ICI during pregnancy: what is it. How to endure pregnancy with ICN (personal experience)

Isthmicocervical insufficiency (ICI) is pathological condition, characterized by insufficiency of the isthmus and cervix, leading to spontaneous abortion in the second and third trimesters of pregnancy. In other words, this is a condition of the cervix during pregnancy in which it begins to thin out, becoming soft, shortening and opening, losing the ability to hold the fetus in the uterus for up to 36 weeks. ICI is a common cause of miscarriage between 16 and 36 weeks.

Causes of ICN

In accordance with the reasons, ICNs are divided into:

- organic ICN– as a result of previous injuries to the cervix during childbirth (ruptures), curettage (during abortion/miscarriage or for diagnosing certain diseases), during the treatment of diseases, for example, erosion or polyp of the cervix using the method of conization (excision of part of the cervix) or diathermocoagulation (cauterization). As a result of injury, normal muscle tissue in the cervix is ​​replaced by scar tissue, which is less elastic and more rigid (harder, stiffer, inelastic). As a result of this, the cervix loses the ability to both contract and stretch and, accordingly, cannot fully contract and retain the contents of the uterus inside.

- functional ICN, which develops for two reasons: due to a violation of the normal ratio of connective and muscle tissues in the cervix or a violation of its sensitivity to hormonal regulation. As a result of these changes, the cervix becomes too soft and pliable during pregnancy and dilates as pressure from the growing fetus increases. Functional ICI may occur in women with ovarian dysfunction or may be congenital. Unfortunately, the mechanism of development of this type of ICI has not yet been sufficiently studied. It is believed that in each individual case it is individual and there is a combination of several factors.

In both cases, the cervix is ​​not able to resist the pressure of the growing fetus from inside the uterus, which leads to its dilatation. The fetus descends into the lower uterus, the amniotic sac protrudes into the cervical canal (prolapses), which is often accompanied by infection membranes and the fruit itself. Sometimes, as a result of infection, amniotic fluid leaks.

The fetus descends lower and puts even more pressure on the cervix, which opens more and more, which ultimately leads to late miscarriage (from 13 to 20 weeks of pregnancy) or premature birth (from 20 to 36 weeks of pregnancy).

Symptoms of ICN

There are no clinical manifestations of ICI during or outside of pregnancy. The consequence of ICI in the second and third trimesters is spontaneous termination of pregnancy, which is often accompanied by premature rupture of amniotic fluid.

Outside of pregnancy, isthmicocervical insufficiency does not threaten anything.

Diagnosis of ICI during pregnancy

The only reliable method of diagnosis is vaginal examination and examination of the cervix in speculums. A vaginal examination reveals the following signs (individually or in combination with each other): shortening of the cervix, in severe cases - sharp, softening and thinning; the external pharynx can be either closed (more often in primigravidas) or gaping; the cervical (cervical) canal may be closed or allow the tip of a finger, one finger or two to pass through, sometimes with separation. When examined in the speculum, a gaping of the external os of the cervix with a prolapsed (protruding) amniotic sac may be detected.

Sometimes, if there is questionable data from a vaginal examination in the early stages of development, ultrasound helps diagnose ICI, which can detect an expansion of the internal os.

Complications of ICI during pregnancy

The most severe complication is termination of pregnancy at various stages, which can begin with or without rupture of amniotic fluid. ICI is often accompanied by infection of the fetus due to the lack of a barrier to pathogenic microorganisms in the form of a closed cervix and cervical mucus, which normally protects the uterine cavity and its contents from bacteria.

Treatment of ICI during pregnancy

Treatment methods are divided into operative and non-operative/conservative.

Surgical treatment of ICI

The surgical method involves placing sutures on the cervix to narrow it, and is carried out only in a hospital. There are various methods of suturing, their effectiveness is almost the same. Before treatment, an ultrasound of the fetus is performed, its intrauterine condition, the location of the placenta, and the condition of the internal os are assessed. From laboratory tests A smear analysis of the flora must be prescribed and, if inflammatory changes are detected in it, treatment is carried out. The operation is performed under local anesthesia; after the operation, the patient is prescribed antispasmodic and painkillers for prophylactic purposes for several days.

After 2-3 days, the consistency of the sutures is assessed and if their condition is favorable, the patient is discharged under the supervision of a doctor at the antenatal clinic. Complications of the procedure may include: increased uterine tone, prenatal rupture of amniotic fluid, infection of sutures and intrauterine infection of the fetus.

In the absence of effect and progression ICN pregnancy prolongation is not recommended, as the stitches may cut through, causing bleeding.

Contraindications for suturing the uterus are:

Untreated genitourinary tract infections;
- history of pregnancy terminations in the second and third trimesters (recurrent miscarriage);
- the presence of intrauterine fetal malformations incompatible with life;
- uterine bleeding ;
- heavy accompanying illnesses, which are a contraindication for prolonging pregnancy (severe cardiovascular diseases, impaired renal and/or liver function, some mental illnesses, severe gestosis in the second half of pregnancy - nephropathy of degrees II and III, eclampsia and preeclampsia);
- increased uterine tone that cannot be treated with medication;
- progression of ICN - rapid shortening, softening of the cervix, opening of the internal pharynx.

Conservative treatment of ICI

The non-operative method consists of narrowing the cervix and preventing it from opening by installing a pessary. A pessary is a ring made of latex or rubber that is “put” on the cervix so that its edges rest against the walls of the vagina, holding the ring in place. This method treatment can only be used in cases where the cervical canal is closed, i.e. early stages ICN or if it is suspected, and can also be an addition to suturing.

Every 2-3 days, the pessary is removed, disinfected and reinstalled. The method is less effective than the first, but has several advantages: bloodlessness, ease of implementation and no need for hospital treatment.

