Even 50-40 years ago, pregnant women could lose a healthy fetus at the end of the first trimester of pregnancy or at the beginning of the second due to premature opening of the cervix. The fact is that in those days the only way to deal with this phenomenon was by suturing the cervical canal, and since such an operation can only be performed under general anesthesia, it had to be postponed until a later date. Fortunately, today such situations are extremely rare, as doctors use special devices - obstetric pessaries. They are not sold in pharmacies and it is not recommended that you try to install them yourself.
Pessary: what is it
The term “isthmic-cervical insufficiency” is used in medicine to indicate problems associated with premature cervical dilatation. To prevent its negative effects, such as a miscarriage, doctors often recommend installing an unloading pessary. The classic version of such a device, created taking into account the anatomical features of the body structure of a woman, is a few plastic or silicone rings interconnected.
Kinds
The obstetric pessary, reviews of which are presented at the end of the article, can be of several types. In particular, the pharmaceutical industry produces such devices in three sizes:
- First one . Such pessaries are suitable for women giving birth less than 2 times, as well as for pregnant women with a length of the upper third of the vagina from 55 to 65 mm or with a diameter of the cervix from 25 to 30 mm.
- Second one . Devices of this size are installed for pregnant women who fall under the criteria corresponding to the first paragraph, however, the length of the upper third of the vagina in which is from 66 to 75 mm.
- Third size. These are the largest pessaries that obstetricians install repeatedly giving birth to mothers, as well as women whose length of the upper third of the vagina exceeds 76 mm or the diameter of the cervix ranges from 30-37 mm.
Surely many people think about the pessary that this is one or more rings interconnected. However, there are many types of such a device in a completely different form. For example, pregnant women sometimes insert a cup-shaped pessary designed to maintain the cervix, reduce the pressure on the fetal head and to prevent the opening of the uterine pharynx. In addition, with isthmic-cervical insufficiency, a donut (thick ring) device made of polyvinyl chloride can be installed. This material has the property of thermoplasticity and, being inside the woman’s body, it becomes soft, taking the form of the organ in which it was placed. Also, for the manufacture of a pessary, silicone is often used, which does not cause allergic reactions. Such devices are pre-sterilized using gamma radiation.
In which cases
During pregnancy, an obstetric pessary is installed in order to keep the uterus and adjacent internal organs in the correct position. And very often it is prescribed in case of multiple pregnancy. In addition, pessaries of various types are also used to solve the health problems of non-pregnant women. In particular, they are effective when it is necessary to prevent the prolapse of internal organs (uterus) or to alleviate the condition of a patient who has incontinence.
Contraindications and possible negative consequences
Although usually for all the concerns of pregnant obstetricians answer about the pessary that it is completely safe, there are cases when it is forbidden to put it. In particular, this cannot be done if:
- there are suspicions of a frozen pregnancy;
- the lower part of the fetal bladder is already in the vagina;
- spotting and / or anemia are observed;
- revealed inflammatory processes of the genital organs.
If such a device is selected or installed incorrectly or has shifted for some reason, then the pregnant woman may develop inflammation (colpitis), which can be eliminated by correcting the position of the pessary and applying medication.
How to put a pessary
Before such a procedure, it is necessary to undergo an examination and, in the event of any infections of the genitourinary system, to cure them. In addition, if a pregnant woman has an increased tone of the uterus, then 30-60 minutes before the ring is installed, she is given an antispasmodic that relieves contractions, and medical glycerin is used to reduce friction. Only after this can you put a pessary. That this is unpleasant enough, confirms any woman. However, sometimes this procedure is the only way to maintain pregnancy, especially in the early stages, when it is impossible to perform a surgical operation to suture the cervix.
When can I put
Most often, the pessary, reviews of which are mostly positive, is placed after the 20th week of pregnancy. However, as already mentioned, sometimes, in connection with the threat of a miscarriage, you have to do this already at 12-14 weeks. Moreover, regardless of how many times the pregnant woman has already given birth, a ring of the first size is always used.
What you need and what you can not do after installing the pessary
After such an auxiliary device was placed on the cervix of the pregnant woman, the woman does not need to do anything special. The only thing that doctors recommend after installing the pessary is to take a swab from time to time (once every 14-21 days) to study the bacteriological flora, and to prevent vaginal infections every 2-3 weeks, treat the vagina, and, of course, refrain from sex life. Moreover, the woman would have to follow the last advice, even if she had not been given a ring. After all, when it comes to the advisability of such a procedure, then this fact itself indicates the presence of a threat of premature termination of pregnancy.
Childbirth
Usually, the device we are considering is left until the 36-38th week of pregnancy. Then the gynecologist on an outpatient basis or in a hospital removes the pessary. This procedure is done without anesthesia, but lasts only a few seconds, so pain, if it occurs, is extremely short. Sometimes it is done in a hospital, in the pathology department, and sometimes on an outpatient basis, at a gynecologist's appointment. Removal of the pessary leads to the fact that the cervix relaxes, and under the pressure of the fetus, it softens very soon, followed by shortening and opening. After that, somewhere within a week (sometimes this period can be a little longer), the woman starts giving birth. However, there are situations when this device has to be removed ahead of schedule. For example, this must be done if amniotic fluid effusion is observed, the fetal bladder is infected, or emergency delivery is necessary.
Obstetric pessary: reviews
Today, the installation of such devices is a fairly common occurrence. Therefore, regarding their effectiveness and problems associated with the use of pessaries, you can hear a lot of comments. In particular, women complain about the unpleasant sensations that arise when they have to make long trips by car or just stay in a sitting position for a long time. In addition, there is also a deterioration in the analysis of the smear, the cause of which is the pessary. Reviews also show that the procedures for installing and removing it can give women quite noticeable pain. But the most unpleasant, according to pregnant women who have such a protective obstetric device, is a sharp increase in the number of secretions 3-4 weeks after the pessary is inserted, which is associated with the body's desire to get rid of a foreign body. Some patients even say that there can be so many of them that there are suspicions of the outflow of amniotic fluid and you have to constantly wear pads.
Now you know what an obstetric pessary is, reviews about which you may have heard from friends and acquaintances. In any case, it is safe to say that at the moment there are no cases where the use of the aforementioned medical device would cause serious health problems - neither before birth, nor after. However, doctors warn that even with the pessary installed, sometimes (though very rarely) a miscarriage can still occur. At the same time, statistics show that after such devices began to be installed with isthmic-cervical insufficiency in the early stages, the number of positive pregnancy outcomes increased significantly.