Sometimes it happens that a normally proceeding pregnancy is suddenly interrupted closer to the middle of the term. There are a great many reasons that provoked this phenomenon, but in this article we will talk about isthmic-cervical insufficiency.
Why does this happen?
To understand the reasons for what is happening, let’s remember our anatomy lessons. The uterus is a hollow muscular organ, which during pregnancy can expand several times and form a cozy container for the developing baby.
The uterus consists of a body and a cervix, the border between them is called the isthmus. The cervix is a cylinder, which is bounded by the internal os on the side of the uterine body, and by the external os on the side of the vagina. The muscle layer of the uterus is much more powerful than the muscles of the cervix.
As a matter of fact, there are only 30% of muscles in the neck, and they are mainly concentrated in the area of the internal pharynx, forming a fairly powerful obturator ring - the sphincter. If the sphincter fully performs its functions, the cervix is able to hold the growing baby in the uterus throughout pregnancy.
Receptors, which are located in large numbers in the uterus and cervix, become more sensitive to the action of hormones closer to childbirth, due to which the muscle ring in the cervix softens, the tissues acquire the ability to stretch, the cervix gradually opens during labor and the baby is born.
Sometimes a condition develops when the cervix and isthmus are not able to support the growing fetus in the uterine cavity until its full functional maturity. This condition is called isthmic-cervical insufficiency.
If we turn to official data, we can find that ICI accounts for about 40% of the structure of abortion in the second trimester, but in the third trimester ICI is found in every third woman with premature birth.
Reasons for the development of the condition
Depending on what caused the development of deficiency, it is divided into organic and functional.
Secondary (organic) ICI is a condition that develops after a traumatic lesion of the cervix. This happens after childbirth, abortion, or other manipulations, for example, after diagnostic curettage. The connective tissue that appears at the site of the rupture cannot contract, and therefore prevents the full closure of the internal pharynx, preventing the sphincter from fully performing its functions.
ICI of a functional nature develops with hormonal disorders. The condition can also occur with a congenitally short cervix, or with excessive pressure on the cervix during multiple pregnancies. The ability of the sphincter to contract is negatively affected by excess androgens in the body of a pregnant woman.
Who is at risk?
There are a number of factors that significantly increase the risk of developing ICI, so women in whom they occur are separated into a separate group and monitored more carefully.
These factors include:
- history of cervical ruptures;
- increased production of male sex hormones by the adrenal glands (hyperandrogenism);
- various malformations of the genital organs
- underdevelopment of the genital organs;
- two or more fetuses in the uterus;
- polyhydramnios, as well as a large fetus.
Development timeframe
Most often, the condition develops in the second trimester of pregnancy (16-27 weeks), less often, especially with multiple pregnancies, the cervix begins to “give up” by 11-12 weeks.
The reason for the development of insufficiency from the 16th week is presumably the beginning of the production of hormones by the fetal adrenal glands, and as a result, the cervix cannot withstand the total effect of a large number of hormones.
But the reason for the development of ICI from 11 weeks is most likely due to increased mechanical pressure on the cervix.
How does it manifest itself?
Most often, when there is a threat of termination of pregnancy, a woman feels alarming symptoms - cramping pain in the lower abdomen, which allows her to react in time and seek help.
Unfortunately, such a clinic is not typical for ICN - the internal os opens gradually, painlessly. At the same time, the woman does not even suspect that her pregnancy is in danger. Particularly careful pregnant women may notice heaviness in the lower abdomen and lumbar region, as well as an increase in mucous discharge from the vagina.
The slightly open cervix exposes the lower pole of the membranes, which, when in contact with the vaginal environment, become infected, lose their strength and protective function and rupture. This entails the rupture of amniotic fluid and the onset of labor.
At the reception
To control the condition of the cervix, a routine examination by a gynecologist of a woman in a gynecological chair is sufficient. Therefore, all pregnant women should visit their personal doctor in a timely manner to limit themselves from unpleasant surprises. According to pregnancy management standards, at certain times a woman’s visit to the antenatal clinic, in addition to measuring the tummy, blood pressure, weight and consultation on test results, should also include a bimanual examination, during which the condition of the cervix is also assessed.