Prediction of pregnancy outcome with ICI

The prognosis depends on the stage and form of ICI, on the presence of concomitant infectious diseases and from the duration of pregnancy. How shorter period pregnancy and the more open the cervix, the worse the prognosis. As a rule, when early diagnosis Pregnancy can be prolonged in 2/3 of all patients.

Prevention of ICN

It consists of careful curettage, examination and suturing of cervical ruptures after childbirth, cervical plastic surgery when old ruptures are detected outside of pregnancy, and treatment of hormonal disorders.

Obstetrician-gynecologist Kondrashova D.V.

It's no secret that every future mom dreams of a happy pregnancy and easy childbirth. However, unfortunately, desires do not always coincide with reality. Changes and disturbances in female body may provoke various diseases, which, in turn, threaten the normal development of the baby’s future. There are more serious problems, which often become the cause of spontaneous miscarriages or. For example, isthmic-cervical insufficiency (ICI), which we want to talk about in today’s publication.

What is ICN?

Isthmic-cervical insufficiency is one of the most common causes of premature birth. This condition is characterized by the fact that the isthmus and cervix during pregnancy cannot cope with the increasing load. Normally, the muscle ring of the cervix should hold the fetus in the uterine cavity during gestation, but with ICI, the muscle ring does not cope with its function, which provokes dilatation of the uterus and creates a threat of miscarriage.

Functional ICI can develop against the background of an increase in the content of male sex hormones in the female body and most often forms at 16-27 weeks of pregnancy. As a result of the development of ICI, excessive pressure on the cervix occurs, especially during multiple pregnancies.

Traumatic INC develops against the background of abortion or other intrauterine interventions. With such manipulations, the integrity of the muscle ring of the cervix is ​​damaged, causing the formation of a connecting scar. At the same time, connective tissue, unlike muscle tissue, is not free to stretch and contract. Also, the development of traumatic ICI can be caused by problems that occurred during previous births.

Symptoms of ICI during pregnancy

Unfortunately, isthmic-cervical insufficiency is asymptomatic and only in some cases, in the early stages of pregnancy, can manifest itself in the form of spotting and nagging pain in the lower abdomen. There may also be a bursting sensation inside the vagina.

Since ICI is asymptomatic in most cases, diagnosing this disease is not an easy task. This is why regular visits to the gynecologist are very important during pregnancy. In this case, the doctor should conduct a vaginal examination at each visit in order to promptly identify and prevent the development of ICI. A more accurate diagnosis can be made using an ultrasound examination, which is carried out with a vaginal probe.

Based on the research results, doctors pay attention to the length of the cervix and the presence of opening of the internal pharynx, after which they confirm or exclude isthmic-cervical insufficiency.

Treatment of ICI during pregnancy

If the development of ICI is provoked by hormonal or endocrine disorders, then treatment will consist of prescribing drugs that correct hormonal levels. Naturally, treatment is carried out under close medical supervision.

As for the treatment of ICI, which was formed as a result of injury, it may be necessary to surgical intervention. To do this, sutures are placed on the cervix, which subsequently helps it cope with the growing load. Note that surgical intervention is performed under general.

An alternative to surgical intervention for some forms of ICI is a special pessary design, which also reduces the load on the cervix.

In conclusion, we note that compliance with the pregnant woman’s regimen also plays a big role in the success of ICI treatment. Therefore, try to reduce physical activity as much as possible, avoid sexual intercourse if possible, avoid stress and visit a doctor regularly. Naturally, you should never ignore your doctor’s prescriptions.

And don’t forget about a positive psychological attitude and faith in success. It is positive thoughts and self-confidence that will allow you to bear and give birth to a healthy baby!

Especially for Ira Romaniy

Pregnancy is the most beautiful thing, but at the same time the most anxious time in the life of every woman. On the path to successful childbirth and happy motherhood, there are many obstacles that can provoke in the early stages.

One of these factors is ICI (isthmic-cervical insufficiency) - a pathological condition in which the muscles of the cervix are weakened so much that they are unable to cope with the increasing load.

To avoid complications or fatal outcome during pregnancy, every woman needs to know what ICI is and whether it is possible to prevent this pathology.

Definition

To understand why isthmic-cervical insufficiency (ICI) is dangerous, you need to know how the uterus works. The uterus is an organ that has a body and a cervix.
The fetus develops in the body, and the cervix helps keep it inside the cavity and protects it from infection.

The muscles of the cervix close during pregnancy and gradually relax towards childbirth. However, sometimes they relax earlier, then the cervix becomes unable to hold the fetus inside the uterus and opens under the pressure of the baby’s weight.

This is ICI - a condition when the muscles of the cervix weaken ahead of time.

At the same time, the amniotic sac descends into the uterine cavity, the membranes are at risk of infection, open, and contractions begin. This can lead to miscarriage or premature birth - if labor begins in the third trimester.

Important! As a rule, a miscarriage with isthmic-cervical insufficiency begins with leakage of amniotic fluid or its discharge. However, it is painless.

ICI is a rare phenomenon, occurring in 1-9% of pregnant women, but women with so-called recurrent miscarriage - when a woman has three or more miscarriages in a row - are at greater risk. Mothers with this diagnosis face isthmic-cervical insufficiency in 15-42% of cases.

Causes

Depending on the causes of its occurrence, ICI occurs in two types: functional and traumatic (anatomical).

Traumatic ICI occurs in cases where, even before pregnancy, the cervix was “compromised” by some damaging factors.

Functional reasons occur against the background of increased levels of the male hormone - androgen.

It is known that the female vagina is populated by a mass of bacteria, and with colpitis (an inflammatory process in the vagina), the number of these microorganisms increases significantly. This circumstance plays important role with existing isthmic-cervical insufficiency.

When the cervix shortens and opens slightly, the fertilized egg (lower pole) becomes infected, the membranes become soft, losing their strength and the amniotic fluid contained in them is poured out.

Most often, cervical insufficiency develops due to anatomical and functional factors.

