biometrics of the cervix is an important study, which is inappropriate to abandon. This study is recommended by the Ministry of Health, but it is not obligatory. Thus, a woman always has the right to refuse to undergo a smear, colposcopy, ultrasound.
There is no need to explain why this should not be done, because the health of a woman and her child must be under control in order to notice any changes in time and take urgent measures.
Obstetrician-gynecologist I. Yu. Skripkina will tell you about how the cervix dilates before childbirth.
