The purpose of the cervix is double. During pregnancy, she is responsible for ensuring that the fetus remains in the womb, does not leave prematurely, grows and develops where it is provided by nature. It is tightly closed. But it depends on her when childbirth begins, because the beginning of its disclosure is the generic process.
It is not surprising that the speed and intensity of opening, as well as possible difficulties, cause many questions for women. In this article, we will discuss the specifics of this process.
What's happening?
The uterus is shaped like a tied bag, while its widest part is called the bottom, and the narrowest part is called the neck. The neck is a round muscle, that is, the ability to contract, close, and open is originally laid in it.
Inside the cervix there is a thin cervical canal, one part of which extends into the uterine cavity, and the other into the vagina. During pregnancy, the cervical canal is closed with a mucous plug, the task of which is to prevent bacteria, viruses and other unwanted "guests" from entering the uterine cavity along the ascending routes from the vagina.
The cervix gradually becomes shorter and shorter throughout pregnancy. If outside of pregnancy its length is about 3.5-4 centimeters, then in the last weeks before childbirth, the process of its shortening, maturation and smoothing to 1 centimeter begins.
The opening of the cervix begins under the pressure of the fetal head after it descends into the uterine cavity below. Also, special hormones and enzymes are actively involved in this process, the psychological attitude is also important. There are cases when, under the influence of fear of childbirth, a woman's cervix does not open even after regular labor pains begin.
The opening is necessary so that the head of the fetus can pass through the canal inside the neck during childbirth, and then he himself. From a tightly closed neck, as labor pains develop, it expands to 10-12 centimeters. This is called full disclosure.... After him, the child begins his journey into this world.
Extension mechanisms
When the cervix is mature, soft, ajar and shortened, labor can begin at any moment. If the timing is right, but maturation does not occur, doctors in the hospital are engaged in preparing the cervix. Even before childbirth, the cervical canal should become softer and more elastic, acquire the shape of a funnel due to the opening of the internal os.
The mechanisms of opening in women who give birth for the first time and in women who already have birth experience are somewhat different from each other.
In primiparous
In women giving birth for the first time, the internal pharynx opens first, and only after that the cervical canal begins to expand. The external pharynx remains closed. The wider the canal becomes, the shorter the neck becomes. When the cervix is flattened and no longer protrudes forward, the external os is still closed.
Its edges stretch and become thinner. When a woman gives birth, they diverge in different directions. Each labor contraction increases erection.
It is absolutely impossible to check the degree of disclosure at home. This is done by the gynecologist during the vaginal examination. But a woman can be guided by signs and symptoms that indicate that the process has started.
First of all, this is the appearance of labor pains - regular, rhythmic, periodic, intensifying with development. The mucous plug may come off. It comes out when the cervical canal is already dilated, either as a whole or in parts... The cork looks like a clot of milky, yellowish mucus, may contain blood impurities and blood streaks, and has a jelly-like appearance.
The first contractions do not mean that the cervix is already open. She has a lot of work ahead of her. At the first birth, the process is usually more protracted.
The latent period of contractions, when uterine spasms are repeated every 30-20 minutes, can last up to 8 hours. The woman in labor should be in the maternity hospital when the contractions will return confidently every five minutes. With such an intensity of uterine contractions, most often the expansion of the external pharynx is about 3-4 centimeters, but everything is individual.
During the period of active contractions, the primiparous woman in labor should spend about five more hours... The speed of opening the neck of the reproductive female organ increases, and during this time it opens up to an average of 7-8 centimeters. The final period is a transitional one. Usually it lasts up to an hour and a half, and the disclosure becomes maximum, complete.
The sensations during the phased disclosure intensify, each contraction, according to reviews, begins with the tension of the lower back, back, gradually moves to the lower abdomen and spreads to the middle part of the uterus and peritoneum.
The cervical opening is controlled by doctors and obstetricians. While the woman is at home, there is no need for supervision. If the fetal bladder is intact, then the vaginal examination will be carried out upon admission to the hospital, and then upon discharge of water and, if necessary, at other periods.
In case of early outpouring of water, the state of the cervix is monitored upon admission to the hospital, and then, without urgent need, the study is not carried out with hands and instruments so as not to introduce an infection into the uterine cavity.
In multiparous
In women who give birth again, the birth canal is usually prepared in advance, the so-called "muscle memory" is triggered. The peculiarities of the mechanism of natural expansion are that both the internal and external cervical os open almost simultaneously. This means that when regular contractions begin, expansion will occur both internally and externally. This feature explains the shortening in time of all birth periods during repeated births.
Second, third and subsequent births are usually faster. Therefore, after a woman is able to determine her labor pains, you need to go to the hospital a little earlier than during the first birth, preferably with an interval between uterine spasms of 10 minutes.
