For almost any woman, pregnancy is a long-awaited and joyful event, which is perceived as a holiday. Moreover, both parents expect the appearance of the baby. However, no matter what progress is made in obstetrics and gynecology, not every child bearing ends without any deviations. One of these pathologies may include ICI during pregnancy.
According to statistics, the proportion of ICI is approximately 30 to 40% of all cases of late spontaneous miscarriage (including premature birth).
What is a CPI?
Many future mothers may be scared by these three letters, let’s consider if it is justified or not, maybe all fears are in vain? The reproductive organ of a woman is, one might say, the muscular structure, where there is, in fact, the body of the uterus and cervix. The fetus develops in the cavity, and with the help of the neck it is retained, and it prevents it from leaving the uterus. In addition, infection protection is provided. Its channel is limited to the internal pharynx relative to the body and external to the vagina.
In the normal state, the neck muscles shrink and form a ring, and as labor approaches, they gradually relax. During pregnancy, the fetus gradually grows, which leads to an increase in amniotic fluid. As a result of this, intrauterine pressure also rises, and it is sometimes difficult for the cervix to withstand such a load. That's what it is - ICI during pregnancy.
Therefore, in some cases, the cervix begins to weaken prematurely, and as a result, it shortens and opens. Fully this pathology stands for isthmic-cervical insufficiency.
Certain risks
If the cervix is not able to cope with the load under the influence of the fetus, then this can lead to various undesirable consequences. In particular, these may be the following cases:
- The fetus descends - the uterine membrane may appear in the uterine cavity, which can easily be damaged by sudden movements.
- Infection of the fetus - this can occur during the contact of the membrane with the vagina containing a large number of microorganisms, most of which are harmful.
- The threat of miscarriage, and during the 3rd trimester.
- Preterm birth (approximately week 37) may occur, resulting in the baby being born prematurely.
All these risks give an almost complete picture of what it is - ICI during pregnancy. In most cases, the disease can develop with the onset of the 16th week of pregnancy. But sometimes a similar kind of pathology occurs in women who are in a position for a period of 11 weeks.
Types of pathology
There are several types of this pathology:
Traumatic ICI, as a rule, occurs due to surgical intervention in the uterus before conception. Moreover, if the need for this was associated with distention of the cervix, then damage to the integrity of the cervix is not excluded. At the site of the operation, adhesions could form from the connective tissue. As a result, these areas are no longer able to stretch and contract.
Similar types of surgical procedures include abortion and curettage. In addition, the situation of rupture of the cervix during the previous ride to carry a child can also be attributed to this.
Functional ICN of the cervix during pregnancy is usually triggered by a hormonal disorder, due to a lack of the female sex hormone progesterone or an excess of another, the male hormone androgen. The latter leads precisely to softening the muscles of the cervix. Most often, this form occurs after the 11th week of pregnancy.
At this time, the endocrine glands begin to function in the fetus. Its endocrine organs also form androgens. And as you know, due to the excess of their number, even insignificant, the cervix softens under their influence, shortens, which, in turn, leads to its premature opening.
What to consider for pregnant women
It is usually possible to diagnose the presence of ICN already in the period from the 11th to the 27th week of pregnancy, but in most cases it is the 16-27th week. It is during this period that the androgen begins to be produced in the child, as already mentioned above. At the same time, the tone of the uterus can remain in a normal state. And if a woman does not visit a gynecologist, as required, then she may not at all suspect an ICI during pregnancy.
The vagina is a habitat for various bacteria. Moreover, during any inflammatory process, their number increases significantly. And this already badly affects the development of the child in the womb, since there are no more obstacles for penetration into the uterine cavity for microorganisms, you just have to open its neck a little.
As a result, the fetal membrane loses its protective properties. In addition, everything can end with the outflow of amniotic fluid. In such a situation, as a rule, a miscarriage is not accompanied by pain, and the beginning of this process is the discharge of amniotic fluid.
The main causes of pathology
Isthmic-cervical insufficiency is caused by a decrease in muscle tone, which forms the uterine sphincter, the main role of which is to keep the cervix closed. Moreover, it should last throughout the entire period of pregnancy, right up to the very birth of the baby.
However, with this pathology, this mechanism works with a violation, which leads to premature opening of the cervical canal. As you can understand, this happens for a reason - there must be a reason for ICI during pregnancy. In most cases, this is caused by trauma to the uterine neck.
