When a gynecologist advises a pregnant woman to put an obstetric pessary, it often causes her fear and distrust. However, in the event of a complicated pregnancy, using this device, you can avoid spontaneous abortion and give birth to a healthy baby. What is an obstetric pessary? What are the indications for its installation? Can he harm the health of the expectant mother or fetus?
What it is?
The Latin term "pessarium" literally translates as "vaginal". Although it is believed that the name of this device comes from the Greek word "pessos", which means "round game stone". It is because of its shape that the obstetric pessary is often called the gynecological ring. However, in modern clinical practice, pessaries of various shapes and designs are widely used. This is determined by their specific purpose.
It is worth noting that these devices are used in various fields of medicine, but this material will focus on the so-called unloading pessaries, which are used in obstetrics. to correct the physiological defects of a woman, complicating the course of pregnancy.
An obstetric pessary is a small, ring-shaped medical device made of hypoallergenic material. Features of its design exclude the possibility of injury to the genitals of a pregnant woman both during wearing and during gynecological manipulations. There are also some modifications of pessaries that are used in gynecology and urology, but in special cases they can also be used in obstetrics.
During pregnancy, an unloading obstetric pessary is installed in order to preserve it in the event of a real threat of spontaneous abortion. This device is a more advanced alternative to surgical correction of the cervix.
Also, indications for the installation of a pessary are cervical dilatation in case of "habitual miscarriage" and the threat of termination of multiple pregnancies.
Purpose of using gynecological rings:
- keeping the cervix closed for a certain period of gestation;
- reducing pressure on the cervix.
The feasibility of setting a gynecological ring is determined by the doctor supervising the pregnancy. In this case, the results of an objective examination of the cervix, as well as data from a number of instrumental studies, are taken into account. The type and shape of the obstetric pessary is also chosen by the gynecologist based on the individual anatomical characteristics of the patient.
Pessaries have been widely used in gynecological and obstetric practice not so long ago. However, this method of maintaining pregnancy has already shown great efficiency. (in more than 80% of cases, the pregnancy ends successfully).
Before the pessary was invented, doctors were forced, when a woman had threatening conditions, to correct them by suturing the cervix, and this manipulation is quite difficult and is carried out under anesthesia. In addition, it could be feasible no earlier than after 20 weeks of gestation. This is due to the fact that at an earlier stage, the toxic effect of anesthesia could have an extremely negative effect on the intrauterine development of the baby. On the other hand, the pessary can be installed even earlier than 20 weeks.
Before the procedure itself, it is necessary to make sure that the expectant mother does not have any urogenital infections. In case of detection of an inflammatory process, appropriate therapy should be carried out, after which a gynecological ring should be installed.
Kinds
There are several types of pessaries:
- The first type of devices is installed mainly in primiparous women, as well as those who have had no more than two births. In this case, DShM should not be more than 32 mm, and VVTV - 6.5 cm.
- The second type is used for women with the same family history, but only with different anatomical data. In this case, DShM should be no more than 3 cm, and VVTV - 7.5 cm.
- The third type is indicated for women who are expecting a third (or more) birth. Suitable physical parameters: DShM - from 3 to 3.5 cm, VVTV - from 7.5 to 8.5 cm.
The required type is selected depending on the patient's anatomical parameters. At the same time, its DShM is taken into account - the diameter of the cervix, and VVTV - the size of the upper third of the vagina.
In each situation, an individual approach is used to select the right obstetric pessary. It is necessary to take into account all the anatomical features of the structure of the genital tract of a particular patient.
It is extremely important that the product is made of environmentally friendly material that is not capable of provoking the development of an allergic reaction. The most widely used pessaries in clinical practice are made of silicone. Gynecological rings made of flexible plastic are also popular. The pessary has a smooth surface, which excludes the possibility of damage to internal organs during wear.
The pessary is for single use only. The shelf life of such products is limited by the period as long as it remains sterile.
Indications and contraindications
In obstetrics, a pessary is used to prevent cervical dilatation, which can occur much earlier than expected. In other words, with the help of this device it is possible to prevent the development of spontaneous abortion in the early and late stages of gestation. Often, a pessary is installed in women with multiple pregnancies.