Anatomical

Pathological changes in the internal os occur due to traumatic injuries in the cervix. Typically this happens due to:

• artificial medical abortions;
• intrauterine diagnostic studies;
• birth injuries (cervical ruptures).

After any traumatic damage to the cervical canal, scar tissue forms, which subsequently leads to cervical incompetence during pregnancy.

Doctors believe that with various intrauterine interventions prior to pregnancy associated with the expansion of the uterine cervix, the integrity of the muscle ring (sphincter) can be damaged. At the site of such damage, a scar is formed from connective tissue, which is not capable of either contraction or stretching.

Intervention in this situation means such manipulations as, for example, diagnostic curettage, medical abortions, etc. In addition, the growth of connective tissue instead of muscle can occur after fairly deep ruptures of the uterine cervix, during previous delivery.

One of the possible damaging factors is also considered to be previous inflammatory processes affecting the cervix: cervicitis, endocervicitis, endocervicosis, colpitis, and so on.

The development of isthmic-cervical insufficiency can also be provoked by previous or existing cervical dysplasia (erosions) (including after treatment).

Functional

Nervous regulation ensures the consistency of contraction and relaxation of the uterine muscles: long-term increase the tone of the uterus leads to relaxation of the cervix, and when it is in a calm state, the internal and external pharynx are always closed. Inconsistency of innervation can cause ICI, and these situations arise with the following problems:

• hyperandrogenism;
• malformations or underdevelopment of the uterus;
• a pronounced decrease in hormonal activity of the ovaries.

In addition, infection in the vagina (specific or banal colpitis, bacterial vaginosis, candidiasis) and pressure of the presenting part of the fetus.

The causes of functional ICI are most often hormonal disorders of the body, usually occurring with an excess of androgens or a lack of progesterone.

Functional ICI usually manifests itself between eleven and twenty-seven weeks of pregnancy. At this stage of intrauterine development, the adrenal glands begin to work in the growing fetus - an endocrine organ that, among other hormones, secretes androgens.

If this additional volume of male sex hormones falls on the “fertile ground” of a woman’s already existing even slightly increased own level of androgens (or the pregnant woman has hypersensitivity to them), then under their influence the cervix softens and, as in childbirth, shortens and opens.

What’s interesting is that uterine hypertonicity is most often not observed, so a woman who does not visit a gynecologist may not be aware of the presence of ICI.

Symptoms and diagnosis

Unfortunately, this disease occurs without any obvious symptoms. Sometimes a woman is bothered by a pulling sensation in the lower abdomen, abundant mucous membranes streaked with blood, or spotting bloody issues from the vagina.

Some pregnant women experience slight tingling in the vaginal area, bloating or pressure. And many people don’t notice anything at all.

It is impossible to detect the disease on your own, at home. Moreover, even timely visits to the doctor will do nothing if the woman is not regularly examined in the chair. Doctors pay special attention to those patients who have previously been diagnosed with ICI - during previous pregnancies.

Important! If a previous miscarriage had symptoms similar to ICI, you should tell your doctor about it at the first appointment.

In the future, when isthmic-cervical insufficiency has already developed, symptoms such as spotting, pain in the lower back or lower abdomen, and a feeling of pressure in the vagina can be detected. These are signs of a threatened miscarriage. It is important to remember: ICI can be completely asymptomatic.

Often, a doctor may not immediately diagnose isthmic-cervical insufficiency, since usually a woman does not present any complaints. Typically, the disorder is detected only when examining the expectant mother in a chair and using an ultrasound:

1. Inspection on the chair. The gynecologist examines the cervix and evaluates its length and consistency, whether it is slightly open, whether the fingertip is missing, or whether there are scars on it. If a woman may experience traumatic ICI due to previous problems, then the doctor should monitor the condition of the cervix every week or once every two weeks starting from the 12th week of pregnancy.
2. On ultrasound. When examined in a chair, the doctor cannot always estimate the length of the cervix in centimeters, so if he has an assumption that the pregnancy will be complicated by ICI, the specialist sends the expectant mother for an ultrasound. This study is carried out starting from the first trimester of pregnancy. Shortening of the cervix to 2-2.5 cm indicates a violation and requires surgical treatment.

The doctor determines the ICI when examining with mirrors, digital examination vagina or ultrasound. It can detect shortening of the cervix, its softening, and dilatation.

The obstetrician-gynecologist can also perform a test - for example, ask the pregnant woman to cough or press on the fundus of the uterus. With isthmic-cervical insufficiency, the cervix may open slightly under such influences. An ultrasound is performed using a vaginal sensor - the length of the cervix is ​​less than two centimeters and the diameter is more than one centimeter - alarming symptoms.

If all studies confirm the development of ICI, the doctor makes a decision on treatment methods and the possibility of continuing the pregnancy.

During the first examination in the first trimester of pregnancy, the doctor must assess the condition of the cervix - length, density, location, condition of the external os. Normally, the cervix should be dense and long (up to 4 cm), with a closed external os.

During the first ultrasound examination at 11-14 weeks, the doctor must perform cervicometry, i.e. assess the length and consistency of the cervix.

If the doctor notices a discrepancy, for example, it seems too short, or if the woman has already had premature birth in the past, as well as miscarriages or abortions, the doctor will order regular examinations every two weeks to carefully monitor the condition of the cervix.

The danger of ICN also lies in the fact that a pregnant woman may not notice the bad changes that are occurring in her body. The uterine os can open painlessly.

Sometimes there are minor nagging pains and very scanty bleeding. The first suspicion of cervical incompetence will arise during a doctor's examination or ultrasound.

For those women who are pregnant for the first time, the length of the cervix, detected using ultrasound cervicometry, should not fall below 30 mm. The optimal length of the cervical canal will be from 36 to 40 mm.

Important! If, during cervicometry, the doctor finds a cervical size of 29 mm or lower, then treatment is necessary to maintain the pregnancy.

