Isthmic-cervical insufficiency is a common cause of loss of a child during pregnancy. Especially often due to this pathology, miscarriages occur in the middle of the gestational period.
At the end of the period of bearing a baby, ICI often leads to premature birth. What is this pathology and what methods of correction exist during pregnancy, we will tell you in this material.
What it is?
The cervix has an important function - it holds the developing baby inside the uterine cavity. The cervical canal, located inside the cervix, fills immediately after fertilization thick mucus plug, which does not allow infections and viruses to enter the baby.
If the neck does not fully cope with the goals set before it by nature, they talk about isthmic-cervical insufficiency. With her, the cervix is simply not able to withstand the pressure of the growing crumbs and amniotic fluid, as a result of which a miscarriage, early childbirth can occur, and during a full-term pregnancy, childbirth with ICI can be dangerous and rapid.
The neck itself in a state of insufficiency is shortened, softened. Normally, the process of shortening and smoothing begins only before childbirth. With isthmic-cervical insufficiency, shortening occurs much earlier. The internal pharynx expands. There is a threat of loss of parts of the membranes from the uterus and the subsequent death of the baby.
According to the observations of obstetricians and gynecologists, the pathological condition occurs in about 2-3% of all pregnancies. One in three women with ICI have preterm labor. Every second death of a child in late gestation is due to this very reason.
Causes of occurrence
There are three large groups of causes that can lead to pathology of the cervix and isthmus.
Congenital factors
This is the rarest reason. Infantilism of the development of the genitals, uterus and its cervix is not so common. Often, sexual infantilism is combined with other congenital anomalies and defects, such as Down's syndrome, for example.
Functional factors
If the tissues of the cervix are in the wrong balance between the connective and muscle fibers, if they respond inadequately to hormonal stimulation, then the functions of the cervix are impaired. This can happen to a woman whose ovaries are depleted, the functions of the sex glands are reduced, and the content of male sex hormones, such as testosterone, is increased in the blood.
If a woman was prepared for conception by stimulating ovulation with gonadotropic hormones, then her relaxin hormone may be increased. Under its action, the muscles of the main female reproductive organ relaxes. The same relaxing hormone is also exceeded in a woman who carries several babies under her heart at the same time.
Gynecological diseases
Often, the cause of cervical insufficiency lies in gynecological diseases that have not been treated for a long time and which have passed into the chronic stage.
The risk of developing a functional ICI increases in women who decide to become mothers after 30 years, in women who are overweight or obese, as well as in women who become pregnant through in vitro fertilization.
Organic factors
This is the most common cause of cervical inconsistency during the period of gestation. It can be associated with previous injuries to the cervix.
This usually happens in the birth process, if the lady gave birth to a large child, twins or triplets naturally, and the birth was difficult. Previous ruptures cannot but affect the health of the cervix during subsequent pregnancy.
If the previous pregnancy was accompanied by polyhydramnios, if the birth process was rapid, if the placenta had to be manually separated, all this also increases the risk of cervical injury and subsequent isthmic-cervical insufficiency.
All operations that were carried out with mechanical expansion of the neck affect its subsequent condition. Such operations include abortion, curettage, including diagnostic, as well as surgery on the cervix.
Symptoms and signs
The pathology has no pronounced symptoms. Pregnant women are often unaware that they have a weak neck, there are pathological changes and there is a serious risk of miscarriage. The ICC does not deliver any unpleasant sensations to the patients.
Infrequently, at the very beginning of gestation, some symptoms of a threat of miscarriage may appear - an abundant bloody or bloody "daub" from the vagina, slight pulling sensations in the lower abdomen and in the lumbar region.
Diagnostics
It is very difficult to diagnose isthmic-cervical insufficiency, since it has no obvious symptoms. The doctor may suspect something was wrong during a gynecological examination, but it is carried out infrequently for pregnant women. Basically only when registering.
However, if a woman is at risk of developing an ICI, then examinations may be carried out more often. On a gynecological chair using obstetric mirrors and normal palpation, the doctor can determine only the consistency of the neck, see the state of the external pharynx and the state of the cervical canal - it is closed or slightly open. This information is extremely small for making an appropriate diagnosis.
At the very beginning of pregnancy, women are prescribed a colposcopy, and in this study, using a special device - a colposcope - it is possible to obtain more information about the cervical canal and about the structure of cervical tissues. Based on the results of this examination, there may be suspicions of cervical weakness.