What happens in the cervix, doctors will find out upon the arrival of the patient at the hospital by conducting a vaginal examination.
Usually, at the end of the gestation period for multiparous women, the external pharynx is slightly open and the tip of an obstetrician-gynecologist's finger can pass. A cervical examination for maturity is done in the last couple of weeks before the expected due date.
Finger method
Many women in the “interesting position” have heard that obstetricians evaluate the degree of cervical dilatation in the fingers. But it can be difficult for a layman to understand exactly whose fingers are taken as the basis of the measurement system and how much it is in our familiar centimeters.
This is a conventional unit for measuring the degree of cervical dilatation, which is proudly called the obstetric finger. Exists there are only two ways to measure the opening - to do a transvaginal ultrasound and manually examine the cervix... The second method is considered to be faster, and therefore it is actively used by obstetricians around the world.
The examination is carried out as needed in the hospital or in consultation with examinations at long periods of pregnancy. The midwife carefully inserts several fingers into the vagina, not counting the thumb, as it is short. The hand should be in a sterile glove, if necessary, the doctor can use medical petroleum jelly.
How many fingers the uterus "lets in", so much and great disclosure. The more the neck expands, the more fingers will pass.
That is why, at a later date, doctors often state with a mature cervix that there is an opening for 1 finger. And in the maternity hospital, where they check the progress of the birth process, they can already report on the opening of 2-3 fingers upon admission.
And how much is it in centimeters? According to generally accepted international practice, one conventional obstetric finger is equal to 1.5-2 centimeters... The half-centimeter error is due to the different size of the fingers of different health workers.
Thus, when a woman arrives at the maternity hospital with contractions that repeat every five minutes, most often 2-finger extension, that is, the actual extension is approximately 3-4 centimeters, which means that the woman has not yet entered into active contractions. Active uterine spasms, repeated every 2-3 minutes, usually lead to expansion by 3-3.5 fingers, which corresponds to 6-7 centimeters.
Full cervical opening corresponds to the concept of "more than 4 fingers"... There are only four free fingers that you can enter (minus the thumb, as we remember). Therefore, it is precisely to measure the full opening and to ascertain whether five or seven fingers pass, there is no physical possibility.
The conclusion about opening to "more than four fingers" should be a signal both for the woman in labor and for the medical staff - it is time to transfer the patient to the delivery room, because attempts begin.
Preparation before childbirth
Preparation of the cervix begins if, by 39-40 weeks of pregnancy, doctors recognize it as immature or not mature enough. In order to make an appropriate conclusion, one finger method will not be enough.
Bishop's scoring system is applied for correct conclusions... It includes several important signs that are taken into account during a vaginal examination. For each feature, from 0 to 2 points are awarded. A mature neck is considered to be 8 points on the Bishop scale.... At the same time, the neck is soft, ready for faster and easier expansion during childbirth, the length of the neck is less than a centimeter, the outer pharynx passes 1-2 fingers, the neck itself (its contraction ring) is located clearly in the middle, not deviating either to the right or to the left , neither back nor forward.
If the assessment of the degree of cervical ripeness is less than 8, preparatory medical measures are taken... In this case, the choice of preparation methods depends on the duration of pregnancy and on the specific number of points.
The cervix, which received less than 3 Bishop points according to the results of the examination, is considered immature and needs an early start to the use of medications and mechanical means to accelerate maturation.
3-4 points on the Bishop scale - insufficient maturity. If the gestational age allows, the woman can be left alone, because the cervix can still mature on its own. 5-8 points gets a sufficiently mature cervix and her condition does not need correction if there is still a week before giving birth.
There are two types of inpatient training - medication and mechanical. Mechanical methods include kelp sticks and a Foley catheter. Medicines are usually represented by hormonal drugs - tablets, suppositories, gel for application directly to the neck. The choice of the method is the doctor's task.
At 38-39 weeks or a little earlier, women are often advised to take "No-Shpu"because this antispasmodic drug effectively relaxes smooth and round muscles and allows you to accelerate the smoothing and maturation process.
In the last weeks, it is considered useful to walk, do feasible homework. The more sedentary a woman leads, the greater the risk that the cervix will not open without help. Gymnastics is useful, especially a set of Kegel exercises.
If the cervix does not open or soften by 40-41 weeks, doctors will take other steps to prepare it for labor.
Foley catheter
A medical device that is used to catheterize the bladder. Some types of catheter (in particular, catheter # 18) are used to induce labor.
It is a thin latex tube coated with silicone. There is a small balloon at the distal end. The tube is inserted into the cervical canal through the vagina and the balloon is filled with 10 ml of saline or water. A small amount of saline is additionally injected into the uterine cavity through the catheter. The balloon, increasing in size, exerts pressure on the cervix, due to which its mechanical expansion occurs.
