Short cervix during pregnancy
- What to do if the cervix during pregnancy was short?
No woman wants her pregnancy to be overshadowed by the occurrence of any complications, especially the threat of miscarriage or premature birth. But, unfortunately, this happens, and many different reasons may contribute to this. One such reason may be a short cervix.
What is dangerous short cervix?
– This is the lower narrowed rounded part of the uterus, which connects to the vagina. Normally, its length is about one-third of the total length of the uterus, from about 3 to 4 cm. But in some cases it can be short, reaching only 2 or even less than centimeters.
Short cervix can cause the development of so-called isthmic-cervical insufficiency (ICN). This condition is characterized by the physiological impossibility of the cervix to keep the constantly growing fetus in the cavity. Under pressure from the baby, the neck begins to shorten and open up even more, which can lead to miscarriage or premature birth.
Information The deformed and shortened cervix of the uterus is not only unable to keep the baby in the cavity, but is also unable to protect it from infections. And during the period of childbirth can serve their rapid course, and as a result, cause the ruptures of the perineum and vagina.
- , short cervix may be a congenital, genetically determined feature of the anatomical structure of the genital organs;
- , it can be shortened against the background of hormonal changes in the body during pregnancy (this becomes especially noticeable in the second trimester of pregnancy);
- , deformations and shortening of the cervix contribute to earlier abortions, curettage of the uterus and childbirth.
Premature birth – miscarriage – obstetric pessary – uterine ring
Examination and Diagnosis
The fact that the cervix is shortened, an obstetrician-gynecologist may be suspected already at the first vaginal examination of a woman. But usually such a diagnosis is made after the transvaginal ultrasound examination or during the second planned ultrasound in the period of 18-22 weeks of pregnancy.
What to do if the cervix during pregnancy was short?
Additionally If you knew about this problem from the very beginning, that is, you have an inborn feature or this has already happened in previous pregnancies, then the most correct solution would be constant supervision by a specialist, respect for peace and respect for yourself.
It is recommended to observe that the uterus during pregnancy is not in good shape, as this provokes the maturation of the cervix, its shortening and opening. It is best to limit physical exertion and resort to wearing a bandage.
If shortening of the cervix is found during pregnancy, that is, hormonal disorders become the cause, then depending on the gestational age and whether there is a discovery, corrective treatment of this condition is offered to the woman.
Actually, there are two methods of treatment: – stitching (overlap up to 27 weeks) and – the use of obstetric pessary (when there is no significant shortening, but there is a threat to the development of ICN).
One of the most common mistakes of women is the fear of these procedures, unwillingness to play it safe and distrust of the doctor. If you have doubts and have a desire to visit another specialist, then it is better to do so. But remember that treating a shortened cervix is not just a reinsurance – it is a necessity that will eliminate the threat of premature birth, will help make and give birth to a healthy baby just in time.
Short cervix during pregnancy
Shortly before the onset of labor, the entire body of a woman begins active preparation for the work ahead. Among other things, there are changes with the cervix: it softens and shortens, starting to open before the birth to miss the baby. But in some cases, these processes are observed long before the hour allotted to them.
Short uterine cervix during pregnancy may be a congenital physiological feature of the female body or occur under the influence of various factors. But regardless of the cause, it poses a threat to carrying the child: the short neck is not able to keep the growing and heavy fetus in the womb and opens up under its weight, due to which a miscarriage or premature birth occurs.
Short cervix during pregnancy: how to recognize?
The normal average length of the cervix is 4 (from 3 to 5 cm). A cervix with a length of less than 2.5-2 cm is considered short. Such a physiological symptom in medicine refers to the symptoms of isthmic-cervical insufficiency (ICN) – a condition in which the cervix softens and opens, which is why it cannot withstand intrauterine pressure and keep the fetus in the uterus. It is always associated with the threat of miscarriage, and therefore may be accompanied by increased uterine tone or bloody discharge from the vagina, although it often occurs without these signs.
The fact that she has a short cervix, a woman may not even suspect. The diagnosis of ICN is usually made during an examination on a gynecological chair or an ultrasound examination with an intravaginal sensor. The ICN is detected approximately in the second trimester, when the fetus begins to actively gain weight, due to which the pressure of the fetal bladder on the cervix increases.
The shortening of the cervix can be congenital, but can also be the result of such processes and disorders:
- surgical interventions in the area of the cervix (due to the formation of scarring, the neck is shortened);
- injuries due to previous births;
- hormonal fluctuations in the body of a woman (during pregnancy, the concentration of androgens may increase above the normal, which affects the formation of ICN).