If, after examination, the doctor doubts the good supporting ability of the cervix, he can refer the pregnant woman for an ultrasound, where, using cervicometry, the length of the cervix, the width of the cervical canal, and the diameter of the internal pharynx will be determined.
Treatment
Once a diagnosis of ICI is made, treatment measures must be started immediately.
If ICI develops due to a hormonal imbalance, sometimes the doctor can start by correcting the hormonal levels. The results of treatment become obvious after 1-2 weeks. If there is no effect from conservative treatment, or it initially developed against the background of a traumatic lesion of the cervix, the pregnant woman will be recommended more effective correction methods.
A method that has been used for quite a long time is surgical - circular sutures are placed on the cervix. The method has proven to be effective, low-traumatic and harmless to both the pregnant woman and the developing fetus.
Before the procedure, the pregnant woman is examined; after suturing, for the first 2-3 days, the sutures and vaginal mucosa are treated with an antiseptic solution. After suturing, women should be examined weekly by a gynecologist. The sutures are removed if the pregnancy progresses well at 37-38 weeks. The procedure can be carried out either in a hospital or in a antenatal clinic. Childbirth and the postpartum period in women after surgical correction of ICI proceed the same as in women without ICI.
Strict bed rest is necessary when correcting ICI with a sagging amniotic sac. After such an intervention, the pregnant woman will have to remain in bed for some time and take certain medications.
For such an intervention, as for any surgical procedure, a certain percentage of complications is allowed. Sometimes it is possible to “cut through” the sutures, when the uterus often comes to tone and the threads cut through the tissue. In addition, seams are an excellent place for bacteria to multiply, so constant monitoring of their condition is necessary - taking smears and subsequent sanitization.
Nowadays, experts are increasingly giving preference to the correction of ICI using an unloading pessary - it is a specially designed unloading ring made of biologically inert materials. The structure of the pessary optimally takes into account the anatomical structure of the woman. There are three sizes of pessaries on sale, which allows, with the help of a doctor, to choose the optimal size for each pregnant woman.
The pessary redistributes pressure directly from the cervix to the pelvic floor, the anterior wall of the uterus.
Like sutures, a pessary requires constant monitoring of the flora and periodic sanitation. The pessary is also removed by week 38.
Both surgical sutures and a pessary are applied only after a medical examination in the absence of contraindications.
Correction of ICI does not have a direct effect on the development of the fetus, but after it is carried out, the development of fetoplacental insufficiency, fetal hypoxia is possible, and the risk of infection also increases if the pregnant woman does not follow the recommendations or does not visit the doctor in a timely manner.
ICI is considered the most common cause of abortion in the second trimester, and its frequency in patients with recurrent miscarriage reaches 13–20%. The pathognomonic signs of ICI are painless shortening and subsequent opening of the cervix ending in miscarriage, which in the second trimester of pregnancy leads to prolapse of the amniotic sac and/or rupture of amniotic fluid, and in the third trimester to the birth of a premature baby.
Risk factors for ICI are listed below.
· History of cervical trauma (post-traumatic ICI).
- Damage to the cervix during childbirth [lacerations not repaired surgically, surgical delivery through the birth canal (application of obstetric forceps, delivery of a large fetus, a fetus in the breech presentation, fetal-destroying operations, etc.)].
- Invasive methods of treating cervical pathology (conization, amputation of the cervix).
- Induced abortions, late pregnancy terminations.
· CD of the cervix (congenital ICI).
· Functional disorders (functional ICI) with hyperandrogenism, connective tissue dysplasia, increased levels of relaxin in the blood (noted in multiple pregnancies, induction of ovulation by gonadotropins).
· Increased load on the cervix (polyhydramnios, multiple births, large fetus).
