Sometimes a long-awaited pregnancy is complicated by the threat of not delivering the baby before the due date. Various pathologies of the cervix can cause cervical-cervical insufficiency. In some cases, the expectant mother is recommended to suture the cervix. Why this is done and how this manipulation takes place, we will tell in this material.
What it is?
Suturing the cervix is a forced necessity, which gives a real chance to preserve and prolong pregnancy if the cervix cannot cope with its direct responsibilities for some reason. After conception has taken place, the cervix closes tightly. The cervical canal is closed and filled with mucus. The task for this part of the female reproductive organ is large and important - keep the growing fetus in the uterine cavity, do not allow it to leave it prematurely.
In addition to retention, the neck with a mucous plug prevents pathogenic bacteria, viruses, and other unpleasant uninvited "guests" from entering the uterine cavity from the vagina, which can cause intrauterine infection of the baby. This is dangerous because infections transferred in the embryonic and later periods usually end in malformations and severe pathologies congenital nature, intrauterine death of the baby.
If the cervix does not provide adequate protection for the growing baby, then the likelihood of miscarriage and premature birth increases. If by this time the baby is not yet able to survive on its own in this world, then such childbirth will end tragically. In order to strengthen a weak neck, doctors recommend to sut it in in certain situations so that a mechanical barrier in the form of stitches does not allow it to open ahead of time.
Indications
There must be strict indications and unequivocal recommendations of the attending physician for this kind of surgical intervention while carrying a baby. These factors include:
- high risk of miscarriage or premature birth due to the presence of similar cases in the history;
- habitual miscarriage in the 1st and 2nd trimesters of pregnancy;
- miscarriage in the third trimester;
- earlier shortening and opening of the neck, expansion of the internal or external pharynx;
- dubious scars left as a “memory” from previous births, in which neck ruptures occurred;
- any destructive changes in the cervix in the process of carrying a child, which are prone to further development.
The doctor cannot make a decision that there is a need for such at least as suturing on the basis of only one examination on the gynecological chair. He needs comprehensive information about the state of the lower segment of the uterus, which is the cervix. For this, complete biometric examination, which includes colposcopy and ultrasound diagnostics, as well as laboratory smear examination.
Only after all risk factors have been identified, the length and width of the cervix have been measured, the condition of the cervical canal inside it has been assessed, as well as the patient's personal history, can a decision be made to suture the cervix.
Contraindications
Sewing up this organ during pregnancy is possible only if, apart from a weak neck, no other global problems have been identified in this pregnancy. If some concomitant pathologies are found, the operation will have to be abandoned. Contraindications include:
- diseases of the heart and blood vessels, kidneys, which worsened in the expectant mother due to pregnancy, the risk of death of a woman in the event of a mechanical prolongation of pregnancy;
- bleeding, increasing in strength and character, as well as recurrent bleeding when threatened;
- gross malformations of the baby;
- hypertonicity of the uterine muscles, which cannot be reduced with the help of medical conservative treatment;
- chronic inflammation of the reproductive organs of a woman, the presence of a genital infection, STDs;
- late detection of cervical pathologies - after 22 weeks of pregnancy (the best time for a successful intervention is considered to be the period from 14 to 21 weeks).
How is the operation going?
The term for the operation is of great importance. From 14 to 21 weeks, the child is not so big as to strongly stretch the walls of the uterus and the muscles of the cervix; at a later date, suturing is not recommended due to the fact that highly stretched tissues may not withstand and the sutures will erupt with subsequent rupture.
The operation, which in medical language is called "Cervical cerclage", carried out only in a hospital. It is not considered painful or excruciating because the woman is given epidural or intravenous anesthesia.
You should not be afraid of him, because experienced anesthesiologists will calculate the dosage of drugs solely taking into account the gestational age, physique, weight and health status of the future mother herself and the developmental characteristics of her baby. The dose will be safe for both mother and fetus.
The duration of the entire manipulation does not exceed a quarter of an hour. According to the condition of the cervix, the doctor will suture either the external or internal os of the cervix. The outside will not be touched if there is erosion, dysplasia, pseudo-erosion on the neck. The technique is very simple - surgeons suture together the edges of the outer part of the neck with strong surgical threads.
This method requires careful preparation. If there is an infection in the uterus, the consequences will be more than dire. Sewing will create a closed space inside the female reproductive organ in which any microbe can begin to multiply rapidly. Previously, the woman undergoes antibiotic treatment, a thorough sanitation of the vagina is done. True, it does not always help.