Also, experts highlight the aggravating factors:
- large fruit;
- carrying multiple pregnancies.
What is dangerous short cervix during pregnancy
The greatest danger with a short cervix during pregnancy is the emerging threat of its termination. Due to the insufficient length of the cervix (less than 2 cm) and the excessive width of its external os, (more than 1 cm), the cervix is not able to hold the fetus, due to which its premature disclosure occurs.
If isthmic-cervical insufficiency is not detected on time and if the necessary measures are not taken, either miscarriage will occur, or childbirth will begin early.
Immediately during childbirth, there is a threat of their rapid course (and, hence, ruptures, injuries and other complications). In addition, the risk of infection in the womb during such pregnancy increases, because the short cervix is not able to properly protect the fetus from pathogenic microorganisms.
Cervical shortening during pregnancy
A pregnant woman in our time should calmly take in the news about the pathologies and deviations of the childbearing. Firstly, modern medicine has tremendous possibilities and methods of treatment, and secondly, excessive nervousness can only harm the condition of the woman and the fetus. So, let’s talk about shortening the cervix during pregnancy. Why does it arise, what threatens and what doctors usually undertake in such a situation.
Cervix and pregnancy
When doctors talk about a short cervix during pregnancy, with confirmation of the diagnosis by research results, this can be a symptom of isthmic-cervical insufficiency (ICN). She, in turn, is the cause of self-abortion and preterm birth. The diagnosis of cervical insufficiency means that the cervix and isthmus cannot cope with the ever-increasing load of fetal pressure and amniotic fluid. This phenomenon leads to early cervical dilatation. Recall that the neck and isthmus are part of the birth canal of a woman. Sometimes the neck is naturally short in nature. And often the shortening of the cervix in a woman occurs as a result of various types of intrauterine interventions associated with its expansion. This may be abortion, scraping, previous childbirth with trauma to the cervical muscle ring. At the site of injury, scars appear, the ability of the muscles to stretch and contraction is impaired – and the neck is shortened.
Read also cervical dilatation
Why during pregnancy shorten the cervix?
The shortening of the cervix during pregnancy can be caused by hormonal disorders. As a rule, this occurs on the period from 11 to 27 weeks of pregnancy, and most often from 16 weeks. At this time, the child develops activity of the adrenal glands. They secrete androgens – hormones that trigger the development of cervical shortening. Under their influence, the cervix softens, shortens and opens. A pregnant woman herself may not suspect that her ICN is being formed. After all, the tone of the uterus at the same time can be normal.
Usually, the ICN is diagnosed by the doctor during the examination of the woman on the gynecological chair. Confirm the diagnosis using vaginal ultrasound. When the length of the cervix is less than 2 cm, and the diameter of the internal pharynx is more than 1 cm, it is possible to state the signs of ICN.
If the cervix is shortened during pregnancy, this is a reason for close monitoring by a gynecologist. When this problem is caused by an excess of androgens, dexamethasone is usually prescribed treatment. Also used for the treatment of drugs that relax the smooth muscles of the uterus, sedatives, vitamins. Usually, after several weeks of such therapy, the condition of the cervix is stabilized. Otherwise, make a surgical correction. This means that the seams are stitched to the neck. As a rule, such a procedure is done up to 28 weeks of pregnancy. Another way to correct the problem is an obstetric pessary, that is, a special device that holds the uterus in the correct position and reduces the pressure of fetal water on the neck. This treatment option is acceptable after 28 weeks of gestation.
What is dangerous short cervix during childbirth?
If the shortening of the cervix occurs immediately before delivery, this is considered a normal preparatory process. However, a short cervix during labor can be a factor in the onset of rapid delivery. They, in turn, are fraught with ruptures of the cervix and vagina.
Medical statistics suggest that cervical shortening during pregnancy may be the norm for women whose birth is not the first.
In order to avoid the negative impact of cervical shortening on childbirth, a pregnant woman must constantly and strictly observe the doctor’s prescriptions, undergo medical examinations in time and visit the gynecologist at the time indicated to her.
Short cervix: the causes of pathology and its elimination
The greatest danger that awaits a woman during pregnancy is the threat of her interruption or premature birth. And from the physiological and psychological side, this problem for the woman becomes one of the most significant.
That is why any pregnancy should take place under the strict supervision of a physician who is able to suspect the threat of miscarriage or premature birth, as well as, if necessary, take measures to preserve the pregnancy. One of the common causes of miscarriage or transient preterm labor is a short cervix.