Treatment

Once a deficiency is detected, usually in the case of large quantity hormones, doctors are trying to correct the situation through various medications. If the excess is traumatic in nature, then surgical intervention is possible.

Then follows a long process of healing and caring for the sutures, since during this period bacteria can accumulate on the sutures on the uterus, and it can form infectious process.

Conservative

The first and main conditions for successful treatment of isthmic-cervical insufficiency are bed rest and emotional peace. In the first case, the pressure of the amniotic sac on the cervix is ​​reduced due to horizontal position expectant mother, and the opening is suspended.

Well, in the second case, it is important not only the absence of stress, but also the positive attitude of the pregnant woman. Then the treatment will give positive results.

If the cause of isthmic-cervical insufficiency is functional and the disease develops due to an excess of hormones, especially androgens, drugs are prescribed that reduce this indicator and correct the level of hormones in the pregnant woman’s body.

After one or two weeks, the doctor examines the patient again - if the condition of the cervix is ​​stable, then treatment is stopped, and the woman is simply observed throughout the pregnancy, paying special attention to the cervix. The doctor should regularly examine the cervix in order to detect the slightest changes in time.

Sometimes patients may have a Meyer ring - a pessary - placed in the vagina. The ring helps to redistribute the weight of the fetus, and the neck helps to hold it.

A plastic pessary is installed in the early stages of the disease or if cervical insufficiency is suspected. It is removed at 37 weeks or before birth.

Installation of a pessary is a painless procedure, so no anesthesia is required. If the ring is chosen correctly, the expectant mother will not feel it at all.

In order to improve the results, along with the placement of the ring, drugs that relax the uterus and hormonal agents are prescribed to correct the general hormonal levels with hyperandrogenism, and also prevent placental insufficiency (since it often occurs with ICI).

A pregnant woman is recommended to sanitize the vagina with antiseptics or, if necessary, prescribe antibiotics. This is done so that dysbiosis does not develop, which can be caused by the presence of a foreign body in the vagina.

There are a few important points things you need to know:

1. Firstly, since a pessary is foreign body in the vagina, the risk of infection increases, and to monitor the situation, the expectant mother will need to have a smear every 2-3 weeks.
2. Secondly, after placing the ring, vaginal sex is prohibited.

The pessary, like sutures, is removed during full-term pregnancy or at the onset of labor. This procedure is completely painless.

Surgical

If drug treatment does not help or isthmic-cervical insufficiency has traumatic cause, the doctor makes a decision about surgical method treatment. The operation involves suturing the cervix and is performed under anesthesia. In this case, the dosage and drugs are chosen to minimize the negative impact of anesthesia on the child.

The optimal time for surgery is 13-17 weeks, but if necessary, the doctor can suggest surgical correction up to 28 weeks.

The method of applying a U-shaped or circular suture to the cervix, closing the exit from the uterus, is used. Indications for surgical correction of ICI are:

• the presence of two or more premature terminations of pregnancy in the 2nd trimester in the past;
• cervical length detected by ultrasound cervicometry is 20 mm or less;
• muscle incompetence in the cervical area discovered before pregnancy.

With such indications, the woman will be “sutured in” and she will most likely carry the pregnancy safely to 37 weeks (at this time the suture is removed).

The operation is most effective when the impact of the disease on the cervix is ​​not yet so great. Non-absorbable sutures are placed on the cervix, which are removed by the 38th week of pregnancy, that is, at the moment when labor suddenly begins is not scary - the baby is full-term.

Before the sutures are removed, they are examined every two weeks. After removing the sutures, if there are complications, additional treatment.

Sutures can be removed earlier for several reasons: cutting through the sutures, rupture or leakage of amniotic fluid, the onset of labor activity, bloody issues.

There are times when correction is necessary. This happens if the doctor, during an examination, finds a fertilized sac in the cervix. If the uterus often tenses, cutting of sutures may develop. To prevent this from happening, the pregnant woman is prescribed drugs that reduce the tone of the uterus - Magnesia, Ginipral, Papaverine.

If correction is not possible, the doctor prescribes bed rest and long-term use of tocolytics.

U surgery There are also contraindications. This - serious illnesses, non-developing pregnancy, congenital pathologies fetus, placenta previa.

In addition, the operation is performed under certain conditions: if the gestational age is at least 25 weeks, the amniotic sac is intact, the fetus is alive and has no malformations, and the tone of the uterus is normal.

The situation becomes much more complicated if the expectant mother has contraindications to this procedure.

• in the presence of acute vaginal infection;
• if the fetus has birth defects developments that are a contraindication to continuing pregnancy;
• serious and dangerous diseases in a pregnant woman, in which it is impossible to bear or give birth;
• Availability uterine bleeding any intensity.

Childbirth with ICN

Due to the fact that this deficiency is characterized by the inability of the muscle ring to be in a closed state, childbirth with such complications occurs very quickly. Modern capabilities make it possible to bring the baby to the patient the required period.

This is precisely why a hospital is needed, which allows for constant monitoring and does not provide opportunities for premature birth, which increases the possibility of miscarriage.

Unfortunately, this does not always work out. In case of early birth, the mother must be at the maternity hospital on time and have a folder with documents, a policy passport and an exchange card. It is very important not to forget the last element, because it contains the necessary information that obstetricians require in order to understand the situation in order to correctly deliver the child without complications.

Street notes that ICI is an infrequent occurrence, and if it is detected, there is no need to panic. After all, modern medicine makes it possible to cope with this pathology without any problems, especially with a timely diagnosis.

It is important not to be nervous and to comply with all the doctor’s requirements. Accept that you will have some physical changes that will be uncomfortable.

It is very important to control your diet when dealing with stress.

If you feel signs of neurosis, then try to dilute your diet with vegetables and fruits, without using special heat treatment. Timely rest is very useful in the fight against the mental influence of ICN.