DIAGNOSTICS ICN
It is usually impossible to assess the likelihood of developing ICI before pregnancy. Such an assessment is possible only in post-traumatic ICI, accompanied by gross anatomical disorders. In this situation, hysterosalpingography is performed on days 18–20 of the menstrual cycle to determine the condition of the internal pharynx. Its expansion by more than 6–8 mm is regarded as an unfavorable prognostic sign.
In patients suffering from recurrent miscarriage in the second trimester, during pregnancy weekly or at intervals of 2 weeks, the condition of the cervix should be monitored starting from 12 weeks if post-traumatic ICI is suspected and from 16 weeks if functional ICI is suspected. Monitoring includes examination of the cervix in speculum, if indicated, vaginal examination, ultrasound assessment of the length of the cervix and the condition of the internal os during transvaginal ultrasound.
Up to 20 weeks of pregnancy, the length of the cervix is very variable and cannot serve as a criterion for predicting the occurrence of future premature births. ICI is indicated by the pronounced dynamics of the condition of the cervix in a particular patient (shortening, opening of the internal pharynx).
· Up to 20 weeks of pregnancy, the length of the cervix is very variable and cannot serve as a criterion for diagnosing the occurrence of future premature birth. At a period of 24–28 weeks, the average length of the cervix is 35–45 mm, at a period of 32 weeks or more - 35–30 mm. Shortening of the cervix to 25 mm or less at 20–30 weeks is considered a sign of ICI and in this case surgical correction is necessary. However, the diagnosis of ICI includes not only ultrasound data, but also the results of a vaginal examination (since the cervix must not only be shortened, but also softened).
· Additional diagnostic ultrasound criteria for ICN obtained during examination with a transvaginal sensor (pressure test on the fundus of the uterus, cough test, positional test when the patient stands up) are proposed.
PREPARATION FOR PREGNANCY
Preparing for pregnancy in patients with recurrent miscarriage and ICI should begin with sanitization of the genital tract, normalization of the vaginal microflora and treatment of chronic endometritis. Due to the fact that the obturator function of the cervix is impaired, the risk of infection of the cervical canal and uterine cavity with opportunistic flora and/or other microorganisms (chlamydia, E. coli) is very high. In this case, appropriate therapy is carried out with subsequent assessment of the effectiveness of treatment.
CLINICAL PICTURE (SYMPTOMS) ICI
Clinical manifestations of ICI are nonspecific, manifested by the threat of miscarriage (discomfort in the lower abdomen and lower back, mucous discharge from the vagina, which may be streaked with blood, scanty bloody discharge from the vagina). Sometimes there is a feeling of pressure, fullness, stabbing pain in the vagina. ICI may be asymptomatic.
TREATMENT OF ICI
Treatment of ICI depends on the presence of pregnancy.
· Outside of pregnancy with post-traumatic ICI, in each specific case, together with a gynecologist surgeon, the possibility of cervical plastic surgery is determined. The patient's medical history should be taken into account (number of late pregnancy terminations, ineffectiveness of correction during pregnancy) and the anatomical condition of the cervix uterus. The most common method is Eltsov-Strelkov. The operation does not exclude the possibility of surgical correction of the cervix during pregnancy and determines mandatory delivery through CS surgery due to the risk of rupture of the cervix with transition to the lower uterine segment.
· During pregnancy. It has been shown that suturing the cervix in women with ICI reduces the incidence of preterm birth up to 33 weeks of pregnancy. The period at which surgical correction is performed (from 13 to 27 weeks of pregnancy) is determined individually, depending on the time of onset of symptoms. In this case, the risk of intrauterine infection should be taken into account, which increases after 13–17 weeks due to mechanical descent and prolapse of the membranes.
The indication for surgical treatment is the progression of ICI: change in consistency and shortening of the cervix, gradual increase (“gaping”) of the external pharynx and opening of the internal pharynx.
Contraindications to surgical treatment of ICI in pregnant women are considered to be: diseases and pathological conditions that are a contraindication to continuing pregnancy (severe forms of diseases of the cardiovascular system, liver, kidneys, infectious, mental and genetic diseases), symptoms of threatened miscarriage, congenital malformation of the fetus, NB, III – IV degree of purity of the vaginal flora, the presence of pathogenic microflora in the discharge of the cervical canal. In the last 2 cases, preliminary sanitation of the genital tract is necessary.
