ICN during pregnancy - what is it. Signs and symptoms of isthmic-cervical insufficiency during pregnancy. What is isthmic-cervical insufficiency during pregnancy and how to treat it

Every expectant mother dreams that her pregnancy will proceed easily and calmly and end with the birth of a long-awaited baby. But, unfortunately, this is not always the case. Some violations in female body can cause a threat of termination of pregnancy in the first trimester, while others, even more sadly, in the second or even third. And among such problems, which often become the cause of late spontaneous miscarriages or premature births, is isthmic-cervical insufficiency (ICI).

What is ICN and why is it dangerous?

The uterus is a muscular organ that includes the body and cervix. The fetus develops in the body cavity, and the cervix helps hold it and protects it from infection. The cervical canal from the side of the uterine body is limited by the internal pharynx, and from the side of the vagina - by the external pharynx. Normally, during pregnancy, the cervical muscles close into a ring and relax gradually as labor approaches. But sometimes the muscles of the neck weaken earlier than required, and it begins to shorten and open. This state is called isthmic-cervical insufficiency. It occurs in 1-9% total number pregnant women and in 15-42% of women with recurrent miscarriage. Dilatation of the cervix leads to the descent of the amniotic sac into the lower part of the uterine cavity, as a result of which the membranes of the fetus become infected and open prematurely. Then labor develops, leading to late miscarriage (up to 22 weeks of pregnancy) or premature birth (up to 37 weeks) with the appearance of a premature baby.

Risk factors for ICI

The reasons that can cause the development of isthmic cervical insufficiency during pregnancy, consider:

injury to the cervix (severe ruptures and damage) during childbirth or abortion
treatment of cervical pathologies by conization or amputation
abnormalities of the uterus
functional changes in dysplasia connective tissue, hyperandrogenism, sex hormone deficiency
carrying out IVF
multiple births, polyhydramnios, large fetus.

Symptoms and signs of ICN

It is difficult to suspect the development of ICI on your own. In the first trimester of pregnancy, its symptoms are usually absent. In the future, signs characteristic of a threatened miscarriage may appear: a small amount of bloody or mucous discharge streaked with blood, pain in the lower back and lower abdomen, a feeling of “bloating” or “pressure” in the vagina. But most often, ICI is asymptomatic, so every pregnant woman should regularly visit an obstetrician-gynecologist in order to recognize it in time. Doctors determine ICI by examining the cervix with a speculum, by performing a digital vaginal examination, or by performing an ultrasound.

Upon examination the doctor may notice softening and shortening of the cervix, and then the opening of its canal, in which the amniotic sac is visible. But since the external os nulliparous women may be closed, it is important to confirm the diagnosis using transvaginal ultrasound.

On ultrasound signs of ICN are determined according to the following criteria:

cervical length

Normally, at 24-28 weeks of pregnancy it is 35-45 mm, after 32 weeks - 30-35 mm. Shortening at 20-30 weeks to 25 mm or less confirms the doctor’s fears.

the presence of a V-shaped opening of the internal throat

it is easy to determine, and additional tests can be performed with pressure on the fundus of the uterus or cough.

Upon confirmation of the diagnosis, the gynecologist makes a decision on methods for correcting ICI and the possibility.

Treatment of ICN

There are two main methods: surgical and conservative. They are often used simultaneously.

Surgical method

Consists of placing sutures on the cervix, which mechanically narrows internal os and the outer one is sutured, which significantly reduces the likelihood of miscarriage.

The timing of the operation is set individually, but most often - up to 17 weeks, in order to avoid progression of the process, and no later than 28 weeks of pregnancy. Sutures are placed in a hospital under short-term intravenous anesthesia, which does not affect harmful influence for the fruit. Usually, a few days before the intervention, a smear is taken from the cervical canal to determine pathogenic microflora and carry out preliminary sanitation of the vagina. There are also contraindications to surgical treatment ICN: this serious illnesses mothers, non-developing pregnancy, congenital pathologies of the fetus, placenta previa. To prevent complications after surgery, the composition of the microflora is examined again, and the vagina is treated with antiseptics. Drugs that reduce uterine tone (such as ginipral, indomethacin, magnesia) and antispasmodics (papaverine) are often prescribed. Use according to indications hormone therapy. Sutures are inspected every 2-3 weeks and removed in the following cases:

after 37-38 weeks of pregnancy
at the beginning labor activity at any time
with leakage and rupture of amniotic fluid
when bloody discharge
during teething

After removal of the sutures, in case of complications, necessary treatment. If repeated correction is not possible, bed rest and long-term use of tocolytics are recommended.