A catheter is installed for a day. If the cervix is immature at all, installation is not performed. This procedure is quite painful and, alas, not always effective. In more than half of cases, cervical dilatation does not occur.
Recently, the method has been used infrequently, mainly in cases where other methods are contraindicated for a woman.
Kelp
The sticks made of dried kelp algae are about 6 cm long, and their thickness is different - from 3 to 9 mm. What size to choose is determined by the doctor, basing his choice on the real state of the cervix at the time of the start of preparation.
Sticks are inserted into the cervical canal... Laminaria tends to expand and increase in volume upon contact with liquid media. The stick in the canal begins to swell, the cervix, as a result, expands mechanically. In addition, algae stimulate the production of prostaglandin F2A. This substance at the biochemical level contributes to a faster shortening and smoothing of the neck.
Set sticks for a day... After this time, they can be removed. Whether it is necessary to install new, broader ones, the doctor decides.
This procedure is less painful than the installation of a Foley catheter, but it is still quite tangible. In addition, the effectiveness of the method is also not one hundred percent - in half of the cases, the sticks do not give the desired effect.
Medication
This method is the most popular and frequently used in modern obstetrics. In addition to "No-Shpa", the antispasmodic effect of which was described above, can appoint candles "Buscopan" or "Papaverine".
Among the hormonal drugs that are used in the hospital under the supervision of a doctor, drugs that belong to estrogens and prostaglandins prevail.
The exact names of the drugs, as well as the dosage and frequency of use, are selected individually for each woman. The method is considered quite effective.
Possible problems
Problems with the cervix can occur both during pregnancy and during childbirth. The possible consequences should be told in more detail so that a woman can navigate the spectrum of different situations.
Before giving birth
If the shortening and flattening of the cervix occurs too early, for example, in the second trimester, they speak of a functional failure of the cervix - isthmic-cervical insufficiency (ICI).
In order to prevent premature birth, a woman is recommended, according to the situation, to apply surgical sutures to the cervix or to install an obstetric pessary.
With these devices, a woman has every chance to bring pregnancy to a normal period, subject to all the doctor's recommendations.
In childbirth
With the onset of labor, the cervix can behave in different ways, and the process does not always occur exactly as described in courses for expectant mothers or in books for women in childbirth.
The disclosure may go too fast. This creates the preconditions for rapid childbirth. They pose a real danger to the child and mother, because they often end in serious birth injuries. Most often this occurs in women with a weakened round muscle of the neck. - giving birth many times, pregnant with twins or triplets, with ICI, which was mentioned above.
Premature birth is quite often accompanied by an excessively rapid opening of the external pharynx. Also, such an anomaly may be a consequence of the stimulation of labor as such.
In this case, they carefully assess whether there is discoordination of labor. They try to help the woman with medication - they introduce funds that somewhat slow down the opening in particular and the birth process in general.
Another common complication is primary weakness of the labor force. With it, the opposite processes occur - contractions are discoordinated, weak or absent, or present, but the cervix opens very slowly, at an insufficient pace. In this case use amniotomy - puncture of the fetal bladder, and if this does not help, injections of oxytocin and antispasmodics are performed according to a certain scheme. If this also turns out to be ineffectual, can perform manual cervical openingbut it is a very painful and traumatic procedure. It is carried out mainly if a woman in this situation flatly refuses to have an emergency caesarean section.
Erection problems are often experienced by women who give birth at a too young age (under 18), as well as after 37 years, especially if a long time has passed since the first birth. The cause of weakness can be strong fear and muscle clamps arising from it at the psychosomatic level. Rebirths are less likely to develop primary weakness than births... Also, the problem may lie in a complicated obstetric history, for example, previous abortions. Often the reason for the lack of proper disclosure lies in hormonal imbalances.
Recommendations
A woman who is preparing to become a mother should not miss scheduled appointments at the antenatal clinic, because this is important, among other things, for the timely diagnosis of problems with the cervix. In advance also it is worth enrolling in courses for expectant mothers and learning the technique of correct breathing in childbirth and postures that help disclosure... This knowledge will be very useful during the period of labor pains.
A woman is recommended sufficient physical activity, frequent walks, yoga and a set of Kegel exercises to strengthen the muscles of the pelvic floor. Shortly before birth, you can drink a decoction of raspberry leaves at home - this remedy has long been considered one of the most effective folk remedies in preparation for the upcoming labor.
Having sex is also not forbidden, the cervix begins to mature faster due to the prostaglandins contained in the semen. But you should check with the doctor if there are any contraindications to intimacy.
Read more about cervical dilatation during labor in the next video.