At the 17th Congress of the International Federation of Obstetricians and Gynecologists (FI-O), surgical correction of ICI using a circular suture in the area of the internal os using the Shirodkar method was recognized as the most effective for prolonging pregnancy.
The measures required in the postoperative period are given below:
– bacterioscopy of vaginal discharge;
– correction of microbiocenosis;
– if there are signs of myometrial excitability, tocolysis is performed. The drug of choice for tocolysis is hexoprenaline sulfate (ginipral©). Ginipral© 10 mcg (2 ml) is diluted in 10 ml of sodium chloride or glucose solution and administered intravenously slowly. In the future, if necessary, treatment can be continued with infusions or tablets of 0.5 mg 4-6 times a day;
– during subsequent pregnancy management, inspection of the sutures on the cervix is necessary every 2–3 weeks.
Indications for removing sutures from the cervix are listed below:
– gestational age 37 weeks;
– leakage or overflow of fluid, bloody discharge from the uterine cavity, cutting of sutures (formation of a fistula), the onset of regular labor at any stage of pregnancy.
In complex cases, when the vaginal portion of the cervix is so small that suturing transvaginally is impossible (after amputation of the cervix), there is evidence of suturing through a transabdominal laparoscopic approach (about 30 operations have been described during pregnancy).
In recent years, a less traumatic method of correcting ICI using a pessary - a Meyer ring, placed on the cervix, has become widespread in clinical practice.
Pregnancy is the most wonderful, but at the same time the most worrying time in the life of every woman. On the path to successful childbirth and happy motherhood, there are many obstacles that can provoke in the early stages.
One of these factors is ICI (isthmic-cervical insufficiency) - a pathological condition in which the muscles of the cervix are so weakened that they are unable to cope with the increasing load.
In order to avoid complications or death during pregnancy, every woman needs to know what ICI is and whether it is possible to prevent this pathology.
Definition
To understand why isthmic-cervical insufficiency (ICI) is dangerous, you need to know how the uterus works. The uterus is an organ that has a body and a cervix.
The fetus develops in the body, and the cervix helps keep it inside the cavity and protects it from infection.
The muscles of the cervix close during pregnancy and gradually relax towards childbirth. However, sometimes they relax earlier, then the cervix becomes unable to hold the fetus inside the uterus and opens under the pressure of the baby’s weight.
This is ICI - a condition when the muscles of the cervix weaken ahead of time.
At the same time, the amniotic sac descends into the uterine cavity, the membranes are at risk of infection, open, and contractions begin. This can lead to miscarriage or premature birth - if labor begins in the third trimester.
Important! As a rule, a miscarriage with isthmic-cervical insufficiency begins with leakage of amniotic fluid or its discharge. However, it is painless.
ICI is a rare phenomenon, occurring in 1-9% of pregnant women, but women with so-called recurrent miscarriage - when a woman has three or more miscarriages in a row - are at greater risk. Mothers with this diagnosis face isthmic-cervical insufficiency in 15-42% of cases.
Reasons
Depending on the causes of its occurrence, ICI occurs in two types: functional and traumatic (anatomical).
Traumatic ICI occurs in cases where, even before pregnancy, the cervix was “compromised” by some damaging factors.
Functional causes arise against the background of an increase in the level of the male hormone - androgen.
It is known that the female vagina is populated by a mass of bacteria, and with colpitis (an inflammatory process in the vagina), the number of these microorganisms increases significantly. This circumstance plays an important role in cases of existing isthmic-cervical insufficiency.
When the cervix shortens and opens slightly, the fertilized egg (lower pole) becomes infected, the membranes become soft, losing their strength and the amniotic fluid contained in them is poured out.
Most often, cervical insufficiency develops due to anatomical and functional factors.