Don't forget to sleep well, and we also recommend reading good books. Sometimes you can go for a walk fresh air, which will reduce the percentage of stress, but you don’t need to burden yourself for too long.

Remember that your psychological mood will play a very important role. Charge yourself with optimism, faith in the right outcome.

Fortunately, ICI does not appear so often, and if you are not at risk, then most likely this pathology It won't affect you. However, you should not be discouraged when you discover it.

Modern medicine has learned to deal with this serious illness. The most an important condition here is unquestioning execution medical recommendations. In addition, give up additional physical activity and lie down more.

Leave household chores in the care of your family and friends. Reception should not be ignored the necessary drugs that will help you decide this problem as quickly as possible.

Rehabilitation

After surgery, many questions arise. For example, is it possible for a woman to give birth on her own after such an operation or is this a direct indication for a cesarean section? How will your future health be? female organ?

After surgery, as a rule, women give birth on their own, after the stitches are removed. ICN is not an indicator of the need for caesarean section. Postpartum period proceeds in the same way as in other women in labor.

During and after treatment for isthmic-cervical insufficiency, the expectant mother must follow a regimen: reduce physical activity, avoid stress, visit a doctor, take prescribed medications in a timely manner, and get more rest.

When treating ICI, it is important not only to carry out therapy, but also to prolong pregnancy as much as possible.

A baby who is born to a mother diagnosed with “isthmic-cervical insufficiency” needs examination immediately after birth. And for some time afterward, the child should be observed and promptly examined in order to identify possible intrauterine infection, which could have occurred due to the fact that the cervix was slightly open.

A woman in labor with isthmic-cervical insufficiency is recommended to wait a couple of years for her next pregnancy, and before planning it, she needs to undergo necessary research and examination to eliminate the risk of relapse. Women with functional ICI are usually given appropriate therapy before their next pregnancy.

Important! Don't shy away from regular doctor's checkups. If your OB/GYN doesn't offer you such an exam, insist on having one anyway.

No matter how doctors correct the ICI, the expectant mother with this problem must adhere to the following rules:

1. Minimize physical activity: stop playing sports, yoga, etc. You should rest more and, if possible, delegate household chores to loved ones.
2. Avoid sexual contact. Like physical activity, this can provoke unwanted changes during pregnancy, so it is better to abstain until the baby is born.
3. Do not lift weights - even if it is an older child. Any physical activity can harm the fetus or cause a miscarriage, so before giving birth and for the first time after it, you must avoid any exercise.
4. Avoid stress. Equally important is a positive psychological attitude and belief in success.
5. Visit your gynecologist regularly. Remember to take all your prescribed medications on time. At the slightest deterioration in your health, you should immediately go to your doctor. Your health and the birth of your child depend on this.

Pregnancy is a period when it is better to play it safe. Well, if you are nevertheless given an unpleasant - nothing more - diagnosis, follow all the doctor’s prescriptions and look forward with optimism.

Prevention

The best prevention of ICN– refusal of medical abortions. In some cases, even a single artificial termination of pregnancy can cause cervical canal incompetence.
In order for the pregnancy to go well, it is necessary to carry out pre-conception preparation and prepare for it.

To prevent isthmic-cervical insufficiency it is important:

• pregnancy planning (careful adherence to contraception, since every surgical abortion injures the cervix);
• register with the antenatal clinic (up to 12 weeks) - it is on the chair that the doctor diagnoses ICN, the woman herself may not even be aware of it;
• regularly visit an obstetrician-gynecologist according to the schedule - this way the specialist will be able to monitor the condition of the cervix - the occurrence of ICI or the rate of opening of the cervix, if this disorder already exists.

If a miscarriage occurred during a previous pregnancy due to ICN, then you must prepare in advance for the next conception and gestation. When menstruation is delayed and positive test You must immediately begin the treatment prescribed by your doctor to help preserve the integrity of the cervix.

ICI occurs quite often - in almost every tenth woman (according to statistics in 9-10% of cases) in the first pregnancy and much more often with repeated ones. Moreover, the more births a woman has had, the greater the likelihood of isthmic-cervical insufficiency during subsequent pregnancy.

Regular assessment of cervical length using ultrasound cervicometry will be mandatory. When shortening begins, surgical intervention will be required to maintain and carry the pregnancy to term.

Pregnancy is a complex process during which new life grows and develops in the mother’s body. Of course, every woman wants her pregnancy to proceed smoothly, without problems, but this does not always work out that way. According to statistics, the diagnosis of ICI during pregnancy is present in 1 to 9% of pregnant women. Isthmic-cervical insufficiency, what is it? What symptoms are present? Is it possible to carry a child with such a diagnosis?

What is the ICN?

The pathology leading to involuntary termination of pregnancy is called isthmic-cervical insufficiency (ICI). Basically, the development of ICI occurs after 3 months of gestation. To explain more clearly what kind of pathology is hidden behind the diagnosis of ICI during pregnancy, let’s look at the structure of the main reproductive organ- uterus.

Physiological structure of the uterus

The uterus is a hollow organ similar to a sac; it consists of muscle tissue. In it, the egg attaches to one of the walls and begins to grow, turning into an embryo. The uterus has a cervix, which is part birth canal. More details on how the cervix changes during pregnancy is written in the article:.

During pregnancy, the lower segment of the uterus (cervix) is entrusted with the function of holding and protecting the fertilized egg from infection. During a normal pregnancy, without complications, the muscles of this neck close into a tight ring, and begin to relax gradually under the influence of the hormone progesterone, closer to the birth process. How progesterone levels change during pregnancy is written in the article:.

Types of ICI during pregnancy. What are the reasons for its development?

In medicine, ICN during pregnancy is divided into two types. The appearance of which is due to the causes of the pathology.

