The common phrase pregnancy is a physiological condition for some women is a pipe dream. Miscarriage follows the miscarriage and report such a long-awaited pregnancy does not succeed! For some reason, sometimes women’s health fails. Perhaps the cause is in isthmico-cervical insufficiency.
Isthmiko-cervical insufficiency, its symptoms and treatment, undoubtedly, are one of the important subjects of discussion of obstetrics and gynecology, as it often becomes an occasion for premature termination of pregnancy. The reason for this pathology lies in the inability of the neck-uterine cortex to retain the growing fetal egg.
Mechanism of development of ischemic-cervical insufficiency.
Uterus is a hollow, pear-shaped organ, mostly composed of smooth muscles. The uterus has a body (copus), neck (cervix) and isthmus (isthmus). Isthmus is a narrow zone on the border between the body and the cervix. Figuratively speaking, the uterus is a receptacle for the fetus, and the cervico-ismic section is a lock that holds the fetus in the uterine cavity.
Isthmiko-cervical insufficiency (ICI) is a violation of the cervix’s barrier ability, which leads not only to miscarriages, but also to the risk of infection in the uterine cavity.
As the fetus grows, the isthmus as it unfolds and forms with the body of the uterus a single whole. The shape of the uterus varies from pear-shaped to spherical, and the cervix is considerably shortened and softens more close to birth. Just imagine that during pregnancy the mass of the uterus increases in 20, and the volume of the uterine cavity is 500 times.
During pregnancy, the intrauterine pressure increases and, if there is an incompetence of the cervico-ismic section, the cervix is shortened, opened and softened. Fetal membranes are introduced into the cervical canal, they are opened and (alas) spontaneous abortion occurs. Most miscarriages are observed in the second trimester (after 12 weeks of pregnancy.
Causes of isthmico-cervical insufficiency.
Isthmiko-cervical insufficiency is divided into anatomical and functional.
Anatomical is the result of various injuries of the cervix during labor (use of forceps, a large fetus, manual separation of the placenta, improper suturing with the formation of gross scars) and abortion.
Functional arises as a result of congenital malformations of the uterus, infantilism, deficiency of sex hormones, increased content of androgens, acquired pathology of the muscular and connective tissue layers of the uterus or congenital dysplasia of tissues.
The risk for the emergence of ICI is IVF (in vitro fertilization), since massive hormonal preparation naturally leads to softening of the cervix. And if a woman has any anatomical abnormality of the cervix, the likelihood of developing the NIH increases several times.
Symptoms of isthmico-cervical insufficiency.
Symptoms of ICI are usually scanty and nonspecific, because it is based on the opening of the cervix, which proceeds without pain, bleeding and fetal anomalies. Pregnancy may be discomfort in the vagina, frequent urination, heaviness in the lower abdomen or minor sanguineous discharge from the vagina symptoms of a threat of abortion and a miscarriage.
The provoking moment for abortion in an ICI can be served only by sneezing, coughing, lifting of gravity or even fetal movement.
Diagnosis of ischemic-cervical insufficiency.
It is difficult to suspect a disease before pregnancy, because the symptoms of ischemic cervical insufficiency are evident only if there are gross scars or deformities on the cervix. Most often, failure is first diagnosed after the spontaneous interruption of the first pregnancy.
The diagnosis of ICI is based on an anamnesis (cervical lesions, miscarriages, endocrine disorders), examination (deformities, pathological shortening, softening and opening of the cervix) and instrumental methods of examination (hysterosalpingography and ultrasound.
Hysterosalpingography is an X-ray method, which is supplemented by special tests and repeated studies to confirm the diagnosis. The method is contraindicated in pregnancy.
Transvaginal ultrasound is used to determine the size of the cervix and the condition of the internal pharynx. Ultrasound can be performed at any time of pregnancy.
Treatment of isthmic cervical insufficiency.
Treatment of ICI is surgical and conservative. In some cases, according to the doctor’s decision, a comprehensive application of various techniques is possible.
Surgical treatment in non-pregnant patients is the plasticity of the cervix. After surgery, contraception is recommended for six months.
In pregnant women, surgical correction is performed by suturing the cervix. which prevent the gaping yawn. For best results, surgery is advisable until 16-18 weeks of gestation. If the operation was successful and without complications, the sutures are removed before delivery at approximately 37 weeks of gestation.
At the postoperative stage appoint drugs that reduce the tone of the uterus, and if necessary, hormone therapy.
Conservative treatment of ICI is the use of obstetric discharge pessaries, a kind of bandage that, by reducing and distributing the load, helps the cervix retain the growing fetus.
Obstetrical pessary is a silicone or plastic construction of a special form, it is placed in the vagina in the early stages of pregnancy. Pessary is removed at a gestational age of 37-38 weeks.
The method is very effective, atraumatic, absolutely safe for the woman and the fetus.
Treatment of isthmic cervical insufficiency is also a special regimen for a woman seeking to maintain a pregnancy. It is necessary to minimize any physical exertion to a minimum, avoid emotional shocks, be under constant supervision of an obstetrician-gynecologist and strictly observe the intake of medicines prescribed by a doctor. Sexual contacts are excluded for the entire period of pregnancy.
In the presence of anatomic ICP, delivery is justified by a planned cesarean section. that will prevent additional traumatization of the cervix in childbirth.
If you or someone close to a similar problem is diagnosed, then ischemic-cervical insufficiency, its symptoms and treatment should be the topic of a confidential discussion in the family. Since the prevention of ICI is not only an early diagnosis, constant observation of the doctor and the correct choice of therapy, but also the care and attention of others.