Anatomical
Pathological changes in the internal os occur due to traumatic injuries in the cervix. Typically this happens due to:
- induced medical abortions;
- intrauterine diagnostic studies;
- birth injuries (cervical ruptures).
After any traumatic damage to the cervical canal, scar tissue forms, which subsequently leads to cervical incompetence during pregnancy.
Doctors believe that with various intrauterine interventions prior to pregnancy associated with the expansion of the uterine cervix, the integrity of the muscle ring (sphincter) can be damaged. At the site of such damage, a scar of connective tissue is formed, which is not capable of either contraction or stretching.
Intervention in this situation means such manipulations as, for example, diagnostic curettage, medical abortions, etc. In addition, the growth of connective tissue instead of muscle can occur after fairly deep ruptures of the uterine cervix, during previous delivery.
One of the possible damaging factors is also considered to be previous inflammatory processes affecting the cervix: cervicitis, endocervicitis, endocervicosis, colpitis, and so on.
The development of isthmic-cervical insufficiency can also be provoked by previous or existing cervical dysplasia (erosions) (including after treatment).
Functional
Nervous regulation ensures the consistency of contraction and relaxation of the uterine muscles: a prolonged increase in the tone of the uterus leads to relaxation of the cervix, and when it is in a calm state, the internal and external pharynx are always closed. Inconsistency of innervation can cause ICI, and these situations arise with the following problems:
- hyperandrogenism;
- malformations or underdevelopment of the uterus;
- a pronounced decrease in hormonal activity of the ovaries.
In addition, the viability of the cervix is negatively affected by infection in the vagina (specific or banal colpitis, bacterial vaginosis, candidiasis) and pressure from the presenting part of the fetus.
The causes of functional ICI are most often hormonal disorders of the body, usually occurring with an excess of androgens or a lack of progesterone.
Functional ICI usually manifests itself between eleven and twenty-seven weeks of pregnancy. At this stage of intrauterine development, the adrenal glands begin to work in the growing fetus - an endocrine organ that, among other hormones, secretes androgens.
If this additional volume of male sex hormones falls on the “fertile soil” of a woman’s already existing even slightly increased own level of androgens (or the pregnant woman has hypersensitivity to them), then under their influence the cervix softens and, as in childbirth, shortens and opens.
What’s interesting is that uterine hypertonicity is most often not observed, so a woman who does not visit a gynecologist may not be aware of the presence of ICI.
Symptoms and diagnosis
Unfortunately, this disease occurs without any obvious symptoms. Sometimes a woman is bothered by a pulling sensation in the lower abdomen, abundant mucous membranes streaked with blood, or spotting bloody discharge from the vagina.
Some pregnant women report slight tingling in the vaginal area, bloating or pressure. And many people don’t notice anything at all.
It is impossible to detect the disease on your own, at home. Moreover, even timely visits to the doctor will do nothing if the woman is not regularly examined in the chair. Doctors pay special attention to those patients who have previously been diagnosed with ICI - during previous pregnancies.
Important! If a previous miscarriage had symptoms similar to ICI, you should tell your doctor about it at the first appointment.
In the future, when isthmic-cervical insufficiency has already developed, symptoms such as spotting, pain in the lower back or lower abdomen, and a feeling of pressure in the vagina can be detected. These are signs of a threatened miscarriage. It is important to remember: ICI can be completely asymptomatic.
Often, a doctor may not diagnose isthmic-cervical insufficiency immediately, since usually a woman does not present any complaints. Typically, the disorder is detected only when examining the expectant mother in a chair and using an ultrasound:
- Inspection on the chair. The gynecologist examines the cervix and evaluates its length and consistency, whether it is slightly open, whether the fingertip is missing, or whether there are scars on it. If a woman may experience traumatic ICI due to previous problems, then the doctor should monitor the condition of the cervix every week or once every two weeks starting from the 12th week of pregnancy.
- On ultrasound. When examined in a chair, the doctor cannot always estimate the length of the cervix in centimeters, so if he has an assumption that the pregnancy will be complicated by ICI, the specialist sends the expectant mother for an ultrasound. This study is carried out starting from the first trimester of pregnancy. Shortening of the neck to 2-2.5 cm indicates a violation and requires surgical treatment.