Direct indications for the installation of a gynecological ring are the following pathologies:
- isthmic-cervical insufficiency (ICF is a type of pregnancy complication characterized by weakness of the cervix and premature opening of the amniotic bladder. The consequence of this pathology may be spontaneous abortion, which occurs before 22 weeks);
- preventing the development of ICS (if this diagnosis was made during the patient's previous pregnancy);
- early ineffective surgical treatment of ICS.
Thanks to the use of a gynecological ring, it is possible to keep the cervix closed throughout the gestation period, and also to prevent its softening, since the pessary can reduce the intensity of pressure on it.
In addition to its direct purpose, the vaginal ring can to some extent have a psychological effect for women who are very worried about the outcome of pregnancy, thereby unconsciously increasing the risk of the threat of spontaneous abortion. It is much easier for such patients to cope with their anxiety if they know that they have an obstetric pessary installed.
Like most other medical procedures, the installation of a gynecological ring has a number of contraindications. Among them:
- "Frozen pregnancy" (it makes no sense to prolong the pregnancy);
- the presence of pathologies in the fetus that are incompatible with life and are an indication for artificial termination of pregnancy for medical reasons;
- bloody discharge from the genital tract of a pregnant woman, appearing in the first or second trimester;
- inflammatory diseases of the vagina or cervix;
- damage to the amnion.
More about ICS
During the normal course of pregnancy, the cervix should be filled with a viscous mucous plug, due to which the canal remains tight until the very moment of delivery. When labor begins, the opening of the canal gradually opens, as a result of which the natural expulsion of the fetus through the birth canal occurs.
If the cervix was previously deformed as a result of exposure to any factors, then it cannot “withstand” the load, which increases with the course of pregnancy. Because of this, the cervical canal opens without the expected contractions.
The causes of isthmic-cervical insufficiency can be:
- the patient's previous cone biopsy procedure;
- chronic inflammatory diseases of the genitourinary system;
- excessive physical activity;
- congenital malformations of the anatomy of the uterus;
- post-traumatic deformation of the tissue structure of the uterus.
Installation
The procedure for setting the gynecological ring itself is not lengthy. Before starting the manipulation, the patient must empty the bladder. The doctor flexes the pessary using a certain method and inserts it into the vagina. This is followed by the direct installation of the ring on the cervix.
To ensure that the process of introducing this product into the vagina does not cause additional discomfort to the patient, it is pre-lubricated with a sterile moisturizer.
The gynecological ring has a base that allows it to be securely fixed in a certain position. The main part of the product is directed towards the rectum, the smaller part towards the pubic symphysis. The pessary with a closed ring restricts the cervix, which prevents its premature disclosure. Also, in its design, it has several special holes that are designed for the outflow of secretions.
As already mentioned, the edges of the pessary do not have sharp ends. This form eliminates the likelihood of injury to the internal organs of a woman, and also allows her to feel no discomfort during the period of wearing.
With the correct installation of the ring, a woman should not be hurt in the lower abdomen or in the perineum. If after the procedure no unpleasant sensations are observed, then no other additional manipulations are necessary.
The algorithm for the subsequent actions of a pregnant woman after installing an obstetric pessary is as follows:
- regular examination of the vaginal microflora (optimally - once every 20 days) to prevent the development of an inflammatory disease in the genital tract;
- every month it is necessary to conduct an ultrasound of the cervix to assess its condition;
- every two weeks, a procedure for processing the pessary with an aseptic solution is carried out to prevent the development of colpitis. It is not required to remove the product for processing in advance;
- abstinence from sexual relations while wearing a gynecological ring;
- strict dosage of physical activity.
Each woman, due to her uniqueness, has a different degree of pain perception. That is why reviews of subjective sensations during the installation of the pessary are rather controversial.
To reduce possible pain sensations, it is better to take an antispasmodic 30 minutes before the manipulation. Reception of analgesics is not indicated in this case.
Complications
Statistics show that the appearance of complications after the installation of a gynecological ring is a rather rare occurrence. However, there have been cases when, as a result of a doctor's violation of the technique for carrying out this manipulation, the patient experiences certain complications. For example, if the uterine ring is poorly fixed, then it can move or completely fly off, which can give an impetus to the development of colpitis.
The removal of the pessary earlier than the due date may be associated with damage to the integrity of the membranes before the expected end of gestation, as well as in the case of the development of premature birth. In addition, endometritis can cause the spontaneous removal of the pessary.
