What happens to the cervix
Normally, the cervix remains tight and closed almost until the end of pregnancy, retaining the fertilized egg and protecting it from ascending infection. With isthmic-cervical insufficiency, the muscle ring in the area of the internal os cannot cope with the load: the canal opens, the amniotic sac descends, the membranes become vulnerable to infection and are easily opened. The process is gradual and painless, so it is almost impossible to notice without measuring the length of the neck. The earlier shortening begins, the higher the risk of pregnancy loss.
- The cervix loses its ability to bear the load
- Shortening and opening of the internal pharynx
- Prolapse of membranes
- Increased risk of ascending infection
- Rupture of membranes and premature birth
- All this is usually without contractions and pain
Causes and risk factors
There are traumatic and functional forms. Traumatic is associated with damage to the cervix: ruptures in previous births, expansion of the canal during curettage, conization and other operations on the cervix. Functional is determined by the structural features of tissues, hormonal influences and increased load - with multiple pregnancies and polyhydramnios. Congenital anomalies and connective tissue dysplasia are taken into account separately. The most significant risk factor is a late miscarriage or very early premature birth in the past.
- Late miscarriage or premature birth in the past
- Cervical ruptures in previous births
- Conization and cervical surgery
- Repeated curettage
- Multiple pregnancy and polyhydramnios
- Congenital structural features of the cervix
- Connective tissue dysplasia
Symptoms
Most often there are no complaints at all, and this is the main difficulty. Some women note a feeling of heaviness, pressure or fullness in the lower abdomen and perineum, increased urination, and an increase in the amount of mucous discharge. Sometimes spotting and spotting appears. The sensation of a foreign body in the vagina may mean that the amniotic sac has already descended, which is a reason to immediately consult a doctor. Pain and contractions with isthmic-cervical insufficiency, as a rule, do not occur.
- Most often asymptomatic
- Feeling of pressure in the lower abdomen
- Frequent urination
- Increasing the number of discharges
- Spotting and spotting
- Sensation of a foreign body in the vagina
Diagnostics
The main method is transvaginal cervicometry: measuring the length of the closed part of the cervix using ultrasound. It is usually performed during second trimester screening, and for women at risk - earlier and again at an interval determined by the doctor. Not only the length, but also the shape of the internal pharynx and the presence of prolapse of the membranes are assessed. Speculum examination and careful vaginal examination complete the picture. Be sure to take a smear on the flora, because infection often accompanies shortening of the cervix and requires treatment.
- Transvaginal cervicometry
- Repeated measurements over time in a risk group
- Examination of the cervix in speculums
- Fetal ultrasound
- Flora smear and infection testing
- Assessment of uterine tone
Treatment
The choice of method depends on the length of the cervix, gestational age, number of fetuses and obstetric history. With moderate shortening in a woman with a singleton pregnancy, vaginal progesterone is usually prescribed until a certain period. In case of pronounced shortening and a complicated medical history, cerclage is performed - a suture is placed on the cervix, which is removed closer to full term or at the onset of labor. An alternative or complement is an obstetric relief pessary. Additionally, it is recommended to limit exercise, avoid heavy lifting and sexual activity, and treat any identified infection.
- Vaginal progesterone
- Suturing the cervix
- Obstetric relief pessary
- Treatment of vaginal infections
- Limiting physical activity and sexual rest
- Regular monitoring of cervical length
- Prevention of respiratory distress when early labor is threatened