The doctor determines the ICI by examination with mirrors, digital examination of the vagina, or ultrasound. It can detect shortening of the cervix, its softening, and dilatation.
The obstetrician-gynecologist can also perform a test - for example, ask the pregnant woman to cough or press on the fundus of the uterus. With isthmic-cervical insufficiency, the cervix may open slightly under such influences. An ultrasound is performed using a vaginal sensor - the length of the cervix is less than two centimeters and the diameter is more than one centimeter - alarming symptoms.
If all studies confirm the development of ICI, the doctor makes a decision on treatment methods and the possibility of continuing the pregnancy.
During the first examination in the first trimester of pregnancy, the doctor must assess the condition of the cervix - length, density, location, condition of the external os. Normally, the cervix should be dense and long (up to 4 cm), with a closed external os.
During the first ultrasound examination at 11-14 weeks, the doctor must perform cervicometry, i.e. assess the length and consistency of the cervix.
If the doctor notices a discrepancy, for example, it seems too short, or if the woman has already had premature birth in the past, as well as miscarriages or abortions, the doctor will order regular examinations every two weeks to carefully monitor the condition of the cervix.
The danger of ICN also lies in the fact that a pregnant woman may not notice the bad changes that are occurring in her body. The uterine os can open painlessly.
Sometimes there are minor nagging pains and very scanty bleeding. The first suspicion of cervical incompetence will arise during a doctor's examination or ultrasound.
For those women who are pregnant for the first time, the length of the cervix, detected using ultrasound cervicometry, should not fall below 30 mm. The optimal length of the cervical canal will be from 36 to 40 mm.
Important! If, during cervicometry, the doctor finds a cervical size of 29 mm or lower, then treatment is necessary to maintain the pregnancy.
Treatment
Once a deficiency is detected, usually in the case of a large amount of hormones, doctors try to correct the situation through various medications. If the excess is traumatic in nature, then surgical intervention is possible.
Then follows a long process of healing and caring for the sutures, since during this period bacteria can accumulate on the sutures on the uterus, and an infectious process can form.
Conservative
The first and main conditions for successful treatment of isthmic-cervical insufficiency are bed rest and emotional peace. In the first case, the pressure of the amniotic sac on the cervix is reduced due to the horizontal position of the expectant mother, and dilatation is suspended.
Well, in the second case, it is important not only the absence of stress, but also the positive attitude of the pregnant woman. Then the treatment will give positive results.
If the cause of isthmic-cervical insufficiency is functional and the disease develops due to an excess of hormones, especially androgens, drugs are prescribed that reduce this indicator and correct the level of hormones in the pregnant woman’s body.
After one or two weeks, the doctor examines the patient again - if the condition of the cervix is stable, then treatment is stopped, and the woman is simply observed throughout the pregnancy, paying special attention to the cervix. The doctor should regularly examine the cervix to detect the slightest changes in time.
Sometimes patients may have a Meyer ring - a pessary - placed in the vagina. The ring helps to redistribute the weight of the fetus, and the neck helps to hold it.
A plastic pessary is installed in the early stages of the disease or if cervical insufficiency is suspected. It is removed at 37 weeks or before birth.
Installation of a pessary is a painless procedure, so no anesthesia is required. If the ring is chosen correctly, the expectant mother will not feel it at all.
In order to improve the results, along with the placement of the ring, drugs that relax the uterus are prescribed, hormonal agents are prescribed to correct the general hormonal levels in case of hyperandrogenism, and placental insufficiency is also prevented (since it is often found in ICI).
A pregnant woman is recommended to sanitize the vagina with antiseptics or, if necessary, prescribe antibiotics. This is done so that dysbiosis does not develop, which can be caused by the presence of a foreign body in the vagina.
There are several important points to be aware of:
- Firstly, since the pessary is a foreign body in the vagina, the risk of infection increases, and to monitor the situation, the expectant mother will need to undergo a smear every 2-3 weeks.