In the presence of this pathology, a woman may be unable to bear the fetus and give birth to a child without medical intervention.
Short neck. The physiological side of the issue
The isthmus and cervix is the first section of the birth canal. The neck has the shape of a truncated cone or cylinder, 70% consists of connective tissue, and 30% consists of muscles. The muscles of the cervix are located closer to the body of the uterus and form the so-called sphincter – the muscular ring, which keeps the cervix in the closed state, and opens during the birth process, which becomes the beginning of the last phase of labor. The normal cervix with all its divisions is approximately 40 mm long.
By the end of pregnancy, when preparing the body for childbirth, the cervix shortens, its internal pharynx expands and childbirth occurs. For various reasons, this process may begin earlier. In this case, there is ICN – cervical insufficiency. This condition is characterized by premature shortening of the cervix and softening of the sphincter, as a result of which the opening of the first section of the birth canal and preterm labor can occur.
If the cervix in the first and second trimesters of pregnancy is shortened to 20-30 mm – this is a signal of the presence of ICN – a condition in which the risk of miscarriage increases several times.
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Short cervix: causes of pathology
Cervical insufficiency may be congenital or acquired. In the first case, the pathological condition is associated with individual features of the structure of the body, as well as genetic predisposition.
Congenital form may be detected during a gynecological examination or ultrasound of the pelvic organs of a woman before the first pregnancy. If it is present, pregnancy can be complicated, so when a child is born, a woman should carefully monitor her state of health, eliminate the maximum possible amount of physical activity and ensure rest, and also regularly visit a doctor.
However, even in the absence of congenital abnormalities, the cervix can shorten even before pregnancy. The reason for this may be complicated by previous ruptures, spontaneous and medical abortions, surgical intervention into the uterine cavity, diagnostic curettage, conization and many other factors one way or another associated with dilation or injury of the cervix.
As a result, scars may form on its muscular walls, the cervix deforms, becomes incapable of normal stretching and shortens. There is also a quite physiological reason for the shortening of the cervix during pregnancy. At 10-21 weeks of obstetric period, the fetus begins to produce its own hormones, in particular androgens, which are necessary for normal labor.
If by that time the androgens are abundant in the maternal organism, there is a gradual premature preparation for childbirth: shortening of the cervix and opening of the internal pharynx, which leads to the risk of premature birth.
How to keep a pregnancy with a short cervix?
The shortening of the cervix may be suspected by the doctor during a gynecological examination and confirmed by an ultrasound specialist during an intravaginal examination. When a pathology is detected, a series of studies is assigned to determine the cause of its development, one of which is obligatory among which is a blood test for hormone levels.
If the cervix shortens against the background of an excess of hormones, then it is often possible to stabilize the condition by prescribing hormonal therapy. A pregnant woman with a shortened cervix is given rest and bed rest, wearing a prenatal bandage. In some cases, the patient is offered preservation of pregnancy in the hospital.
Progressive shortening of the cervix despite bed rest and the absence of physical exertion requires taking measures to preserve pregnancy. In this case, it may be recommended to install on the cervix obstetric pessary – a special polymer device like a ring that supports the uterus in a physiologically normal position, reduces fetal pressure on the cervix and prevents further shortening and opening of the cervix.
If the condition is critical, that is, the length of the cervix is less than 20 mm and the opening of the pharynx is observed more than 10 mm, the doctor may recommend a surgical correction of the cervix by imposing a cervical cercleum. The procedure involves suturing certain areas of the cervix. Stitches impose no later than 27 weeks of pregnancy in a stationary mode when using anesthesia and under the control of ultrasound.
Cervical cerclage is removed at the beginning of labor: during contractions, discharge of water, or the beginning of birth bleeding. If the delivery does not begin before 38 weeks, the sutures are removed as planned, and with a planned caesarean section, they may not be removed at all. A shortened cervix is not a sentence for a pregnant woman. In most cases, the situation is reparable, so that a woman can safely bear and give birth to a child without any special consequences for her body.
The main thing is to detect pathology in time and take measures, as well as lead a quiet lifestyle, rest more often, reduce physical exertion and wear a prenatal bandage, which reduces the pressure of the amniotic bubble on the internal cervix.
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- 4 What if a short cervix during pregnancy?
What is the cervix?
The cervix is the lower segment of the uterus, in the center of which is the cervical canal, where one end opens into the uterine cavity and the other into the vagina. The average length of the cervix is 3.5-4.5 cm, and the diameter is not more than 2.5-3 cm.