In addition, often an ICI can occur in women who have undergone one of the fruit-destructive operations, or, in the medical language, embryotomy. As a result of such surgical interventions, not only the cervix is injured, there is a violation of the location of muscle cells in relation to each other. As a result, they are no longer able to fully function.
Who can be at risk?
Some factors contribute to the development of CPI, and therefore those women in whom they occur automatically fall into the risk group for the development of ischemic-cervical insufficiency. These include:
- Cervical rupture, as determined by research.
- Excessive concentration of male sex hormones (hyperandrogenism).
- Abnormal development of the reproductive system of the female body.
- The presence of genital infantilism.
- Conducting IVF.
- Not enough progesterone.
In addition, the risk of ICI during pregnancy can be caused by other factors. For example, multiple pregnancy or polyhydramnios. And here the cervix has to experience a much greater load than during normal pregnancy (one child). It can also be a reason to start the development of the CPI. In addition, we should not forget cases when the uterus develops with defects.
Symptoms of ICI during pregnancy
From a clinical point of view, pathology does not manifest itself in any way, since the opening of the internal pharynx occurs gradually and painlessly. For this reason, it is very difficult for a woman to find out what condition the cervix is in and whether there is a real threat to the baby. This is especially true of the first trimester of pregnancy.
Nevertheless, there are still some symptoms by which cervical isthmus can be recognized, although they are observed a little later. During the first three months of gestation, bleeding without pain can serve as a sign of ICI during pregnancy, and only in some cases this is accompanied by mild discomfort.
At later stages of pregnancy (usually this is from the 18th to the 20th week), the ICI can cause fetal death and, consequently, miscarriage. Symptoms that indicate such a threat may be the following:
- In addition to the bleeding itself, the secretions contain mucus and blood streaks.
- Pain or palpable discomfort in the back and lower abdomen.
- Feeling of fullness of the vagina.
But since in most cases the development of pathology is painless and practically in the absence of any symptoms, it is necessary to regularly visit a gynecologist in order to check his condition. This is the only way to detect pathology in a timely manner and quickly determine the course of treatment.
Diagnosis of ICI during pregnancy
How is the diagnosis? For this, doctors conduct a specular examination of the cervix, palpation of the vagina, ultrasound. During the examination of a woman, the doctor can determine the shortening of the cervix, as well as the fact that she has become softer. He is also able to detect the opening of the canal and whether the fetal bladder is visible.
If this is the first pregnancy for a woman, then in this case, the external pharynx is usually closed. Therefore, for the establishment of an accurate diagnosis, a transvaginal ultrasound is prescribed. Ultrasound scanning is the most informative way to determine the ICI. The main symptom is a shortening of the cervix, and depending on the gestational age, there are their own norm indicators:
- up to six months: the size of the channel is 34-45 mm;
- in later periods, this indicator is already slightly less - 30-35 mm.
If a woman has obvious symptoms of ICI during pregnancy, then the size of the channel is even smaller. That is, if it is shortened to 25 mm or less, then this indicates a probable miscarriage or premature pregnancy.
What is characteristic, the cervix in the presence of ICI opens V-shaped, which is well detected during ultrasound examination. In some cases, a load test is taken to confirm the diagnosis during the scan. That is, a woman is asked to cough or is pressed on the uterine cavity.
If the expectant mother is at risk or there are indirect signs of pathology, an ultrasound scan is prescribed at least twice a month.
Treatment features
If a woman was diagnosed with isthmic-cervical insufficiency, treatment should be started immediately, for which the obstetrician-gynecologist is responsible. For effectiveness, it is carried out in a hospital environment, which allows you to choose the best technique.
In total, there are two main ways to correct the ICI during pregnancy:
- operational;
- conservative.
The first type is surgery, which avoids the further opening of the cervix. The second is the installation of a special design called the Meyer ring. Hormone therapy may also be prescribed.
Surgery
The essence of this treatment method is to mechanically narrow the internal pharynx by suturing the external. The stitch can be:
Before the procedure, a swab from the vagina is taken in order to study it in detail. This is done in order to find out if a woman has contraindications for the operation. These include:
- congenital malformations of the fetus;
- the presence of severe vaginitis;
- diseases of a chronic form in which it is not recommended to bear a child;
- uterine bleeding;
- complications caused by gestosis;
- noncupable uterine hypertonicity;
- rapid progression of the CPI.