- Secondly, after placing the ring, vaginal sex is prohibited.
The pessary, like sutures, is removed during full-term pregnancy or at the onset of labor. This procedure is completely painless.
Surgical
If drug treatment does not help or the isthmic-cervical insufficiency has a traumatic cause, the doctor decides on a surgical treatment method. The operation involves suturing the cervix and is performed under anesthesia. At the same time, such a dosage and drugs are chosen to minimize the negative impact of anesthesia on the child.
The optimal time for surgery is 13-17 weeks, but if necessary, the doctor can suggest surgical correction up to 28 weeks.
The method of applying a U-shaped or circular suture to the cervix, closing the exit from the uterus, is used. Indications for surgical correction of ICI are:
- the presence of two or more premature terminations of pregnancy in the 2nd trimester in the past;
- cervical length detected by ultrasound cervicometry is 20 mm or less;
- muscle incompetence in the cervical area discovered before pregnancy.
With such indications, the woman will be “sutured in” and she will most likely carry the pregnancy safely to 37 weeks (at this time the suture is removed).
The operation is most effective when the impact of the disease on the cervix is not yet so great. Non-absorbable sutures are placed on the cervix, which are removed by the 38th week of pregnancy, that is, at the moment when labor suddenly begins is not scary - the baby is full-term.
Before the sutures are removed, they are examined every two weeks. After the sutures are removed, if there are complications, additional treatment is carried out.
Sutures can be removed earlier for several reasons: cutting through the sutures, rupture or leakage of amniotic fluid, the onset of labor, bleeding.
There are times when correction is necessary. This happens if the doctor, during an examination, finds a fertilized sac in the cervix. If the uterus often tenses, cutting of sutures may develop. To prevent this from happening, the pregnant woman is prescribed drugs that reduce the tone of the uterus - Magnesia, Ginipral, Papaverine.
If correction is not possible, then the doctor prescribes bed rest and long-term use of tocolytics.
Surgery also has its contraindications. These are serious illnesses, non-developing pregnancy, congenital pathologies of the fetus, placenta previa.
In addition, the operation is performed under certain conditions: if the gestational age is at least 25 weeks, the amniotic sac is intact, the fetus is alive and has no malformations, and the tone of the uterus is normal.
The situation becomes much more complicated if the expectant mother has contraindications to this procedure.
- in the presence of acute vaginal infection;
- if the fetus has congenital malformations that are a contraindication to continuing the pregnancy;
- serious and dangerous diseases in a pregnant woman, during which pregnancy and childbirth cannot be carried out;
- the presence of uterine bleeding of any intensity.
Childbirth with ICN
Due to the fact that this deficiency is characterized by the inability of the muscle ring to be in a closed state, childbirth with such complications occurs very quickly. Modern possibilities make it possible to deliver the baby to the patient until the required term.
This is precisely why a hospital is needed, which allows for constant monitoring and does not provide opportunities for premature birth, which increases the possibility of miscarriage.
Unfortunately, this does not always work out. In case of early birth, the mother must be at the maternity hospital on time and have a folder with documents, a policy passport and an exchange card. It is very important not to forget the last element, because it contains the necessary information that obstetricians require in order to understand the situation in order to correctly deliver the child without complications.
Street notes that ICI is an infrequent occurrence, and if it is detected, there is no need to panic. After all, modern medicine makes it possible to cope with this pathology without any problems, especially with a timely diagnosis.
It is important not to be nervous and to comply with all the doctor’s requirements. Accept that you will have some physical changes that will be uncomfortable.
It is very important to control your diet when dealing with stress.
If you feel signs of neurosis, then try to dilute your diet with vegetables and fruits, without using special heat treatment. Timely rest is very useful in the fight against the mental influence of ICN.
Do not forget to sleep well, and we also recommend reading good books. Sometimes you can walk in the fresh air, which will reduce the percentage of stress, but you don’t need to strain yourself for too long.
Remember that your psychological mood will play a very important role. Charge yourself with optimism, faith in the right outcome.
