The obstetric pessary helps women with a weak cervix to carry the pregnancy to the end, saves the life of the child. But shortly before the due date, such pregnant women have many questions, the main ones of which relate to whether contractions with the pessary can begin and how long after the removal of the device childbirth can begin.
In this article, we will try to give answers to all these questions.
How and when is it installed?
The need to install a pessary, which is a tight ring, on the cervix usually arises in the second trimester of pregnancy in women with identified pathologies of the state of the cervix. The function of the ring in this case is to keep the uterus closed, thereby preventing miscarriage, premature birth.
As a result, the fetal pressure on the cervix from the inside is compensated and distributed more evenly.
More often the pessary is placed after 20 weeks of pregnancy and up to 32-33 weeks... The procedure is quick, almost painless. But the very installation of a rubber or latex ring can provoke childbirth or miscarriage, and therefore doctors always weigh the existing and potential risks.
The installed pessary with its edges reliably abuts against the fornix of the vagina, which provides it with a secure and stable position.
The pessary is not able to make the pathologically short cervix longer when carrying the fetus - it only allows, in most cases, to prolong the pregnancy with high efficiency.
After the expectant mother has a ring installed on the cervix (the procedure takes place in a stationary environment), she needs special care and adherence to medical recommendations.
Excessive physical activity, intercourse, stress and excitement are prohibited. Once a week, it is recommended to do a smear analysis for the state of the vaginal microflora: this will help prevent infection. Vaginal irrigation suppositories are often prescribed.
In the case of severe isthmic-cervical insufficiency, after applying a fixing ring to the neck, the woman is shown bed rest until childbirth.
How is it filmed?
Do not think that removing the pessary is more difficult than installing it. Usually, removing the latex or rubber ring from the cervix is even easier and faster than insertion. After removal, it is necessary to carefully observe the rules of intimate hygiene, to irrigate the genital tract solution prescribed by the doctor.
The pessary is usually removed at 38 weeks... It should be noted that the very preparation of a pregnant woman's body for childbirth does not at all depend on whether she has a fixing device on her cervix or not. Everything goes on as usual, and therefore 38 weeks is considered the optimal time to remove the ring. The child is mature enough to easily adapt to his new environment after birth. The birth canal is also almost always ready by this time, the hormonal background is "tuned" to labor.
The beginning of labor
One of the most common questions is whether labor can begin before the ring is removed. They can, because, as we have found out, the internal preparation for this reflex act in no way depends on whether there is a foreign body on the cervix or not.
A birth after 37 weeks of pregnancy with an installed pessary should not be perceived as a tragedy.... The baby is full-term, and the birth process itself will not differ much from the classical ones, except that the cervical dilation will proceed somewhat faster, which in a certain way will reduce the total time of delivery.
If childbirth begins with the retainer ring installed earlier than 37 weeks, you also need to stay calm - the modern level of intensive care allows you to care for even very premature babies.
The onset of labor may be indicated by regular contractions, which begin to repeat at a certain frequency. Also, the beginning may be marked by the discharge of amniotic fluid.
If a pregnant woman without a pessary can afford to stay at home until the contractions gain a certain strength and intensity, then an expectant mother with a ring on her uterus should call an ambulance right away. To avoid damaging the cervix, the pessary must be removed as soon as possible..
There are times when during contractions the pessary slips by itself, but it is better to play it safe. In the maternity hospital, the obstetrician will definitely remove the pessary, and the further course of labor will be normal. Do not assume that childbirth will necessarily be swift or rapid when the pessary leaves its place and stops fixing the cervix. Regularities between wearing a pessary and rapid childbirth have not been identified, the risk of the likelihood of such an abnormal labor activity is at baseline values, as in women who did not wear rings on the uterus.
Where more dangerous is the onset of spontaneous labor with surgical sutures superimposed on the neck... During contractions, they can "cut through" the cervix, lead to its serious injury.
Despite the great safety of the pessary, both women with sutures and women with a rubber or latex ring on their neck are advised to go to the hospital in advance. Most often - at 38–39 weeks of gestation.
If there are no concomitant pathologies, after removing the pessary at 38 weeks, they can go home — to wait for the onset of labor. If there are other complications of pregnancy, it is highly likely that the woman will be left in the hospital under the supervision of doctors.
When will labor start?
For women who have had their pessary removed on time, on time, before the onset of labor, it is very interesting to know when to expect the onset of labor. The baby can start to be born at any time.
Sometimes it takes about half an hour after removing the latex ring before the first contractions start, and sometimes you have to wait. On average, statistics show that most women in labor give birth 7-9 days after the fixation device is removed.
After the ring is removed, the pressure of the fetal head on the internal os of the cervix is no longer compensated and distributed, it becomes quite strong. Under the influence of the changed hormonal background, as well as under the weight of the fetus, the internal pharynx begins to open and becomes funnel-shaped.
Following it, the external pharynx begins to open. This process is gradual, smooth, therefore, the first signs of approaching the cherished day may be changes in the sensations of the expectant mother: aching, breaking pains in the lower back appear, a mucous plug that can no longer be in the cervical canal due to its expansion when the internal pharynx is opened.
Labor pains will lead to a gradual opening of the external pharynx. The neck should open completely up to 10-12 centimetersto release the baby from the uterine cavity into the birth canal.
Do not think that the very fact of the presence of a pessary during pregnancy can somehow affect the upcoming birth processes. If the fixation device did not cause infection, then childbirth will be the most common, no different from others.
There are also known cases when the pregnancy was maintained by fixing the cervix with an obstetric pessary, and after removal, its independent labor activity did not develop until 41-42 weeks, in connection with which there was a need to stimulate labor.
Reviews
According to women, when removing the pessary, you need to be fully armed (collect the bag in the hospital, prepare the necessary documents and things), because childbirth can begin almost immediately after removing the ring. Waiting after withdrawal can be quite painful, especially if you have to wait a long time.
Many people worry that labor does not begin, although after removing the fixation device, the doctor noted that the cervix was dilated by 1-2 fingers. You don't have to worry about this. The absence of a mucous plug and a slightly opened neck is not yet a reason to believe that the life and health of the child are in danger. As long as the fetal bladder is intact, the baby has reliable protection against viruses and bacteria, but reasonable precautions are still necessary.: while waiting for childbirth after removing the pessary, it is important to follow the rules of intimate hygiene, wash yourself several times a day, do not have sex, do not douche.
Many women who have repeated childbirth after wearing a pessary argue that the birth process itself was simpler and easier than the first. Some primiparas also indicate that they managed to give birth quickly and quite easily, because the cervix opened faster.
More details about the functions of an obstetric pessary are in the next video.