The operation itself to eliminate the ICI during pregnancy takes place in several stages:
- Diagnostics.
- Preparation - vaginal debridement can be provided here.
- The procedure itself - suturing of the pharynx is carried out under local anesthesia with the help of silk threads. After that, the seam is treated with antiseptics.
- Rehabilitation course.
To minimize the risks of complications, various medications are prescribed in the face of antispasmodics (drotaverine hydrochloride), antibiotics (if necessary) and tocolytics (Ginipral, magnesia). The latter should be taken with the tone of the uterus.
As for the timing for this operation, then everything is individual. Usually no later than the 17-28th week of pregnancy, so that the progression of the pathology can be avoided.
On the second or third day after the operation, the cervix is examined, and if the patient has no complaints, she is discharged under the supervision of a specialist. A further routine examination is carried out every two weeks during the treatment of ICI during pregnancy.
During the normal course of pregnancy, the sutures are removed at 37-38 weeks. It also includes the onset of labor (regardless of duration), the appearance of regular contractions, bleeding, and teething.
Conservative treatment
Using a rubber or latex structure (also called a "pessary"), you can redistribute the pressure inside the uterine cavity, including the mass of the fetus, which slightly relieves the load on the cervix. The method is highly effective at the initial stage of development of pathology. If the disease is already progressing, then the ring is used as an aid to treatment.
Typically, you can install the pessary even in late pregnancy - more than 28 weeks, while suturing is no longer possible. Since the ring, which helps to eliminate ICI during pregnancy, is perceived by the body of a woman as a foreign body, then doctors prescribe sanitation with antiseptic agents and a smear is regularly taken. If necessary, antibiotics are prescribed.
Every two weeks, the ring is removed and processed in order to exclude the possibility of infection of the fetus. It is completely removed after 37-38 weeks of pregnancy or with the onset of labor, regardless of the term.
What is the forecast?
Such a pathology as isthmic-cervical insufficiency is fraught with a miscarriage, which in most cases occurs spontaneously, or prematurely. In addition, the opening of the cervix threatens the infection of the fetus, which negatively affects its further development.
The prognosis of the stage of ICN depends on how much the cervix has opened, the term of gestation, how effective the treatment procedure is and the presence of infectious pathogens.
The shorter the gestation period and the more the cervical canal opens, the less chance of a successful outcome. This is confirmed by reviews of ICI during pregnancy.
Pregnancy planning
According to statistics, an ICI is found in every 10th women in labor, for whom this is the first time. Women with “experience” risk much more often. And what is typical, the more children a woman carries, the higher the risks of pathology in subsequent pregnancy.
Therefore, those mothers who want another child need good preparation. First of all, you need to get rid of chronic endometritis (if any) and normalize the vaginal microflora. In the course of a violation of the protective function of the cervix, pathogens of various infectious diseases can enter its body.
In this regard, it is necessary to take a course of taking antibiotics, and since all women have different characteristics of the body, then taking medications is prescribed in a strictly individual order. The effectiveness of such therapy is evaluated based on the bacteriological study of the sample taken.
Preventive actions
As many reviews of the treatment of ICI during pregnancy note, the effectiveness of the procedure depends on whether the pregnant woman is careful in everything. It is necessary to refrain from heavy physical exertion, sexual intercourse, avoid stressful situations, do not ignore visits to the doctor and take the necessary drugs.
During pregnancy, it is important to relax as much as possible, and all the housework can be done by loved ones. It is also important to maintain emotions in a positive manner and pre-configure yourself for the successful birth of a baby without any complications!
For the prevention of preterm birth for the period from the 20th to the 40th week of gestation, the doctor may prescribe medications that contain progesterone. One of such means is Utrozhestan. With ICI during pregnancy, it is often prescribed. The indicated hormone is produced by the placenta, and it is simply vital for the proper development of pregnancy. In this connection, Utrozhestan is well known to many gynecologists as well as women who have already gone from conception to the birth of a child.
To console future mothers, there are many cases where a woman, as a result of ICI, loses her baby, but in the end she has a healthy and fully developed baby. This proves in practice that a lot depends on the efforts of doctors, mom herself and the timeliness of treatment.