1. Organic ICN, it is also called traumatic. This type of ICN develops as a result of injury to the muscles of the lower segment of the uterus. Such an injury can occur during:

• the birth process is ruptures;
• examination (therapy) – damage when diagnosing pathology or during its treatment;
• gynecological operations - the conization method (an area on the cervix is ​​excised) or diathermocoagulation (cauterization);
• miscarriages (abortions) are mechanical damage when scraping.

Any of these injuries to the cervix in the birth canal leads to the replacement of muscle tissue at the site of scarring with connective (scar) tissue. These muscle tissues are rigid and inelastic.

2. Functional ICN. This type of pathology develops for three main reasons:

• disruption of the tissue composition of the birth canal when connective tissues present in the area of ​​the upper part of the organ (at the internal pharynx). This is a pathological feature of the individual organism;
• impaired sensitivity to the production of the hormone progesterone, this leads to softening and opening of the cervix under the pressure of the growing embryo;
• dysfunction of the ovaries or congenital abnormal functioning; the mechanism of development of such a pathology has not yet been studied, so doctors cannot yet answer why there is such an effect on the cervix.

Is there a danger of having ICN during pregnancy?

With any type of ICI during pregnancy, the lower segment of the uterus cannot cope with the pressure created by the growing fetus. The child begins to sink to the bottom of the organ and presses on the amniotic sac, which puts pressure on the muscles of the cervix. This causes this bladder to protrude into the fallopian canal. Since a woman’s vagina is not sterile, the membranes and fetus itself often become infected with various infections. Leakage of amniotic fluid may occur due to thinning of the membranes due to infection.

Medical statistics indicate that most cases of ICI during pregnancy are diagnosed in the second trimester of pregnancy.

Symptoms of ICI during pregnancy and the “risk zone”

The deplorable situation with ICI is that it has a minimum of symptoms. In the first trimester there are simply no symptoms. In II, prerequisites for a possible miscarriage may appear:

• a little muco-bloody discharge;
• nagging pain in the lower back, tailbone;
• lower abdomen hurts;
• a feeling of constant desire to go to the toilet due to a feeling of “fullness”.

Women who are in the so-called “risk zone” should be more careful about their condition and health during pregnancy. This “zone” includes expectant mothers:

• suffered severe ruptures during previous births;
• those who have had an abortion, such an intervention is especially dangerous due to trauma later;
• those who have undergone conization, amputation or cauterization of cervical tissue;
• having anomalies in the development of this organ;
• in whom this pregnancy is multiple or has polyhydramnios.

How can ICI be diagnosed during pregnancy?

In the early stages, up to 12 weeks, even an experienced gynecologist will not always be able to make a diagnosis. Therefore, after this period, a woman needs to regularly visit a gynecologist, not only to check in, weigh herself and measure her blood pressure (now this is done in many antenatal clinics), but also undergo a vaginal examination at each visit. If necessary, insist on an examination in a gynecological chair.

By digitally examining the lower segment of the uterus and using a special mirror, the gynecologist can detect:

• thinning;
• shortening;
• softening;
• passing a finger or two through the church canal;
• when using a mirror, you can see the fetal bladder protruding into the uterine canal.

It happens that in primigravidas the external os is tightly closed, and it is not possible to confirm the diagnosis with a digital examination. Then you should go ultrasonography(ultrasound).

How to treat ICI during pregnancy?

ICI can be treated during pregnancy only after an accurate diagnosis has been established and the causes of the pathology have been clarified. Only by knowing the cause of the problem can you choose an adequate treatment method. There are two methods of treating ICI during pregnancy.

Conservative method of treatment for ICI

If ICI during pregnancy is caused by hormonal imbalances, then hormonal drugs, which are aimed at leveling the background and toning the muscles of the lower segment of the uterus. They take the drugs for two weeks and undergo re-examination. If everything stabilizes, taking these hormonal drugs continue until birth. If the medications do not give an effect, a pessary is installed. A pessary or Meyer ring is a latex ring designed to be “put on” the cervix. The edges of the pessary rest against the walls of the vagina, preventing the muscles from relaxing and opening. This method is used in the early stages of ICI progression.

As a side effect of this method, the ring must be removed and disinfected every three days. Then put it back on. But for the sake of birth healthy child You can go for something else.

Treatment method by suturing

When conservative methods treatments do not have the desired effect, they are used surgery. It consists of “stitching” the cervix. Suturing is performed under local anesthesia.

Seams can be adjusted at different dates, but not later than 28 weeks. After several days, the condition of the stitches is checked, if everything is normal, the pregnant woman is discharged.

The main complications of the procedure include:

• suture infection;
• activation of uterine tone;
• discharge of amniotic fluid before the onset of labor.

Is it possible to carry a child to term if ICI is diagnosed during pregnancy?

As you already understand, timely detected ICI during pregnancy can be treated. Therefore, it is possible to carry and give birth to a child, the main thing is constant monitoring by doctors and compliance with the regime.

What regimen is necessary for ICI during pregnancy?

For any abnormalities during pregnancy, the expectant mother must follow the regimen. ICN is no exception. A pregnant woman should avoid any, even minimal physical activity, abstain from sexual intercourse, follow the recommendations of the gynecologist. Rest more, lie down, spend time in the fresh air.

Don’t forget about morale, because if you give up, you won’t achieve results. Set yourself up for a positive pregnancy, only good emotions and optimism. Talk to your baby, both the child and his mother need this. Even if there is deterioration, you should not be upset right away, because negative emotions will only make the process worse. Nervousness, anxiety, and fear can provoke uterine tone, which will not benefit your condition in any way.

The birth process with ICN

The birth process in women diagnosed with ICI occurs naturally, through the birth canal. Since the cervical muscles are weak and unable to remain in closed, then childbirth in women with this diagnosis proceeds quickly. Each case is individual and the time of the birth process cannot be predicted.

