Pregnancy is a special period in the life of every woman. Unfortunately, not everything goes smoothly. Many expectant mothers face various complications while bearing a child. Such a pathology as isthmic-cervical insufficiency can also be attributed to their list.
It is immediately worth noting that such a complication is dangerous. In the absence of timely assistance, spontaneous abortion is possible. That is why many patients are looking for additional information. Why does isthmic-cervical insufficiency develop during pregnancy? Symptoms, risk factors, correction methods - this is important information that should be thoroughly studied.
What is a pathology?
Isthmic-cervical insufficiency (the ICD assigned code O34.3 to this condition) is a pathology that is accompanied by the opening of the internal uterus under pressure. According to statistics, in different countries from 1 to 9% of pregnant women face a similar problem.
As you know, the uterus consists of the body (this is a kind of muscle bag, in the cavity of which the development of the fetus is carried out) and the neck. The neck is a small tube inside which the cervical canal passes. The bulk of the muscle is concentrated in the upper part of the cervix - this is where the internal pharynx is located. The throat muscles are compressed into a ring, thereby preventing the fetus from leaving ahead of time.
Isthmic-cervical insufficiency is characterized by muscle weakness. As a result, the pharynx begins to open, as a result of which the prolapse of the membranes in the vagina, miscarriage or premature birth is possible.
Traumatic form of failure
A similar pathology can develop under the influence of various factors. However, often failure is the result of cervical injuries. Almost any procedure that involves the expansion of the cervical canal can lead to this. In particular, the risk factors include abortion, diagnostic and therapeutic curettage. In addition, trauma can occur during childbirth, as well as IVF procedures. The fact is that in the place of damage, connective scar tissue is formed. It is not elastic and is not able to stretch, which in the future leads to the development of insufficiency.
Functional form of pathology
The functional form of isthmic-cervical insufficiency, as a rule, is associated with hormonal disorders. The weakening of the muscle tissue of the uterus can be associated, for example, with a deficiency of progesterone or an increase in the level of androgens.
Symptoms of this form of pathology, as a rule, begin to appear in the early stages (from 11 weeks). Fortunately, this type of insufficiency, as a rule, lends itself well to hormonal drug therapy.
Other types of failure. Are there any risk factors?
Of course, there are other causes and risk factors that should not be ignored. Isthmic-cervical insufficiency often develops in women with congenital anomalies regarding the structure of the uterus (for example, a saddle-shaped or two-horned uterus). By the way, such pathologies can be detected even at the stage of pregnancy planning - you just need to see a doctor and undergo the necessary examinations.
Isthmic-cervical insufficiency sometimes develops with increasing pressure on the uterus. Risk factors include multiple pregnancy, the presence of one, but very large fruit, as well as the formation of too much amniotic fluid.
The risk group includes patients who have a history of information about previous miscarriages or premature births.
Ischemic cervical insufficiency during pregnancy: symptoms
What signs are worth paying attention to? What disorders are accompanied by isthmic-cervical insufficiency? Symptoms are sometimes completely absent. Insufficiency is diagnosed already during the examination after a miscarriage or premature birth.
But there are a number of quite characteristic signs that accompany isthmic-cervical insufficiency during pregnancy:
- Vaginal discharge is one of the symptoms. They are usually plentiful, mucous, sometimes with streaks of blood.
- Some women complain of discomfort in the suprapubic region, pulling back pain.
- Often there are unpleasant pains in the lower abdomen, which often spread to the lumbar region and sacrum.
- Sometimes patients note the appearance of a bursting sensation in the vagina. Some women describe this as a feeling of pressure, fullness. There may be sharp, stitching pains.
If such violations occur, you should immediately consult a doctor. In no case should you ignore such symptoms.
Why is this condition dangerous?
Isthmic-cervical insufficiency during pregnancy is a very serious problem, which in no case can be ignored. The result of such a pathology is, as a rule, miscarriage - pregnancy either ends in spontaneous miscarriage in the early stages, or premature birth, which, in turn, is dangerous for the fetus (a baby born too early needs medical attention and appropriate care, the risk of baby's death is high )
In addition, due to increased pressure and weakness of the cervix, the risk of penetration of pathogenic microorganisms and infection of the membranes of the membranes is high. Partial damage to the membranes is also possible, which is also fraught with a host of dangerous complications.
What does the diagnostic process look like?
If there are suspicions of any violations, a woman must definitely consult an obstetrician-gynecologist who is conducting a pregnancy.
- To begin with, a history is collected. It is important to get acquainted with all the complaints of the patient, to determine exactly when the problems started. You also need to study the medical record of a woman, which may contain information about previously transferred gynecological diseases, abortions, miscarriages, etc.