Ultrasound diagnostics helps to finally clarify the situation. Ultrasound allows you to measure the length of the neck, compare it with the normal average values and confirm or deny the presence of an ICI.
It is reasonable to measure such a parameter as the length of the neck after 20 weeks, because by this time this indicator becomes important for diagnosis.
The length of the cervix during pregnancy - the norm and fluctuations within the norm:
Ultrasound is done internally, intravaginally. This is the only way to find out the answer to the main question - what is the state of the internal os of the cervix. If it starts to open, then the uterus on the monitor of the ultrasound scanner acquires a characteristic V-shaped look.
In this case, such a concept as prolapse of the fetal bladder... The bubble can protrude to varying degrees, and the assessment of the real threat to pregnancy and projections will depend on it.
- If the fetal bladder is located over the internal pharynx, it is considered the most favorable prognosis the first degree of threat.
- If the bubble is already at the level of the internal pharynx, they speak of ICN grade 2,.
- If the bladder is already partially protruding into the cervical lumen - oh ICN grade 3.
- The most severe degree - fourth, with her, the prolapse of the fetal bladder is already in the vagina.
When making a diagnosis, the obstetric history of this future mother must be taken into account - how many births and abortions there were, how they took place, were there any complications, what chronic gynecological diseases she has. Particular attention will be paid to the facts of habitual miscarriage, if each pregnancy was interrupted earlier than the previous one.
If in pregnant women who are not at risk of developing isthmic-cervical insufficiency, cervical examinations by means of exposure to ultrasonic waves are carried out simultaneously with the passage of prenatal screening at the beginning of pregnancy, in the middle and in the third trimester, then women with ICI or preconditions for the occurrence of such insufficiency will have to visit the ultrasound office a little more often.
Dangers and complications
The main and most dangerous complication of cervical insufficiency is the loss of the long-awaited crumbs at any week of gestation. A miscarriage or premature birth in this case develops rapidly, quickly.
Quite often, it all starts with the discharge of amniotic fluid, and it can be either complete or partial. Abundant watery discharge may indicate water leakage.
Often, isthmic-cervical insufficiency leads to infection of the fetus inside the mother's womb, because the cervical canal, which is normally tightly closed, opens slightly, and there are practically no barriers to pathogenic bacteria and viruses. Intrauterine infection is dangerous for the development of the baby, it can lead to the birth of a child with severe pathologies, diseases, as well as the death of the child before birth.
Treatment
The treatment regimen depends on the degree and characteristics of cervical insufficiency in a particular woman. In some cases, it is possible to get by with drug therapy, and often it is necessary to resort to surgical correction.
Surgical correction methods
Suturing the cervix helps to bring the baby to the due date. The operation is strongly recommended for women suffering from chronic miscarriage both in the early and late stages, as well as in case of premature shortening of the cervix.
The operation is contraindicated in the event that the expectant mother has chronic gynecological diseases, profuse bleeding, if the uterus is in a state of increased tone and cannot be eliminated with medication.
It is customary to suture the cervix for a period from 14-15 weeks to 20-22 weeks. Applying after 22 weeks is considered inappropriate. The child is growing rapidly, the walls of the uterus are stretched, suturing may result in the cutting of sutures and tissue rupture.
The operation technique is quite simple. Manipulations are carried out under general or epidural anesthesia. The dosage of drugs for medication sleep and anesthesia is selected by the anesthesiologist, taking into account the “interesting position” of the patient, so as not to harm the baby. Sutures can be placed on the external or internal pharynx.
Before the operation, the woman must undergo a thorough examination for infections, if necessary, the existing infection is treated.
Only being sure that there is no inflammatory process in the uterine cavity, surgeons will begin to suture the cervix.
After the removal of the stitches, and this happens at a period of 36-37 weeks or earlier, if the situation requires it, labor can begin in a short time. The cervix can be severely damaged if labor has already started, and the stitches have not yet been removed. therefore it is recommended that women with cervical stitches go to the hospital in advance.
Conservative treatments
One of the most common methods for correcting ischemic-cervical insufficiency is the installation of an obstetric pessary. This method is widely used if a woman has functional impairment from 14-15 weeks to 32-34 weeks of pregnancy.
The pessary is a rubber or latex ring that is put on the neck so that its edges rest against the walls of the vagina. This allows you to keep the cervix in a stable position, and the load on it from the baby growing in the uterus is significantly reduced.