It should be noted that after 22 weeks of gestation, the chance of survival of the child appears, which increases by 3% with each week spent in the uterine cavity. Premature babies are no longer uncommon; they account for 10% of the total number of children born. The longer the period spent in the mother's womb, the greater the chance of giving birth to a healthy baby. Compliance with the regime and correct therapy helps to carry the fetus to term at 36–38 weeks.

After 35 weeks, it is better to go to a hospital, where the pregnant woman will be monitored 24 hours a day. As soon as you cross the 24 week mark, prepare all your things and documents for the maternity hospital, in case delivery begins ahead of time. Find out what you need to take with you by reading the article:.

Modern medicine can cope with ICI during pregnancy, so don’t give up on your situation. Be patient, positive emotions, optimism and take care of your health, because very soon you will meet the long-awaited baby.

Author of the publication: Victoria Teterina

Among the various causes of miscarriage, isthmic-cervical insufficiency (ICI) occupies an important place. If it is present, the risk of miscarriage increases almost 16 times.

The overall incidence of ICI during pregnancy ranges from 0.2 to 2%. This pathology is the main cause of miscarriage in the second trimester (about 40%) and premature birth - in every third case. It is detected in 34% of women with habitual spontaneous abortion. According to most authors, almost 50% of late pregnancy losses are caused by isthmic-cervical incompetence.

In women with a full-term pregnancy, labor with ICI often has a rapid nature, which negatively affects the condition of the child. In addition, rapid labor is often complicated by significant ruptures of the birth canal, accompanied by massive bleeding. ICN - what is it?

Definition of the concept and risk factors

Isthmic-cervical insufficiency is a pathological premature shortening of the cervix, as well as expansion of its internal os (muscular “obturator” ring) and the cervical canal as a result of increased intrauterine pressure during pregnancy. This can cause prolapse of the membranes in the vagina, their rupture and loss of pregnancy.

Reasons for the development of ICN

In accordance with modern ideas, the main causes of cervical inferiority are three groups of factors:

1. Organic - the formation of scar changes after traumatic injury to the cervix.
2. Functional.
3. Congenital - genital infantilism and uterine malformations.

The most common provoking factors are organic (anatomical and structural) changes. They may arise as a result of:

• cervical ruptures during childbirth with a large fetus, and;
• and removing the fetus by the pelvic end;
• rapid labor;
• overlays obstetric forceps and vacuum extraction of the fetus;
• manual separation and release of placenta;
• carrying out fruit-destroying operations;
• artificial instrumental abortions and;
• operations on the cervix;
• various other manipulations, accompanied by its instrumental expansion.

The functional factor is presented:

• dysplastic changes in the uterus;
• ovarian hypofunction and increased levels of male sex hormones in a woman’s body (hyperandrogenism);
• increased levels of relaxin in the blood in cases of multiple pregnancy, induction of ovulation by gonadotropic hormones;
• long-term chronic or acute inflammatory diseases internal genital organs.

Risk factors also include age over 30 years, overweight and obesity, and in vitro fertilization.

In this regard, it should be noted that the prevention of ICI consists of correcting the existing pathology and excluding (if possible) the causes of organic changes in the cervix.

Clinical manifestations and diagnostic possibilities

It is quite difficult to make a diagnosis of isthmic-cervical insufficiency, except in cases of gross post-traumatic anatomical changes and some developmental anomalies, since currently existing tests are not fully informative and reliable.

Most authors consider a decrease in the length of the cervix to be the main diagnostic sign. During a vaginal examination in the speculum, this sign is characterized by flaccid edges of the external pharynx and gaping of the latter, and the internal pharynx freely allows the gynecologist’s finger to pass through.

The diagnosis before pregnancy is established if it is possible to introduce cervical canal during the secretory phase of dilator No. 6. It is advisable to determine the state of the internal pharynx on the 18th – 20th day from the beginning of menstruation, that is, in the second phase of the cycle, using, in which the width of the internal pharynx is determined. Normally, its value is 2.6 mm, and the prognostically unfavorable sign is 6-8 mm.

During pregnancy itself, as a rule, women do not present any complaints, and clinical signs suggesting the possibility of a threat of miscarriage are usually absent.

In rare cases, indirect symptoms of ICI are possible, such as:

• sensations of discomfort, “bloating” and pressure in the lower abdomen;
• stabbing pain in the vaginal area;
• discharge from the genital tract of a mucous or sanguineous nature.

During the period of observation in the antenatal clinic, a symptom such as prolapse (protrusion) of the amniotic sac is of considerable importance in relation to the diagnosis and management of a pregnant woman. At the same time, the degree of threat of termination of pregnancy is judged by 4 degrees of location of the latter:

• I degree - above the internal os.
• II degree - at the level of the internal pharynx, but is not visually determined.
• III degree - below the internal pharynx, that is, in the lumen of the cervical canal, which indicates a late detection of its pathological condition.
• IV degree - in the vagina.

Thus, the preliminary criteria clinical diagnostics isthmic-cervical insufficiency and inclusion of patients in risk groups are:

1. Anamnesis data on the presence in the past of low-painful miscarriages in late gestation or rapid premature births.
2. . It is taken into account that each subsequent pregnancy ended in premature birth at increasingly earlier gestational stages.
3. The onset of pregnancy after a long period of infertility and use.
4. The presence of prolapse of the membranes in the cervical canal at the end of the previous pregnancy, which is established according to the anamnesis or from the dispensary registration card located in the antenatal clinic.
5. Data from vaginal examination and speculum examination, during which signs of softening of the vaginal cervix and its shortening, as well as prolapse of the amniotic sac in the vagina are determined.

However, in most cases, even a pronounced degree of prolapse of the amniotic sac occurs without clinical signs, especially in primiparas, due to a closed external os, and risk factors cannot be identified until labor occurs.

In this regard, ultrasound for isthmic-cervical insufficiency with determination of the length of the cervix and the width of its internal pharynx (cervicometry) acquires high diagnostic value. A more reliable method is an echographic examination using a transvaginal sensor.

