ICN during pregnancy: causes, symptoms and treatment

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

For almost any woman, pregnancy is a long-awaited and joyful event that is perceived as a holiday. Both parents are expecting a baby. However, whatever the progress in the field of obstetrics and gynecology, not every childbearing ends without any deviations. One of these pathologies can be attributed to CCI during pregnancy.

According to statistics, the proportion of CCI is approximately 30 to 40% of all cases of late spontaneous miscarriage (including preterm birth).

What is an ICI?

Many expectant mothers may be frightened by these three letters, let's consider whether this is justified or not, maybe all fears are in vain? The reproductive organ of a woman is, one might say, a muscular structure, where there is, in fact, the body of the uterus and the cervix. The fetus develops in the cavity, and with the help of the neck it is held, and it does not allow it to leave the uterus. In addition, protection against infections is provided. Its channel is limited to the internal pharynx in relation to the body and external in relation tovagina.

In a normal state, the muscles of the cervix contract and form a ring, and as labor approaches, they gradually relax. During pregnancy, the fetus gradually grows, which leads to an increase in amniotic fluid. As a result of this, intrauterine pressure also increases, and it is sometimes difficult for the cervix to withstand such a load. That's what it is - ICI during pregnancy.

Therefore, in some cases, the cervix begins to weaken prematurely, and as a result, it shortens and opens. Completely this pathology stands for isthmic-cervical insufficiency.

Certain risks

If the cervix is not able to cope with the load under the influence of the fetus, then this can lead to various undesirable consequences. In particular, these may be the following cases:

• The fetus descends - there may be a fetal membrane in the uterine cavity, which can be easily damaged by sudden movements.
• Infection of the fetus - this can occur during contact of the membrane with the vagina, which contains a large number of microorganisms, most of which are harmful.
• The threat of miscarriage, and during the 3rd trimester.
• Premature labor (around 37 weeks) can occur, resulting in a premature baby.

All these risks give an almost complete picture of what it is - ICI during pregnancy. In most cases, the disease can develop with the onset of the 16th week of pregnancy. But sometimes this kind of pathologyalso occurs in women who are in position for a period of 11 weeks.

Types of pathology

There are several types of this pathology:

• traumatic;
• functional.

Traumatic CCI is usually caused by surgery to the uterus before conception. Moreover, if the need for this was associated with stretching of the cervix, then damage to the integrity of the cervix is possible. At the site of the operation, adhesions could form from the connective tissue. As a result, these areas are no longer capable of stretching and contracting.

Such types of surgical procedures include abortion and curettage. In addition, situations of rupture of the cervix during the previous trip to carry the baby can also be attributed here.

Functional ICI of the cervix during pregnancy is usually provoked by a hormonal disorder, which is due to a lack of the female sex hormone progesterone or an excess of another - the male hormone androgen. The latter leads just to the softening of the muscles of the cervix. Most often, this form occurs precisely after the 11th week of pregnancy.

At this time, the endocrine glands begin to function in the fetus. Its endocrine organs just form androgens. And as you know, due to the excess of their number, even if insignificant, the cervix softens under their influence, shortens, which, in turn, leads to its premature opening.

Things to consider when pregnantwomen

Usually diagnosing the presence of CCI is possible already in the period from the 11th to the 27th week of pregnancy, but in most cases this is the 16th-27th week. It is during this period that the child begins to produce androgens, as already mentioned above. At the same time, the tone of the uterus can remain in a normal state. And if a woman does not visit a gynecologist, as required, then she may not suspect ICI during pregnancy at all.

The vagina is a habitat for various bacteria. Moreover, during any inflammatory process, their number increases significantly. And this already has a bad effect on the development of the child in the womb, since there are no longer any obstacles for microorganisms to enter the uterine cavity, as soon as her neck opens a little.

As a result, the fetal membrane loses its protective properties. In addition, everything can end with the outflow of amniotic fluid. In such a situation, as a rule, a miscarriage is not accompanied by pain, and the beginning of this process is the discharge of amniotic fluid.

Main causes of pathology

Isthmic-cervical insufficiency is caused by a decrease in the tone of muscle tissue, which forms the uterine sphincter, the main role of which is to keep the cervix closed. Moreover, it should last throughout the entire period of pregnancy, until the very birth of the child.

However, with such a pathology, this mechanism does not work properly, which leads to premature opening of the cervical canal. How can you understandthis happens for a reason - there must be causes of ICI during pregnancy. In most cases, this is caused by trauma to the cervix.

In addition, CCI can often occur in women who have undergone one of the fruit-destroying operations, or, in medical terms, an embryotomy. As a result of such surgical interventions, not only the cervix is injured, but the location of muscle cells in relation to each other is disturbed. As a result, they are no longer able to fully function.

Who may be at risk?

Some factors contribute to the development of CI, in connection with which those women in whom they occur are automatically at risk of developing isthmic-cervical insufficiency. These include:

• Cervical rupture as determined by research.
• Exceeding the concentration of male sex hormones (hyperandrogenism).
• Abnormal development of the female reproductive system.
• The presence of genital infantilism.
• IVF.
• Not enough progesterone.

In addition, the risk of CCI during pregnancy can be caused by other factors. For example, multiple pregnancy or polyhydramnios. And here the cervix has to experience a much greater load than during a normal pregnancy (one child). This may also be the reason for the start of the development of the ICI. In addition, we should not forget the cases when the uterus develops with defects.

Symptoms of CCIpregnancy

From a clinical point of view, the pathology does not manifest itself in any way, since the opening of the internal os occurs gradually and painlessly. For this reason, it is very difficult for a woman to find out what condition the cervix is in and whether there is a real threat to the baby. This is especially true of the first trimester of pregnancy.