In addition to these complications, the negative consequences of improper installation of the gynecological ring can be:
- ulcerative lesion of the vaginal wall;
- bleeding from the genital tract;
- deformation of the walls of the vagina. In difficult cases, a fistula may form between the vagina and the rectum;
- constipation;
- unnatural protrusion of the rectum from the vaginal wall.
The nature of the discharge after the establishment of the pessary
If the procedure for setting the gynecological ring was carried out in compliance with all the rules, then the appearance of any unusual discharge is unlikely. But there are situations when they do appear. It is necessary to immediately inform the gynecologist about the occurrence of uncharacteristic vaginal discharge, for example:
- dark brown;
- bright red;
- yellowish with green blotches;
- profuse watery.
Bloody discharge or "smear" usually appears immediately after setting the ring. Their presence does not always indicate any threatening condition, but you should still notify your doctor about the appearance of such a symptom.
Yellow discharge indicates the presence of an infectious process in the genitourinary system of the patient. This condition requires urgent therapy.
Watery discharge can be a sign of amniotic fluid leaking. Also, this symptom may be a sign that the immunity of a pregnant woman rejects a "foreign object".
When to shoot?
If, after installing the ring, the pregnancy passes without complications, then it is removed at about 37-38 weeks, because after this period the fetus is considered full-term.
In some situations, the gynecologist may decide to remove the gynecological ring earlier than 37-38 weeks of gestation. Such cases include:
- the need for emergency delivery (if there is a real threat to the life or health of the expectant mother);
- development of an infectious process in the patient's reproductive system;
- amnion infection;
- outpouring of amniotic fluid;
- the beginning of labor.
How does it affect?
A pregnant woman who has been recommended by a gynecologist to install a gynecological ring should at least in general terms understand the mechanism of the effect of this device on the body. Because he is able to influence not only the course of pregnancy, but also her psycho-emotional status.
The following is a list of the main mechanisms of influence on the female body of this device, based not only on clinical studies, but also numerous reviews of women who received a pessary during pregnancy:
- Helps reduce stress on the cervix by shifting the intrauterine pressure.
- Optimally distributes fetal pressure on the walls of the uterus, which occurs as a result of its venous-oblique location.
- Thanks to the special fixation of the device (behind), it is possible to achieve a natural sacralization of the cervix.
- The gynecological ring tightly limits the walls of the central opening to the cervix.
- Prevents premature discharge of the mucous plug.
- During the period of wearing the ring, a woman's libido decreases, which to some extent reduces the risk of infection in the genital tract.
- An obstetric pessary reduces the likelihood of developing thrush.
- In most cases, the setting of a gynecological unloading ring helps to stabilize the emotional state of the expectant mother.
Historical reference
To create an obstetric pessary the way it looks in our time, mankind has gone for more than one century. In ancient times, doctors used primitive devices that were in the form of a ring to exclude the prolapse of the pelvic organs.
Even contemporaries of Hippocrates used ring-shaped devices in obstetrics and gynecology.Descriptions of analogs of such items are also found in ancient Egyptian papyri. Later, natural materials such as pomegranate were used as pessaries. To fix the cervix, its empty, cup-shaped half was used. In the early Middle Ages, pessaries, which are a woolen tampon soaked in a medicinal substance, began to be widely used in medicine.
In the 17th century, a ring-shaped obstetric pessary was first used. This invention belongs to the famous scientist of the Renaissance, Ambroise Paré.
Closer to the second half of the 19th century, rubber pessaries began to be used in obstetrics. At the same time, the Khodja pessary was developed, named after its author. This product had an oblong shape, which more closely corresponded to the anatomical shape of the vagina.
In the middle of the last century, it was proposed to replace obstetric rubber pessaries with plastic counterparts. Later, scientists developed gynecological rings made of elastic material - silicone, which was hypoallergenic.
Despite the fact that in recent years in clinical obstetrics there have been a large number of discoveries associated with the development of new methods of treating certain complications arising during pregnancy, there are still disputes regarding the choice of optimal methods of therapy for ischemic-cervical insufficiency and other pathologies. capable of provoking weakness of the cervix.
However, almost all leading experts in this field agree that obstetric pessary is "number 1" in the prevention of spontaneous abortion in women with this diagnosisThis is achieved due to its availability, easy installation and the minimum number of possible side effects.
For more information about the Juno obstetric pessary, see below.