There will be no confined space if the doctor decides to suture the internal os of the cervix. In this case, specialists leave a small drainage hole. The sutures themselves are applied in different ways, each surgeon has his own favorite, moreover, a lot depends on the anatomical features of the patient.
The cerclage itself can be performed laparoscopic method. It has many advantages - speed, fairly easy postoperative period, low blood loss, and a lower risk of complications.
Laparoscopic cerclage is indicated for women with congenital shortening of the cervix and those who have had unsuccessful vaginal suturing.
Potential problems and complications
As with any surgical intervention, cerclage can also have complications. The most dangerous are the accession of infection, the development of the inflammatory process and an increase in the tone of the uterine muscles. Inflammation can develop due to an internal infection that could not be “defeated” in the preoperative period. Sometimes a woman has an individual allergic reaction to the suture material used by the doctors.
Potential problems can be discussed prolonged discharge after surgery, burning sensation, mild pain syndrome... Moreover, inflammation can manifest itself not only immediately after the operation, but also several weeks after suturing. That is why it is important to visit your doctor more often and monitor any changes.
Hypertonicity is also a reaction of the uterus to surgery. and suture material foreign to its structures. Some heaviness in the abdomen, slight pulling sensations may be quite normal in the first time after the operation, but later they should disappear. If this does not happen, you should inform your doctor about it.
It is not often, but it also happens that a woman's body categorically refuses to accept a foreign body, which is a surgical thread, a violent immune process of rejection begins, which may be accompanied by high fever, atypical discharge, pain.
In the later stages, cerclage can have another unpleasant consequence - the sutured cervix can be severely damaged if childbirth has already begun, and the stitches have not yet been removed. Therefore, it is important not to ask the doctor "to stay at home for another week", but to go to the hospital in advance.
Recommendations for the postoperative period
After the intervention, the woman needs to be under the round-the-clock supervision of doctors in the hospital for several more days. She is prescribed antispasmodic drugs to reduce the muscle tone of the uterus, as well as strict bed rest. Vaginal sanitation is performed daily to avoid infection. After that, the pregnant woman can be sent home. Discharge after the intervention lasts about 3-5 days.
The seams on the neck will require the expectant mother to reconsider her lifestyle until the very birth. Physical activity, prolonged standing in an upright position, prolonged walking are contraindicated. In no case should you lift weights. You should also refrain from sexual activity, so as not to provoke hypertonicity of the uterus, which can lead to teething.
Until childbirth, a woman will have to monitor her stool - constipation is extremely undesirable, since it is forbidden to push. Therefore, you will have to go on a diet, introduce more fresh vegetables and fruits, juices into the diet, limit salt, an abundance of protein foods, as well as baked goods and pastries.
You will have to go to the doctor more often, than women in an "interesting position" usually do. The doctor will monitor the condition of the seams, take smears for the vaginal microflora, and, as necessary, prescribe unscheduled ultrasound examinations, the purpose of which will be to measure the parameters of the cervix and assess its internal structures.
In the maternity hospital, a woman with stitches in the uterus will have to lie down at 36-37 weeks... Around this time, the stitches are removed. After that, labor can begin at any time, even on the same day.
It is not painful to remove the sutures themselves; there is no need to use anesthesia or other methods of anesthesia.
Predictions and consequences
The percentage of gestation after cerclage is quite high - more than 80%. The prognosis depends on the degree of cervical insufficiency and the reasons why the woman was shown surgery. If after the operation she observes all the doctor's recommendations, then the chances of delivering a baby to 36-37 weeks increase significantly.
Reviews
In general, women tolerate this intervention well. The reviews of those who went through the suturing of the cervix are positive - they managed to bring the long-awaited babies before the scheduled time. Among the disadvantages, women point to a large number of prohibitions that are imposed on everyday life after such an operation. Almost all patients note that for a long time, the increased tone of the uterus remained, which caused a lot of psychological and physical inconvenience and anxiety.
Not all of the pregnant and young mothers who left reviews about the cervical cerclage agreed to undergo an operation on a referral in a public hospital. Some people deliberately choose private and paid medicine. Many clinics in Russia carry out such operations.
Their cost is within 50 thousand rubles, not counting preliminary analyzes, and a lot of them are required.
For those who think about suturing when expanding the internal or external os of the cervix in a private clinic, experienced mothers are advised to choose such an institution in which good specialists work, because the outcome of the operation largely depends on the qualifications of the doctor. Don't make a hasty choice you should carefully read the reviews about this or that clinic.