Fortunately, ICI does not appear so often, and if you are not at risk, then most likely this pathology will not affect you. However, you should not be discouraged when you discover it.
Modern medicine has learned to deal with such a serious disease. The most important condition here is the unquestioning implementation of medical recommendations. In addition, give up additional physical activity and lie down more.
Leave household chores in the care of your family and friends. You should not ignore taking the necessary medications that will help solve this problem as quickly as possible.
Rehabilitation
After surgery, many questions arise. For example, is it possible for a woman to give birth on her own after such an operation or is this a direct indication for a cesarean section? How will the future health of the female organ develop?
After surgery, as a rule, women give birth on their own, after the stitches are removed. ICI is not an indicator of the need for a cesarean section. The postpartum period proceeds in the same way as for other women in labor.
During and after treatment for isthmic-cervical insufficiency, the expectant mother must follow a regimen: reduce physical activity, avoid stress, visit a doctor, take prescribed medications in a timely manner, and get more rest.
When treating ICI, it is important not only to carry out therapy, but also to prolong pregnancy as much as possible.
A baby who is born to a mother diagnosed with “isthmic-cervical insufficiency” needs examination immediately after birth. And for some time afterward, the child should be observed and promptly examined in order to identify possible intrauterine infection, which could have occurred due to the fact that the cervix was slightly open.
A woman in labor with isthmic-cervical insufficiency is advised to wait a couple of years for her next pregnancy, and before planning it, she needs to undergo the necessary studies and examinations to eliminate the risk of relapse. Women with functional ICI are usually given appropriate therapy before their next pregnancy.
Important! Don't shy away from regular doctor's checkups. If your OB/GYN doesn't offer you such an exam, insist on having it done.
No matter how doctors correct the ICI, the expectant mother with this problem must adhere to the following rules:
- Minimize physical activity: stop playing sports, yoga, etc. You should rest more and, if possible, delegate household chores to loved ones.
- Avoid sexual contact. Like physical activity, this can provoke unwanted changes during pregnancy, so it is better to abstain until the baby is born.
- Do not lift weights - even if it is an older child. Any physical activity can harm the fetus or cause a miscarriage, so before giving birth and for the first time after it, you must avoid any exercise.
- Avoid stress. Equally important is a positive psychological attitude and belief in success.
- Visit your gynecologist regularly. Remember to take all your prescribed medications on time. At the slightest deterioration in your health, you should immediately go to your doctor. Your health and the birth of your child depend on this.
Pregnancy is a period when it is better to play it safe. Well, if you are nevertheless given an unpleasant - nothing more - diagnosis, follow all the doctor’s prescriptions and look forward with optimism.
Prevention
The best prevention of ICI is avoidance of medical abortions. In some cases, even a single artificial termination of pregnancy can cause cervical canal incompetence.
In order for the pregnancy to go well, it is necessary to carry out pre-conception preparation and prepare for it.
To prevent isthmic-cervical insufficiency it is important:
- pregnancy planning (careful adherence to contraception, since every surgical abortion injures the cervix);
- register with the antenatal clinic (up to 12 weeks) - it is on the chair that the doctor diagnoses ICN, the woman herself may not even be aware of it;
- regularly visit an obstetrician-gynecologist according to the schedule - this way the specialist will be able to monitor the condition of the cervix - the occurrence of ICI or the rate of opening of the cervix, if this disorder already exists.
If a miscarriage occurred during a previous pregnancy due to ICN, then you must prepare in advance for the next conception and gestation. If menstruation is delayed and the test is positive, you should immediately begin treatment prescribed by your doctor to help maintain the integrity of the cervix.
ICI occurs quite often - in almost every tenth woman (according to statistics in 9-10% of cases) in the first pregnancy and much more often with repeated ones. Moreover, the more births a woman has had, the greater the likelihood of isthmic-cervical insufficiency during subsequent pregnancy.
Regular assessment of cervical length using ultrasound cervicometry will be mandatory. When shortening begins, surgical intervention will be required to maintain and carry the pregnancy to term.