The pessary is not applied if the cervical canal is slightly open. In this case, sutures are applied, and a pessary can be used as an addition to the surgical method.
The pessary, like the stitches, is removed before childbirth in a hospital setting. In pregnant women, the question often arises whether the cervix can lengthen after the pessary is applied. Elongation like this does not happen, but the risk of termination of pregnancy after installing the fixation ring is significantly reduced.
Conservative treatment also includes medication. At the initial stage, a woman with a diagnosed cervical incompetence is treated with antibiotics and "Dexamethasone" specific antibacterial drugs are selected by the doctor. This helps to reduce the likelihood of intrauterine infection of the baby.
To reduce the pressure inside the uterine cavity, drugs that relieve the tone of the uterine muscles help. For this purpose, a woman is prescribed "No-shpu", "Papaverine"... If these drugs in tablets, injections or suppositories do not help, the woman may be prescribed "Nifedipine".
Hormone therapy is used to prevent miscarriage - "Duphaston", "Utrozhestan" in an individual dosage and according to an individual scheme, sometimes up to 34 weeks of gestation.
The drugs prescribed by the doctor should be taken strictly, without violating the dose and frequency, without missing the next appointment.
Prevention
The best prevention of ischemic-cervical insufficiency is planning pregnancy. If you go to a gynecologist not on the fact of pregnancy, but even before its onset, with a high degree of probability the doctor will be able to tell whether a woman is threatened by pathological dysfunction of the cervix.
The doctor inserts a special dilator into the cervix and measures the width of the internal pharynx. It is advisable to do this on days 19-20 of the cycle.
If there is no problem, then the internal throat is of normal size (within 2.5 mm). If there is a pathological expansion, this number will be exceeded. The most unfavorable is the size of the internal pharynx more than 6-7 mm.
A woman who wants to report normally and give birth to a baby on time should not have abortions and curettage without an urgent medical need. To do this, you should take a responsible approach to contraception issues with the onset of sexual activity.
All gynecological diseases need to be examined and treated in time, without "starting up" to a chronic condition.
Clinical guidelines
Women who are usually caught unawares by the diagnosis of ischemic-cervical insufficiency are advised to seek help from a psychologist who accepts at every antenatal clinic. This specialist will be able to give them the right attitude and explain that this diagnosis is not a verdict, and in most cases such pregnancies end quite safely with the birth of a healthy baby at term.
The psychological attitude of a pregnant woman is of great importance in treatment, because stresses are reflected in the hormonal background, increase the tone of the uterine muscles, which complicates the task of doctors.
Physical activity should also be reduced to the point of complete limitation - in case of a serious threat, bed rest helps. Women with a lower degree of danger are prohibited from long walks, as well as lifting anything heavier than 2 kilograms.
The longer the gestation period, the more attention a woman should pay to her position in space. You can't sit or stand for a long time, this increases the pressure in the uterine cavity, and the load on the cervix increases significantly.
A woman should also lie correctly - on your back and slightly lifting your legs... To do this, you can put a small pillow or roller under them, this will help reduce uterine pressure.
From 24-26 weeks of pregnancy, weekly monitoring of the condition of the cervix is needed.After 30-31 weeks, a woman may be shown preventive hospitalization, since a large number of premature births occur during this period.
At 37 weeks, you need to go to the hospital in advance, since childbirth with ICI often passes quickly. Without constant monitoring of the expectant mother, very negative consequences can occur.
A woman with cervical insufficiency should not make love.
If there is pain in the lower abdomen, atypical discharge, you should immediately consult a doctor... This does not mean that premature birth or miscarriage has begun, but in this matter it is always better to be safe.
Reviews
Most of the women who left their reviews and stories about overcoming isthmic-cervical insufficiency during pregnancy on the forums dedicated to motherhood, note that the efforts of doctors were crowned with success, and the baby was saved and delivered until the due date. With repeated pregnancy, the situation with cervical insufficiency usually repeats, but a woman who is already ready for anything knows exactly the importance of diagnostic examinations and agrees to unconditionally accept all prescribed medications.
Positive feedback was left on both the pessary and the suture operation. In both cases, women who were diagnosed with cervical insufficiency after 18 weeks were able to bring babies to 37-39 weeks.
More about what an ICN is in the next video.