Conservative way

It consists of installing an obstetric unloading pessary (Meyer ring) - a specially shaped plastic structure that is placed in the vagina on different dates pregnancy (including after 28 weeks, when suturing is not possible). It redistributes the weight of the fetus and helps the cervix hold it. Installation of a pessary is effective in case of suspicion and early stages ICN. In case of severe manifestations, the method is used as an auxiliary one. The presence of a foreign body in the vagina can cause dysbiosis, so doctors prescribe preventive courses of sanitation with antiseptics and regularly take smears. Antibiotics are prescribed if necessary. The pessary is removed at 37-38 weeks of pregnancy or immediately after the onset of labor at any stage.

Compliance with the regime

Do not forget that the success of treatment for ICI also depends on the woman’s adherence to special caution in all household affairs: you need to reduce physical activity as much as possible, avoid sexual intercourse, avoid stress, regularly visit a doctor and take prescribed medications. You should rest more and, if possible, delegate household chores to loved ones. Equally important is a positive psychological attitude and belief in success. All this will help to prolong your pregnancy as much as possible and give birth to a healthy baby.

This is the most common reason premature birth and miscarriages. Isthmic-cervical insufficiency is called cervical insufficiency. Fortunately, early diagnosis of the abnormality and adequate treatment greatly increases the chances of a successful birth when the time comes.

Cervix- this is very important element female reproductive system. The uterus, combined with the vagina, represents the “canal” through which the child bursts when it comes into our world. However, before the baby is born, the cervix blocks open access to the uterus and protects the baby from bacteria, viruses or fungi from the outside. In a properly progressing pregnancy, the cervix softens and begins to shorten only at the end of the 3rd trimester of pregnancy.

Since the cervix consists of little elastic connective tissue, its integrity is very easily damaged during pregnancy, when the growing child puts more and more pressure on it. Manifestations of cervical insufficiency are varied - it can be premature contraction cervix, excessive loosening or softening of its tissues. Any of these abnormalities carry a risk of miscarriage or premature birth. The risk is due to the fact that the growing fetus can easily slide towards the vagina if the entrance to the uterus is not securely closed - long before the planned due date.

Causes of isthmic-cervical insufficiency of the cervix

A healthy cervix is 3 to 5 cm long. In women who are not pregnant, the cervix is slightly open, and after fertilization it becomes firm, dense and lengthened. It should remain this way until childbirth, and contraction and dilation of the cervix occurs only at the end of the third trimester of pregnancy.

Most often, isthmic-cervical insufficiency manifests itself after pregnancy, when the child grows more rapidly and gains weight, and therefore puts more pressure on the cervix. If the organ is too weak, it becomes soft, and this is a real threat to pregnancy.

Doctors identify several reasons for a weakened cervix. For example, this may be caused by damage during previous medical procedures(curettage, artificial miscarriage) or childbirth. Other causes include the following: congenital cervical defect, improper production of collagen or elastin, hormonal disorders. Excessive shortening of the cervix can be caused by an intense lifestyle expectant mother.

To support pregnancy, prevent miscarriage and premature birth, patients with isthmic-cervical insufficiency are prescribed progesterone.

How to avoid the consequences of cervical insufficiency

Thanks to timely ultrasound examinations and frequent visits to the gynecologist, it is possible to quickly diagnose any disorders associated with the cervix. Therefore, adequate medical control is the first step to prevent or minimize the risk of developing the consequences of cervical insufficiency.

It is also important for a pregnant woman to notice the first alarming symptoms:

premature contractions;
tension in the abdomen;
pain;
brown

If you have any of these, you should consult a doctor.

To avoid consequences associated with cervical disorders, the speed of adoption is important medical measures. Fortunately, today doctors can offer many solutions in case of isthmic-cervical insufficiency, which in most cases guarantees a happy completion of pregnancy.

Pessary- this is a rubber washer (casing) that mechanically unloads the cervix, taking on part of the pressure exerted by the fetus. Its introduction does not require any pre-treatment, however, you need to remember that the presence of a pessary increases the risk of developing an infection in the body, therefore, towards the end of pregnancy, the expectant mother should additionally use vaginal suppositories. The pessary is removed when the pregnancy reaches .

Circular seam is a suture that is placed at the base of the cervix during an operation performed under anesthesia. Applying a circular suture is the most effective way avoiding premature birth. The percentage of women who manage to carry a child to term if this measure is taken reaches 80-90%.

It should also be borne in mind that in the case of isthmic-cervical insufficiency, the pregnant woman should lead a modest lifestyle - lie down a lot, do not make sudden movements, avoid physical activity and give up entertainment. This reduces the likelihood of injury and stressful situations and the chances of a happy ending to pregnancy increase.

Patients who are at increased risk of preterm birth should be treated in facilities that can provide the best specialized care for a preterm baby.

Symptoms that require you to go to the hospital

Cervical insufficiency often appears suddenly, without prior alarming symptoms. At the same time, it is difficult to prevent miscarriage or premature birth, because the cervix expands prematurely and is no longer able to compress the membranes, as well as the rapidly growing and pressing eggs of the fetus.

However, the disease is not always asymptomatic. When the cervix contracts and dilates prematurely, this can be noticed by the following signs:

bloody discharge (dark, brown color);
pain in the abdomen and spine.

What is the treatment for isthmic-cervical insufficiency?

Sometimes it happens that for the treatment of isthmic-cervical insufficiency, bed rest and administration medicines at home is not enough, and, despite the short period of pregnancy, labor begins. In such a situation, the woman should immediately go to the hospital. Characteristic symptom premature birth is, first of all,... The expectant mother experiences more than 4 contractions in 20 minutes, or more than 8 contractions in 60 minutes, with the systole lasting more than half a minute. To others possible symptoms include the loss of amniotic fluid and dilatation of the cervix, which can be detected during a gynecological examination. In this case, the pregnant woman will need hospitalization.

All necessary medical research can be carried out in the hospital ward: the length and consistency of the cervix, the width of the uterine dilatation, analysis of vaginal discharge, etc. To assess the position of the baby and placenta, gestational age, and monitoring contractile activity uterus and fetal heart rate are prescribed ultrasonography(ultrasound). As a rule, in such situations, obstetricians consult with a neonatologist, who, based on research, assesses the condition of the child and its likely viability outside the mother’s womb. The doctor must also decide whether the baby will need to be transported to a facility that specializes in treating premature babies. Further adoption of medical measures depends on the condition of the expectant mother and the changes that have occurred in her cervix.

As a rule, a patient with isthmic-cervical insufficiency is recommended to remain in the pregnancy pathology department and follow bed rest, which will avoid increasing pressure on the cervix, and also take medications that reduce. Hydration with physiological solutions (potassium, magnesium) is also necessary. All procedures used in this case are aimed at maximally delaying the onset of labor, because every day of pregnancy has great value for the development of the child’s body and increases his chances of having good health.

Isthmic-cervical insufficiency- video

Isthmic-cervical insufficiency: icn during pregnancy, what is it

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Pregnancy is a special period in the life of every woman. Unfortunately, things don't always go smoothly. Many expectant mothers face various complications while carrying a child. Their list also includes such pathology as isthmic-cervical insufficiency.

It is worth immediately noting that such a complication is dangerous. In the absence of timely assistance, spontaneous termination of pregnancy is possible. This 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 is worth studying thoroughly.

What is pathology?

Isthmic-cervical insufficiency (ICD assigned code O34.3 to this condition) is a pathology that is accompanied by the opening of the internal os of the uterus under the influence of pressure. As statistics show, in different countries From 1 to 9% of pregnant women face a similar problem.

As you know, the uterus consists of a body (this is a kind of muscular sac, in the cavity of which the fetus develops) and a cervix. The cervix is a small tube with the cervical canal running inside it. The bulk of the muscles are concentrated in the upper part of the cervix - this is where the internal os is located. The muscles of the pharynx are compressed into a ring, thereby preventing the fetus from leaving prematurely.

Isthmic-cervical insufficiency is characterized by muscle weakness. As a result of this, the pharynx begins to open, resulting in possible prolapse membranes in the vagina, miscarriage or premature birth.

Traumatic form of failure

Such a pathology can develop under the influence of various factors. However, insufficiency is often the result of cervical injury. Almost any procedure that involves expanding cervical canal. In particular, risk factors include abortion, diagnostic and therapeutic curettage. In addition, trauma can occur during childbirth, as well as IVF procedures. The fact is that connective scar tissue forms at the site of damage. It is not elastic and cannot stretch, which in the future leads to the development of insufficiency.

Functional form of pathology

The functional form of isthmic-cervical insufficiency is usually associated with hormonal disorders. Weakening of the muscle tissue of the uterus may be associated, for example, with a deficiency of progesterone or an increase in androgen levels.

Symptoms of this form of pathology, as a rule, begin to appear at early stages(from 11 weeks). Fortunately, this type of deficiency usually responds well to hormonal drug therapy.

Other types of deficiency. Are there risk factors?

Of course, there are other reasons and risk factors that should not be ignored. Isthmic-cervical insufficiency often develops in women with congenital anomalies relating to the structure of the uterus (for example, saddle or bicornuate uterus). By the way, such pathologies can be identified even at the stage of pregnancy planning - you just need to see a doctor and undergo the necessary examinations.

Isthmic-cervical insufficiency sometimes develops as pressure on the uterus increases. Risk factors include multiple births, the presence of one but very large fetus, as well as the formation of too many large quantity amniotic fluid.

The risk group includes patients who already have a history of previous miscarriages or premature births.

Isthmic-cervical insufficiency during pregnancy: symptoms

What signs should you look out for? What disorders are accompanied by isthmic-cervical insufficiency? Sometimes there are no symptoms at all. Insufficiency is diagnosed already during an examination after a miscarriage or premature birth.

But there are quite a number characteristic features, which are accompanied by isthmic-cervical insufficiency during pregnancy:

Vaginal discharge is one of the symptoms. They are usually abundant, mucous, sometimes streaked with blood.
Some women complain about discomfort in the suprapubic region, nagging pain in the lower back.
Appear frequently unpleasant pain lower abdomen, which often spread to lumbar region and sacrum.
Sometimes patients note the appearance of a bursting sensation in the vagina. Some women describe it as a feeling of pressure, fullness. Sharp, stabbing pain may occur.

If such violations occur, you should immediately consult a doctor. Such symptoms should not be ignored under any circumstances.

Why is such a condition dangerous?

Isthmic-cervical insufficiency during pregnancy is very serious problem, which under no circumstances should be ignored. The result of such a pathology, as a rule, is miscarriage - pregnancy either ends in spontaneous miscarriage in the early stages, or premature birth, which, in turn, is dangerous for the fetus (a child born too early needs medical care and appropriate care, the risk of death of the baby is high).

In addition, due to the increasing pressure and weakness of the cervix, the risk of penetration is high pathogenic microorganisms and infection of the membranes of the fetal bladder. It is also possible partial damage membranes, which is also fraught with mass dangerous complications.

What does the diagnostic process look like?

If you suspect any violations, a woman should definitely contact an obstetrician-gynecologist who is managing the pregnancy.

To begin with, anamnesis is collected. It is important to familiarize yourself with all the patient’s complaints and determine when exactly the problems began. You also need to study the woman’s medical record, which may contain information about previously suffered gynecological diseases, abortions, miscarriages, etc.
A 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, and the presence of pain 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, and identify areas with scar changes (if any).
A transvaginal ultrasound examination is also indicated, which will give the specialist more information about the condition of the cervix and the degree of closure of its internal os.

Isthmic-cervical insufficiency: treatment with medications

The treatment regimen is determined depending on general condition patient, gestational age, degree of cervical insufficiency and some other factors.

If there is a violation hormonal levels, then it is brought back to normal by taking hormonal drugs.
For decreasing muscle tension patients are prescribed tocolytics (such drugs help relax the muscles of the uterus).
Sometimes women are prescribed vasodilators, low molecular weight dextrans (help improve blood properties), vasoactive agents (ensure dilation of small vessels). This therapy helps prevent the development of placental insufficiency.

The right regimen for the expectant mother

The presence of insufficiency does not mean that the pregnancy will necessarily be terminated. With proper treatment, a woman can successfully carry a child. Drug treatment and surgical correction, of course, will help prevent miscarriage. However, a woman needs to follow certain rules.

Required Physical exercise, as well as sexual intercourse are contraindicated, as this can further weaken the cervix. You need to stop lifting weights and homework, get more rest, eat right. It is important to maintain peace of mind, since any stress is accompanied by the release of certain hormones, which affects work reproductive system. A woman should maintain a positive attitude, follow all the doctor’s recommendations, take the medications chosen by the specialist and, of course, not skip routine examinations. In some cases, until the end of pregnancy, a woman remains in a hospital under constant medical supervision.

What is the installation of a relief pessary?

In addition to drug therapy, a woman is sometimes fitted with a special unloading pessary. The Meyer ring is a special plastic structure that is placed deep into the vagina. This device provides support for the cervix and redistributes the loads associated with the pressure on the tissue of the amniotic fluid and the growing child.

This simple procedure, which should be done in case of 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.

It is usually removed at 37 weeks or when labor is active. 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 possibility of developing vaginal dysbiosis. That is why patients need to regularly undergo microflora smears.

Surgical correction and its features

If for one reason or another drug therapy and installing the Meyer ring does not give desired result, then correction of isthmic-cervical insufficiency is carried out surgically.

In this case, we are talking about narrowing the pharynx of the uterus with the subsequent application of strong non-absorbable sutures to it. This is a rather responsible procedure that is carried out in a hospital setting. First, the vagina is sanitized, after which sutures are placed on the pharynx tissue. The procedure requires short-term anesthesia.

As a rule, such fixation is carried out in the early stages of pregnancy. In any case, the procedure should not be performed after 28 weeks of gestation. The sutures are removed in the gynecological office at approximately 38 weeks. Premature removal of suture material is carried out if there is active labor, bleeding, or leakage of amniotic fluid. The patient is also required to take medications to prevent uterine hypertonicity.

Forecasts for expectant mothers: what do you need to know?

Proper management of pregnancy with isthmic-cervical insufficiency includes regular examinations and ultrasound monitoring. If it is possible to stabilize the uterus with the help of medications or sutures, then the woman can successfully carry a child.

Nevertheless, childbirth in most cases proceeds very quickly and requires certain skills from the doctor. That is why the patient is recommended to go to the hospital several days or even weeks before the expected date of birth. The process itself, as a rule, proceeds without any serious deviations.

Prevention of pathology during recurrent pregnancy

If a woman had isthmic-cervical insufficiency during pregnancy, then conceiving the next child can begin to be planned after at least two years. Before immediate fertilization, the patient is recommended to undergo full examination to determine if there is a risk re-development insufficiency.

During pregnancy, it is very important that expectant mother adhered to correct mode, monitored the slightest changes in health, regularly visited 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.

Isthmic-cervical insufficiency (ICI) is a pathology in which the opening and natural shortening of the cervix occurs before the due date (up to 27 weeks of pregnancy). ICI is considered one of the leading causes of spontaneous miscarriage in the second trimester. The frequency of pathology in women with recurrent miscarriage is 15-20%.

Causes of ICN

Isthmic-cervical insufficiency can be congenital or acquired. Congenital pathology most often associated with concomitant developmental anomalies of the genital organs. Surgical correction of the defect allows you to cope with the problem and gives the woman a chance to bear and give birth to a child.

Reasons for acquired INC:

cervical injury;
hormonal disorders;

Cervical injury most often occurs after a difficult birth. Large fruit breech presentation and a narrow pelvis - all this provokes the appearance of deep ruptures in the cervix, vagina and perineum. Complicated abortions and termination of pregnancy later can also lead to organ injury. Particularly noteworthy are invasive manipulations on the cervix (conization, etc.), after which rough scars remain.

Among all hormonal disorders Connective tissue dysplasia deserves attention. With this pathology, the structure of collagen fibers is disrupted, as a result of which the affected organ cannot fully perform its functions. The clinical manifestations of connective tissue dysplasia are varied, and ICI is only one of the many symptoms of the pathology. The disease is inherited.

Increased load on the cervix occurs with polyhydramnios and multiple pregnancies. In this situation, the organ does not always cope with its task, and the pregnancy often ends ahead of schedule. Carrying a large fetus also provokes the development of ICI.

Symptoms

Insufficiency of the cervix is manifested by its gradual shortening, softening and opening. Normally, the opening of the uterine pharynx should occur no earlier than 37 weeks. This process indicates that the woman’s body is preparing for childbirth and the baby will soon be born. Dilatation of the cervix before 37 weeks of pregnancy leads to premature birth or miscarriage.

ICN does not have typical clinical manifestations. Shortening of the cervix occurs completely painlessly. Nonspecific symptoms may appear:

nagging pain in the lower abdomen;
pain in the lumbar region;
feeling of fullness in the perineum;
scanty bleeding.

In most cases, ICI is asymptomatic. A woman learns about the problem only at the time of a miscarriage or when premature labor begins. Timely ultrasound screening allows you to detect pathology and take all measures to avoid the development of such serious complications.

Diagnostics

Predicting the development of ICI before pregnancy is quite difficult. Women who have suffered a difficult birth, multiple abortions or invasive interventions on the cervix are at risk for the development of pathology. We are talking exclusively about gross damage visible during normal inspection. Minor injuries that can trigger the development of ICI can be quite difficult to detect. Often the problem occurs without any previous signs.

For timely detection of ICI, an ultrasound examination is performed at 19-20 weeks. Until this time, the length of the cervix is very variable, and its measurement is not very indicative.

Normal cervical length (according to ultrasound):

20-28 weeks – 35-45 mm;
28-32 weeks – 30-35 mm;
after 32 weeks – 30 mm.

Shortening of the cervix to 25 mm at less than 28 weeks is considered one of the signs of ICI. This pathology is supported by the softening of the organ and the opening of the uterine pharynx. A doctor can assess the consistency of the cervix when examining a patient in a gynecological chair.

For women suffering from recurrent miscarriage, a different approach is taken. If there have been two or more spontaneous miscarriages in the past, it is recommended to ultrasonic testing cervical length after 12 weeks. Ultrasound is done every 2 weeks. At each appointment, the cervix must be examined in a speculum. When the first signs of ICI appear, the issue of specific therapy is decided.

Treatment methods

There are two ways to cope with the problem during pregnancy:

Obstetric pessary

An obstetric pessary (Meyer ring) is a silicone ring, which is placed directly on the cervix. The ring reduces the load on the organ and holds the neck in the desired position. The use of a pessary allows you to prolong pregnancy until the due date.

Installation of an obstetric pessary does not require anesthesia. The procedure is not very pleasant, but completely painless for the woman. The Meyer ring does not interfere with the normal course of pregnancy, does not interfere with the growth of the uterus and the development of the fetus. After 37 weeks, the pessary is removed, and labor soon begins. If necessary, the doctor can remove the pessary at any stage of pregnancy.

An obstetric pessary is installed at 14-26 weeks. When using the ring it is not recommended to conduct sex life. Physical activity is also prohibited. Like any foreign body in the vagina, a pessary can cause infection. If any strange discharge from the genital tract appears, you should be examined by a gynecologist.

Sutures on the cervix

Suturing the cervix is performed between 13 and 27 weeks of pregnancy. The procedure is performed in a gynecological hospital and requires certain preparation. Before surgery, careful sanitization of the vagina is necessary to prevent the development of a genital tract infection. Otherwise, infection may enter the uterine cavity and infect the fetus.

Circular sutures are applied to the cervix under general anesthesia. The whole procedure takes no more than 10 minutes. After the operation, the woman remains under doctor's supervision for some time. It is imperative to prescribe medications that reduce the tone of the uterus and prevent the start of labor. If the pregnancy progresses well, the sutures are removed after 37 weeks.

Stitches are not the best safe procedure. They resort to it according to strict indications, when there are no other ways to maintain the pregnancy. Surgery and the use of anesthesia themselves can provoke termination of pregnancy. Whenever possible, gynecologists try to avoid an invasive procedure and use a Meyer ring to correct ICI.

Indications for suture or pessary removal:

gestational age 37 weeks;
rupture or leakage of amniotic fluid;
bleeding from the genital tract of any intensity;
the onset of regular labor at any stage of pregnancy;
divergence of seams.

Prevention

With post-traumatic ICI, surgical correction of the pathology before pregnancy is possible. In this situation it is done Plastic surgery on the cervix, which allows the woman to carry the child to term in the future. After surgical correction independent childbirth impossible. A high risk of suture rupture during childbirth is an indication for cesarean section.

The following recommendations will help reduce the risk of developing ICI during pregnancy:

Planning pregnancy and using reliable methods of contraception.
Refusal of abortions (including late stages).
Careful management of childbirth.
Mandatory examination of the genital tract after the birth of a child to exclude cervical ruptures.
Use of advanced technologies when performing cervical surgeries.

During pregnancy, all women at high risk of developing ICI should see their doctor regularly. It is recommended to plan pregnancy in advance to exclude any negative influences on the cervix (genital tract infections, etc.). You should register as early as possible. Timely completion of all screenings and careful attention to your health reduces the risk of developing ICI and all complications associated with this pathology.

The expectation of calm and prosperous intrauterine development and the birth of a baby, unfortunately, is sometimes violated by a variety of pathological processes, occurring in the female body.

And one of the problems leading to spontaneous abortion in the second and third trimesters is isthmic-cervical insufficiency (ICI).

It is a shortening of the cervix, premature opening of the internal os (the so-called “muscular ring” that holds the fetus in the uterine cavity) and, as a consequence, prolapse and rupture of the membranes of the fetus with its subsequent loss.

Isthmic-cervical insufficiency and its varieties

Depending on the causes of occurrence, ICN is divided into two varieties– congenital and acquired.

Congenital ICI, as a rule, is associated with physiological defects of the uterus itself, such as internal organ(for example, with a saddle or bicornuate uterus). These developmental features require refined diagnosis, treatment, and sometimes even surgical intervention even before pregnancy.

Acquired Isthmic-cervical insufficiency, in turn, is also divided into two forms:

However, it should be taken into account that, being foreign body, the pessary can cause vaginal dysbiosis. For prevention, it is necessary to use antiseptics or, in case of problems, antibiotics. A pessary can be installed at any time.

Surgical method for treating ICI used in cases where installing a Meyer ring is not enough. In this case, the cervix is sutured with sutures made of non-absorbable materials (most often silk surgical threads).

They allow you to narrow the internal os of the uterus. Usually this operation is performed for up to 17 weeks, but according to individual indications it can be performed up to 28 weeks.

And, of course, one of the most important components of treatment for ICI is competent and strict compliance the regimen prescribed by the doctor and avoiding any physical or psycho-emotional stress.

Childbirth with a diagnosis of isthmic-cervical insufficiency

Due to the fact that ICN is nothing more than the inability of the uterus to hold the fetus, childbirth in these cases very often proceeds quickly.

If the pregnancy is coming to an end with a favorable outcome, it is best to go to the hospital in advance. So that the situation with the onset of labor does not take you by surprise: at the wrong time, in the wrong place, and most importantly, without documents (exchange card) confirming the complicated condition of the pregnant woman.

Although treatment for ICI cannot give a completely encouraging prognosis, it is, of course, worth believing in the best. Just like fighting for the life of your child. But need to remember: It is necessary to prepare for pregnancy in advance, especially if there is at least one risk factor.

Video about pregnancy with ICN

From the video below you can get acquainted with an eyewitness's story about isthmic-cervical insufficiency and how her “lying down” pregnancy went.