- Gynecological examination with bimanual vaginal examination is mandatory. During palpation, the doctor determines the size of the uterus and ovaries, the condition of the ligamentous apparatus, the presence of soreness during certain manipulations. You also need to examine the cervix using mirrors - it is important to determine its size, position, shape, length, assess the condition of the cervical canal, identify areas with cicatricial changes (if any).
- A transvaginal ultrasound examination is also shown, which will give the specialist more information about the condition of the cervix, the degree of closure of its internal pharynx.
Cervical insufficiency: medication treatment
The treatment regimen is determined depending on the general condition of the patient, gestational age, degree of cervical insufficiency, and some other factors.
- If there is a violation of the hormonal background, then it is brought back to normal by taking hormonal drugs.
- To reduce muscle tension, patients are prescribed tocolytics (such drugs help to relax the muscles of the uterus).
- Sometimes women are prescribed vasodilator drugs, low molecular weight dextrans (help improve blood properties), vasoactive drugs (provide expansion of small vessels). Such therapy can prevent the development of placental insufficiency.
The right regime for the expectant mother
The presence of insufficiency does not mean at all that the pregnancy will necessarily end. With proper treatment, a woman can successfully bear a child. Drug treatment and surgical correction, of course, will help prevent pregnancy termination. However, a woman needs to follow certain rules.
Bed rest is required . Physical activity, as well as sexual contacts are contraindicated, as this can further weaken the cervix. We need to give up weight lifting and homework, relax more, eat right. It is important to maintain peace of mind, since any stress is accompanied by the release of certain hormones, which affects the functioning of the reproductive system. A woman should maintain a positive attitude, follow all the doctor’s recommendations, take medications selected by a specialist and, of course, not miss scheduled examinations. In some cases, until the end of pregnancy, a woman stays in a hospital under the constant supervision of doctors.
What is the installation of an unloading pessary?
In addition to drug therapy, a woman sometimes has a special discharge pessary. Meyer's ring is a special plastic construction that is placed deep in the vagina. This device provides support for the cervix, redistributes the load associated with pressure on the tissue of amniotic fluid and a growing baby.
This is a simple procedure to be done with isthmic-cervical insufficiency, multiple pregnancy, polyhydramnios, as well as in any other situations when it is necessary to prevent premature opening of the uterus. The device can be installed at any stage of pregnancy.
They remove it, as a rule, for 37 weeks or in the presence of labor activity. This is a simple procedure, which, however, is associated with some complications. Despite the fact that the pessary is sterile and made of special materials, there is still a chance of developing vaginal dysbiosis. That is why patients need to regularly do smears on the microflora.
Surgical correction and its features
If, for one reason or another, drug therapy and installation of the Meyer ring does not give the desired result, then the correction of isthmic-cervical insufficiency is carried out surgically.
In this case, we are talking about narrowing of the uterine pharynx, followed by the imposition of durable non-absorbable sutures on it. This is a fairly responsible procedure, which is carried out in a hospital setting. First, vaginal sanitation is performed, after which stitches are placed on the throat tissue. The procedure requires short-term anesthesia.
As a rule, such a fixation is carried out in the early stages of pregnancy. In any case, the procedure should not be performed after 28 weeks of gestation. Sutures are removed in the gynecological office at about 38 weeks. Premature removal of suture material is carried out in the event that there is an active labor, the appearance of bloody discharge, leakage of amniotic fluid. The patient is also required to take medications that prevent uterine hypertonicity.
Predictions for expectant mothers: what you need to know?
The proper management of pregnancy with isthmic-cervical insufficiency includes regular examinations, ultrasound monitoring. If it was possible to stabilize the uterus with medication or suturing, the woman succeeds in successfully carrying out the baby.
Nevertheless, delivery in most cases is very rapid and requires certain skills from the doctor. That is why the patient is recommended to go to the hospital a few days or even weeks before the day of the expected birth. The process itself, as a rule, takes place without any serious deviations.
Prevention of pathology in repeated pregnancy
If a woman had isthmic-cervical insufficiency during pregnancy, then the conception of the next child can begin to be planned after at least two years. Before fertilization, the patient is advised to undergo a full examination to determine if there is a risk of re-development of insufficiency.
During the bearing of the fetus, it is very important that the expectant mother adheres to the correct regimen, monitors the slightest changes in health, and regularly visits a gynecologist. The specialist periodically examines the cervix using mirrors and ultrasound equipment.
According to statistics, isthmic-cervical insufficiency is the most common cause of spontaneous abortion. It is worth noting that with the birth of each subsequent child, the risk of complications increases, so a woman should be careful about her condition.