In the middle of the cervix is the cervical canal, which is blocked by mucus. In normal condition, mucus does not let in microbes or spermatozoa, except in the middle of the menstrual cycle, when mucus is thinned in order to skip spermatozoa for fertilization. The surface of the cervix outside pinkish hue, smooth, transparent and shiny, and inside – friable, velvety bright pink color. When examining a doctor, he always examines the vaginal part of the cervix with a special optical device – a colposcope.
What happens to the cervix during pregnancy?
After conception, this organ begins to change gradually. Immediately after fertilization, the cervix begins to change color: it becomes bluish. This is due to the fact that the blood supply of this organ increases and an extensive vascular grid appears, while the glands of the cervix become more dilated and branched. Throughout pregnancy, there is a significant softening of the tissues and an increase in the cervix, which indicates readiness for the birth of a child. In the last month, the uterine cervix shortens to 12–15 mm and is located in the center of the pelvis. By the way the cervical canal is opened, the gynecologist determines the moment of onset of labor, which begins after the expansion of the internal os and the first contractions.
Short cervix during pregnancy
As mentioned above, in most women the length of the cervix is from 3.5 to 4.5 cm. But in some cases it is shortened or very short. Such a diagnosis is made when the length of the cervix is 2.5 or less centimeters.
The short cervix may be congenital, but in most cases it is an acquired symptom. During pregnancy, the cervix may diminish during hormonal changes. Most often, changes in size are observed between the 14th and 18th week of pregnancy. Also, the size of the cervix may be reduced after mechanical damage caused during intrauterine devices, such as: pre-pregnancy, abortion and curettage. During mechanical damage, scars are formed, as a result of which the neck loses the ability to stretch, gradually deformed and shortened.
A short cervix during pregnancy is the first sign of the physical inability of the uterus to hold the fetus inside it. Since the gradually growing fetus constantly puts pressure on the cervix, this leads to early disclosure, and in such cases miscarriage may occur or preterm labor may begin. If a woman still manages to fully carry out the child, then the small size of the cervix can lead to difficult and painful tears. In addition, the short cervix does not properly protect the fetus from vaginal infections, which significantly increases the risk of infection of the fetus by any infection.
What to do if a short cervix during pregnancy?
If the doctor has identified such a pathology in a woman as a short cervix during pregnancy, the treatment of which is in any case necessary, the first thing to do is to start a bed rest and take a closer look. Most likely, a woman will have to go to the hospital so that the doctor can examine her condition in more detail, observe her and, if necessary, prevent possible consequences that may arise from this pathology.
In cases where there is a short cervix caused by hormonal disorders of the ICN, the doctor usually prescribes special medications that make the size of the cervix normal.
If there is a more critical situation, cervical cerclage is most often performed for a pregnant woman. This is a method that helps prevent miscarriage or premature labor. It involves surgery, during which the doctor stitches the cervix so that it is kept well in the closed position and the probability of its premature opening and rupture of the membranes was minimal. The period at which suturing of the cervix occurs is determined individually, depending on the symptoms. At the same time, it is necessary to take into account the fact that after 15-16 weeks the risk of intrauterine infection increases due to mechanical lowering and breakdown of the fetal bladder. The operation is performed under general anesthesia for 15–20 minutes.
In cases where the doctor does not see the need for suturing the cervix, he most often recommends wearing an obstetric unloading pessary. This is a mechanical special device that is used to support the uterus, rectum and bladder.
Obstetric pessary is a product in the form of rings of different diameters that are interconnected, which, in essence, has the name “ring”. It is made of elastic biologically pure material, all the edges of which are perfectly smoothed and therefore do not injure the fabric.
The pessary is inserted by the doctor into the vagina and holds the cervix, while not allowing it to open up. Its main function is to redistribute the load and reduce the pressure of the fetus on the cervix. In cases of threatened miscarriage or an increased risk of preterm birth, the pessary helps to keep the pregnancy or prolong it.
Setting the pessary, of course, the procedure is not very pleasant, but very quick and rarely causes pain in pregnant women during the production. Also note that before the introduction of the ring into the vagina, you must first cure all infections that occur during pregnancy, if any.
The pessary is inserted only when the bladder is empty. The whole procedure usually takes no more than 20 minutes: the gynecologist treats the ring with a special ointment or gel (glycerin or clotrimazole is most often used) and injects it gently into the vagina of a pregnant woman. A pessary can be of several sizes and the correct size helps the doctor to establish the ring as accurately and physiologically as possible.
To determine the size of the pessary, there is a special table: