Cervical ring: when put on and when removed? Types and types of gynecological pessaries. Isthmic-cervical insufficiency

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Unfortunately, not every pregnancy can go smoothly and without complications. Among all the negative factors, the threat of miscarriage or premature birth is the biggest danger that can lie in wait for every woman during the entire period of bearing a child. Often the cause of such consequences lies in the short cervix. The result of this is its early disclosure. In such situations, women are encouraged to place a ring on the cervix, otherwise known as a pessary, to maintain pregnancy.

Every woman wants to endure, and then give birth to a he althy child in the absence of any complications. But not always pregnancy proceeds according to expectations. At the same time, some disorders in the female body can lead toto a threat to the fetus already during the first trimester. Because of others, the pregnancy is interrupted in the second or already third period, which is even sadder. One of these problems is isthmic-cervical insufficiency or CI. But what is this disease?

Isthmic-cervical insufficiency during pregnancy

Usually, this term is understood not so much as a disease, but as a condition that is not characteristic of the norm. The uterus is a muscular organ consisting of the body and neck. In its cavity, the development of the embryo occurs. Thanks to the cervix, the baby is kept inside the uterus and does not leave it prematurely.

In addition, the neck provides protection against infection. At the same time, the channel from the side of the cavity of the reproductive organ limits the internal pharynx, and on the reverse side it closes the outer one.

Under normal conditions, the muscular structure of the cervix closes, forming a ring, and as delivery approaches, it gradually relaxes. But this is not always the case. In some cases, the muscles of the cervix begin to relax prematurely. As a result, it shortens and opens, which, for obvious reasons, should not happen.

It is this condition in the medical language among specialists called isthmic-cervical insufficiency. During pregnancy, such a case can occur in 9% of the total number of women. As for the miscarriage, here the percentage is slightly higher - 15-42%.

Due to the expansion of the cervix of the reproductive organ, the fetal bladder descends to the bottom of the uterus. itleads to the fact that the shell may be infected or open prematurely. And if this happened, then the birth comes ahead of time. Ultimately, everything ends with a late miscarriage (before 22 weeks) or premature birth (before 37 weeks). In the latter case, a premature baby is born.

Characteristic signs of ICI

Signs of a short neck of the genital organ can be detected with the onset of 15-20 weeks of pregnancy during routine diagnostics. During this period of time, the child gains weight, and quite quickly. As a result, the load on the muscles of the neck increases.

Determine the need to install a cubic pessary or device of any other form can only be a doctor who leads the pregnancy, during a gynecological examination. At the same time, he may notice a softening and shortening of the cervix, including the opening of the channel through which the fetal bladder is visible. Since the external os in women who have not yet given birth is usually closed, ultrasound is prescribed to confirm the diagnosis.

In this case, pay attention to the following characteristic features:

• The length of the neck of the reproductive organ - for the period from 24 to 28 weeks, should normally be 35-45 mm, after 32 weeks - 30-35 mm. The doctor's fears are confirmed when a shortening of up to 25 mm (or less) is detected for a period of 20-30 weeks.
• V-shaped expansion of the internal os - this is exactly the reason for the installation of the ring. It can also be verified with an additional test −pressure on the fundus of the uterus or coughing.

And if a disappointing diagnosis is made, the doctor needs to make a responsible decision regarding the placement of a pessary in order to preserve the pregnancy.

Reason for shortening

The neck of the reproductive organ can be short due to the congenital and anatomical features of its structure. However, in most cases, this condition is acquired. A variety of reasons contribute to this, among which the following factors can be noted:

• Injuries to the cervix during vaginal delivery or abortion.
• Treatment of cervical pathology through conization surgery.
• Abnormal development of the reproductive organ.
• IVF.
• Large baby, polyhydramnios or multiple pregnancies.

In addition, a shortened cervix may be due to hormonal imbalance during pregnancy. In addition, various interventions in the uterine cavity, such as abortion and curettage, also have a negative effect on the condition of the cervix, due to which it is shortened.

As a result, the cervix is covered with scars, which, in turn, leads to the loss of the ability of the muscles to stretch. Eventually the neck will deform and shorten.

What is a pessary?

This medical term should be understood as a special uterine ring that is inserted into the vagina and fixed on the cervix. Due to this, anatomical correction is carried out.or functional ICN.

Although many doctors call the pessary a ring, this device does not always have such outlines. In most cases, the product is made in the form of a concave pyramid from a series of connected rings. The device has smooth edges of a semicircular shape. When the product is installed, its wide base is directed towards the rectum, and the narrow part is turned towards the pubic symphysis.

It is due to the concave shape of the base that pressure on adjacent organs can be avoided. A hole is provided in the center of the device, which is shifted towards the wide base. On the side of it there are smaller holes for the release of secretions. There are jumpers between them to stiffen the structure.

The principle of operation of the gynecological ring is based on the following factors:

• The pressure exerted on the uterus is redistributed to the anterior wall.
• The cervical canal is tightly fixed to one of the vaginal vaults.
• During the use of the device, the risk of disturbing the microflora of the vagina is minimal.
• Premature channel disclosure warning.

In addition, thanks to this product, a thick plug of mucus is formed, as a result of which a barrier is created that prevents the penetration of infection.

Varieties of products

The pessary is the latest development, which is made using silicone or some kind of soft and bendable material. These devices are easy to use and also come in a variety of shapes, sizes andeven to the destination.

These obstetric products are used not only in the field of gynecology for pregnant women, but are also relevant in other areas of medicine, for example, in urology. As for the form of obstetric products, the following are found:

• regular rings;
• donut-shaped;
• oval products;
• cup fixtures;
• cubic pessaries;
• mushroom fixtures.

In addition, pessaries are selected according to the individual parameters of the cervix and depend on the number of pregnancies. These features must be taken into account, since the product must fully correspond to the anatomical structure of a woman in each case.

It is precisely due to this that such obstetric products effectively keep the cervix from premature dilatation. In addition, nearby tissues are not damaged.

Indications

The main reason or indication for the appointment of an obstetric device is the risk of preterm delivery. It should also include the symptoms of a threatened miscarriage in the early stages. Other cases may be the following situations:

• pregnancy with multiple children;
• isthmic-cervical insufficiency;
• after treatment course of ICI;
• as a preventive measure against seam divergence;
• burdened anamnesis.

At the same time, most of the clinical indications are due precisely to the failure of the neck of the reproductive organ. Thanks tothe device relieves the load not only from the cervix, but also from the bladder, rectum.

In what cases it is impossible to install a pessary

Often this procedure is the only way to prevent miscarriage and premature delivery. However, despite such a significant benefit of the gynecological ring, this manipulation has its own medical contraindications:

• presence of spotting and spotting;
• development of the inflammatory process;
• infectious lesion of the genital tract;
• missed pregnancy.

In other words, as with drugs, not all women can benefit from such a procedure.

Symptoms of threatened miscarriage

As mentioned above, the main indication for the installation of an obstetric ring may be the threat of miscarriage. But is it possible for a woman to determine the presence of such a risk?

This is possible, but there are certain difficulties in making a clinical diagnosis:

• Firstly, the symptoms of a threatened miscarriage are insignificant!
• Secondly, the appearance of characteristic signs may indicate completely different processes and pathologies of pregnancy.

However, it is worth paying attention and not ignoring three important and possible symptoms of a threatened miscarriage in the early stages:

• Vaginal discharge. With the threat of a miscarriage, they can be of a different nature: spotting, plentiful, prolonged, fleeting, bright, or, conversely, of a pale shade. Besides, they canstop and then resume.
• Pain syndrome. As a rule, there are pulling sensations, accompanied by heaviness in the lower abdomen and lumbar region.
• Temperature. In the event of a potential threat, it rises to fairly high limits - 38-39 ° C. At the same time, it should be understood that this particular sign does not always indicate the threat of miscarriage.

Usually this is the main triad (bleeding - pain - temperature) of signs of this serious pathology. During pregnancy, the presence of all of them, or at least one separately, should already be alarming. In this case, you should visit the hospital to avoid more dangerous consequences.

Advantages over seams

Should I put a pessary? Previously, in order to prevent isthmic-cervical insufficiency, sutures were applied to the neck of the reproductive organ. This procedure was carried out not earlier than the 20th week of pregnancy, since anesthesia was used. Fortunately, in modern gynecological practice, this invasive technique has been replaced by a more gentle solution in the form of an obstetric ring.

Now, instead of stitches, many gynecologists are looking in favor of a new device. This is largely due to the presence of certain advantages:

• non-invasive nature of manipulation;
• the risk of infection is markedly reduced;
• installation possible on an outpatient basis - i.e. no need for hospitalization;
• easy procedure;
• anesthesia is not needed;
• The insertion of the device does not injure the cervix.

At the same time, it should be borne in mind that a number of clinical cases require suturing, followed by the installation of a ring on the cervix during pregnancy. In other words, the surgical method of correction is still carried out in some cases.

As for the expediency of carrying out this or that method, here the right of choice is the prerogative of only the doctor. It is up to him to decide which method to prefer in each case.

Description

The very procedure for installing a gynecological device is not very pleasant due to the nature of its implementation. However, according to many doctors, women do not experience strong pain. In many ways, it all depends on how competently the preparation for the procedure was carried out. And if a woman has an overestimated sensitive threshold, then during the manipulation she may feel discomfort, which is quite possible to endure.

Installation of a ring on the cervix during pregnancy is carried out from 16 to 34 weeks of pregnancy. In most cases, the procedure occurs during the second trimester. However, beforehand, a woman needs special training, during which various necessary procedures are carried out:

• First of all, diseases of the genital tract of an inflammatory or infectious nature should be excluded. Remediate if the situation calls for it. Even at this stage, a smear and biomaterial of the cervix are taken to detect drug susceptibility.
• When detecting an overestimated concentration of leukocytes inlack of growth of pathogens, the doctor prescribes suppositories with an antiseptic effect. Sometimes antibiotics may be required.
• Immediately at the time of the manipulation, the bladder must be emptied, which, if necessary, should be done beforehand.
• An hour before the procedure, a woman needs to take an antispasmodic (for example, Drotaverine).

Now, actually, how to put a pessary. For this, the woman is comfortably located on the gynecological chair. The obstetric device, the cervix and the vagina are treated with an antiseptic. Next, the doctor inserts the already prepared product into the vagina in a compressed form, and already inside the pessary straightens out.

The whole manipulation is painless and lasts for several minutes. If the size of the device is chosen correctly, the woman should not feel it inside.

After treatment

After installing the ring on the cervix, women need to take a closer look at their own he alth. First of all, you should ensure yourself complete peace. Sexual contact is completely prohibited! The same applies to taking a bath, swimming in a pool or ponds. Although these issues can be discussed with the doctor on a case-by-case basis.

Also, you can not expose yourself to excessive physical exertion, which, in fact, is relevant in general during pregnancy. Sometimes a doctor prescribes a course of vaginal suppositories to avoid infection in the genital tract.

Afterwardsit is required to take a smear every 2 or 3 weeks to monitor the state of the vaginal microflora. In addition, during the entire period of operation of the obstetric device, the expectant mother should regularly visit a personal gynecologist who manages the pregnancy in order to control the position of the ring.

Watching the expectant mother

In some cases, after placing the ring on the cervix, a woman may notice specific vaginal discharge: translucent or white. At the same time, she does not feel any itching or burning in the genital tract. This should not be frightened, since this is the response of the female body to the introduction of a foreign object.

Expectant mothers should be notified about this in advance so that they do not worry too much about the life of their child. A stressful situation will only bring harm to pregnancy, up to premature delivery.

However, after installation, there may be times when you should not hesitate to visit a doctor (and no matter what week it is - 39 or earlier) in order to avoid the worst. This refers to the color and nature of the discharge:

• bloody;
• sacred;
• greenish;
• yellow.

In addition, there may be abundant clear discharge, which in its consistency resembles water. In this case, you need to see a doctor as soon as possible.

When is the ring removed?

In the future, after the installation of the obstetric device, if the pregnancy proceeds normally, it is removed with the advent of 37-39 weeks of the term in the case ofone child. When expecting twins, triplets, etc., the product is withdrawn a little earlier - at 34 weeks. After removing the ring, sanitation of the genital tract is also mandatory.

In some cases, before the 39th week of pregnancy, situations may arise for premature removal of the device:

• There has been an infection of the membranes, including amniotic fluid.
• As a result of the rupture of amniotic fluid.
• Premature start of labor.
• Medical need for preterm birth based on the condition of the mother and baby.

As a rule, the installed gynecological device allows you to save the pregnancy, preventing fetal prolapse and premature onset of labor.

Possible Complications

In some cases, after the vaginal ring is inserted, the woman may experience minor discomfort. As a rule, after 12 hours it passes, which as a result does not cause concern. However, complications can sometimes arise.

For example, an obstetric appliance is displaced or falls out completely. This can happen due to incorrect installation or due to the wrong choice of the size of the pessary. A woman can determine its displacement by characteristic signs. She begins to feel pressure and discomfort. In addition, being in a sitting position becomes uncomfortable, if not painful.

In some cases, the displacement of the ring canprovoke the development of colpitis. Then an appropriate course of treatment is carried out. However, if therapy does not bring the desired effect within 10 days, the pessary must be removed. It is for this reason that it is worth visiting a doctor regularly to check the position of the product.

As practice shows, complications after the installation of the ring are extremely rare. At the same time, their complete absence cannot be ruled out - no one is able to guarantee that in each case a woman will be on the list of lucky ones.

We now know how many weeks the pessary is removed. However, after installing it, the main thing is to listen to your own body and visit a doctor at the slightest reason.

As a conclusion

The condition of the ICI is by no means the case when a pregnant woman has plenty to choose from. A good option is to install a special device on the neck of the reproductive organ in order to avoid the threat of miscarriage and the onset of premature birth.

In addition, it is worth noting that everything does not end with such a procedure for the expectant mother - it is necessary to strictly follow all the doctor's recommendations. Only in this case, women can count on the successful maintenance of pregnancy. As obstetric practice shows, the effectiveness of installing a ring on the cervix (if it is worn correctly) is about 70-80%. And these are already good results in favor of this method of correction of CCI.