How often should cervicometry be done for ICI?

It is carried out at the usual screening periods of pregnancy, corresponding to 10-14, 20-24 and 32-34 weeks. In women with recurrent miscarriage in the second trimester, in cases of obvious presence of an organic factor or if there is a suspicion of the possibility of post-traumatic changes from 12 to 22 weeks of pregnancy, it is recommended to conduct a dynamic study - every week or once every two weeks (depending on the results of examining the cervix in the mirrors ). If the presence of a functional factor is assumed, cervicometry is performed from 16 weeks of gestation.

The criteria for assessing echographic examination data, primarily on the basis of which the final diagnosis is made and treatment of ICI during pregnancy is selected, are:

1. In first- and multi-pregnant women with a period of less than 20 weeks, the length of the cervix, which is 3 cm, is critical in terms of threatening spontaneous abortion. Such women need intensive monitoring and inclusion in the risk group.
2. Up to 28 weeks in multiple pregnancies bottom line The normal cervical length is 3.7 cm for primigravidas and 4.5 cm for multigravidas.
3. The normal cervical length in multiparous healthy pregnant women and women with ICI at 13-14 weeks is from 3.6 to 3.7 cm, and at 17-20 weeks the cervix with insufficiency is shortened to 2.9 cm.
4. An absolute sign of miscarriage, which already requires appropriate surgical correction for ICI, is a cervical length of 2 cm.
5. The normal width of the internal os, which is 2.58 cm by the 10th week, increases uniformly and reaches 4.02 cm by the 36th week. A decrease in the ratio of the length of the neck to its diameter in the area of ​​the internal os to 1.12 has a prognostic value. -1.2. Normally, this parameter is 1.53-1.56.

At the same time, the variability of all these parameters is influenced by the tone of the uterus and its contractile activity, low placental attachment and the degree of intrauterine pressure, creating certain difficulties in interpreting the results in terms of differential diagnosis reasons for the threat of miscarriage.

Ways to maintain and prolong pregnancy

When choosing methods and drugs for correcting pathology in pregnant women, a differentiated approach is necessary.

These methods are:

• conservative - clinical guidelines, treatment with drugs, use of a pessary;
• surgical methods;
• their combination.

Includes psychological impact by explaining the possibility of successful pregnancy and childbirth, and the importance of following all the recommendations of the gynecologist. Advice is given regarding the elimination of psychological stress, the degree physical activity depending on the severity of the pathology, the possibility of decompression exercises. Carrying loads weighing more than 1 - 2 kg, long walking, etc. are not allowed.

Is it possible to sit with ICN?

Sitting for long periods of time, as well as vertical position In general, it helps to increase intra-abdominal and intrauterine pressure. In this regard, it is advisable to be in a horizontal position more often and longer during the day.

How to lie down correctly during ICN?

You need to rest on your back. The foot end of the bed should be raised. In many cases, strict bed rest is recommended, mainly observing the above position. All these measures can reduce the degree of intrauterine pressure and the risk of prolapse of the amniotic sac.

Drug therapy

Treatment begins with a course of anti-inflammatory and antibacterial therapy drugs from the third generation fluoroquinolone or cephalosporin group, taking into account the results of a preliminary bacteriological study.

To reduce and, accordingly, intrauterine pressure, antispasmodic drugs such as Papaverine orally or in suppositories, No-spa orally, intramuscularly or intravenously are prescribed. If they are insufficiently effective, tocolytic therapy is used, which contributes to a significant decrease in uterine contractility. The optimal tocolytic is Nifedipine, which has the lowest number side effects and their insignificant expression.

In addition, in case of ICN, it is recommended to strengthen the cervix with Utrozhestan of organic origin up to 34 weeks of pregnancy, and in the case of a functional form with the drug Proginova up to 5-6 weeks, after which Utrozhestan is prescribed up to 34 weeks. Instead of Utrozhestan, the active component of which is progesterone, analogues of the latter (Duphaston, or dydrogesterone) can be prescribed. In cases of hyperandrogenism, the basic drugs in the treatment program are glucocorticoids (Metypred).

Surgical and conservative methods for correcting ICI

Can the cervix lengthen with ICI?

In order to increase its length and reduce the diameter of the internal pharynx, methods such as surgical (suturing) and conservative in the form of installing perforated silicone obstetric pessaries of various designs are also used to help shift the cervix towards the sacrum and keep it in this position. However, in most cases, the cervix does not lengthen to the required (physiological for a given period) value. Usage surgical method and pessary is carried out against the background of hormonal and, if necessary, antibacterial therapy.

What is better - sutures or a pessary for ICI?

The procedure for installing a pessary, in contrast to the surgical technique of suturing, is relatively simple in terms of technical implementation, does not require the use of anesthesia, is easily tolerated by a woman and, most importantly, does not cause circulatory problems in the tissues. Its function is to reduce the pressure of the fertilized egg on the incompetent cervix, preserve the mucus plug and reduce the risk of infection.

Obstetric relief pessary

However, the use of any technique requires a differentiated approach. With the organic form of ICI, the application of circular or U-shaped (better) sutures is advisable during 14-22 weeks of pregnancy. If a woman has a functional form of pathology, an obstetric pessary can be installed within a period of 14 to 34 weeks. In case of progression of shortening of the cervix to 2.5 cm (or less) or an increase in the diameter of the internal pharynx to 8 mm (or more), in addition to the pessary, surgical sutures. Removal of the pessary and removal of sutures for PCN is carried out in a hospital setting at the 37th – 38th weeks of pregnancy.

Thus, the ICN is one of the most common reasons termination of pregnancy before 33 weeks. This problem has been sufficiently studied and adequately corrected ICI in 87% or more allows achieving the desired results. At the same time, correction methods, methods for monitoring their effectiveness, as well as the question of the optimal timing of surgical treatment still remain controversial.