Nevertheless, some symptoms by which cervical isthmus can be recognized are still present, although they are observed a little later. During the first three months of gestation, bleeding without pain can be a sign of CCI during pregnancy, and only in some cases this is accompanied by mild discomfort.

In the later stages of pregnancy (usually between the 18th and 20th weeks), ICI can provoke fetal death and, accordingly, miscarriage. Signs that indicate such a threat may be the following:

• In addition to bleeding, the discharge contains mucus and blood streaks.
• Pain or tangible discomfort in the back and lower abdomen.
• Feeling fullness of the vagina.

But since in most cases the development of pathology is painless and practically in the absence of any symptoms, it is necessary to regularly visit a gynecologist in order to check your condition. This is the only way to detect pathology in a timely manner and promptly determine the course of treatment.

Diagnosis of CI during pregnancy

How is the diagnosis? To do this, doctors conduct a mirror examination of the cervix, palpation of the vagina, ultrasound. During the examination of the woman, the doctorcan determine the shortening of the cervix, as well as the fact that it has become softer. It is also able to detect the opening of the canal and whether the fetal bladder is visible.

If this is the first pregnancy for a woman, then in this case the external os is usually closed. Therefore, transvaginal ultrasound is prescribed to make an accurate diagnosis. Ultrasound scanning is the most informative way to determine the ICI. The main symptom is a shortening of the cervix, and depending on the gestational age, there are normal indicators:

• up to six months: the size of the channel is 34-45 mm;
• in later periods, this figure is already slightly less - 30-35 mm.

If a woman has obvious symptoms of CCI during pregnancy, then the size of the canal is even smaller. That is, if it is shortened to 25 mm or less, then this indicates a likely miscarriage or premature pregnancy.

Typically, the cervix in the presence of CCI opens in a V-shape, which is well detected during an ultrasound examination. In some cases, a stress sample is taken during the scan to confirm the diagnosis. That is, a woman is asked to cough or they press on the uterine cavity.

If the expectant mother is at risk or there are indirect signs of pathology, an ultrasound scan is scheduled at least twice a month.

Features of treatment

If a woman has been diagnosed with isthmic-cervical insufficiency, treatmentit is necessary to start immediately, for which the obstetrician-gynecologist is responsible. For efficiency, it is carried out in a hospital, which allows you to choose the optimal technique.

In total, there are two main ways to correct ICI during pregnancy:

• operational;
• conservative.

The first type is surgery to avoid further dilatation of the cervix. To the second - the installation of a special design, called the Meyer ring. Hormone therapy may also be prescribed.

Surgery

The essence of this method of treatment is the mechanical narrowing of the internal os by sewing up the external one. Overlay seam can be:

• U-shaped.
• Circular.
• Purse-string.

Before the procedure, a swab is taken from the vagina in order to examine it in detail. This is done in order to find out if the woman has contraindications to the operation. These include:

• congenital fetal anomalies;
• presence of severe vaginitis;
• chronic diseases in which it is not recommended to bear a child;
• bleeding uterus;
• complications caused by preeclampsia;
• intractable uterine hypertonicity;
• rapid progression of CCI.

The operation itself to eliminate CCI during pregnancy takes place in several stages:

1. Diagnosis.
2. Preparation - this may include vaginal sanitation.
3. The procedure itself -The suturing of the pharynx is carried out under local anesthesia with the help of silk threads. After that, the seam is treated with antiseptics.
4. Rehabilitation course.

To minimize the risks of complications, various medications are prescribed in the face of antispasmodics (drotaverine hydrochloride), antibiotics (if necessary) and tocolytics ("Ginipral", magnesia). The latter should be taken with the tone of the uterus.

As for the timing for this operation, then everything is individual. Usually no later than the 17-28th week of pregnancy, so that the progression of the pathology can be avoided.

On the second or third day after the operation, the cervix is examined, and if the patient has no complaints, she is discharged under the supervision of a specialist. Further scheduled examinations are carried out every two weeks during the treatment of CI during pregnancy.

During the normal course of pregnancy, stitches are removed at 37-38 weeks. Also here can be attributed the onset of labor (regardless of the period), the appearance of regular contractions, bleeding, eruption of the seam.

Conservative treatment

Using a rubber or latex structure (also called a "pessary"), you can redistribute the pressure inside the uterine cavity, including the mass of the fetus, which slightly relieves the load on the cervix. The method is highly effective at the initial stage of pathology development. If the disease is already progressing, then the ring is used as an adjunct treatment.

WhatCharacteristically, it is possible to install a pessary even in late pregnancy - more than 28 weeks, while suturing is no longer possible. Since the ring, which helps to eliminate ICI during pregnancy, is perceived by the woman's body as a foreign body, doctors prescribe sanitation with antiseptic agents and take a smear regularly. If needed, antibiotics are prescribed.

Every two weeks, the ring is removed and processed in order to exclude the possibility of infection of the fetus. It is completely removed after 37-38 weeks of pregnancy or with the onset of labor, regardless of the term.

What is the forecast?

Such a pathology as isthmic-cervical insufficiency is fraught with miscarriage, which in most cases occurs spontaneously, or premature birth. In addition, the opening of the cervix threatens the infection of the fetus, which negatively affects its further development.

The prognosis of the stage of ICI depends on how much the cervix has dilated, the gestation period, how effective the treatment procedure is and the presence of infectious pathogens.

The shorter the period of bearing a child and the more the cervical canal opens, the less chance of a successful outcome. This is confirmed by reviews of ICI during pregnancy.

Pregnancy planning

As statistics show, ICI occurs in every 10th woman in labor, in whom this is the first time. Women with “experience” take risks much more often. And what is characteristic, the more children a woman bears,the higher the risk of pathology in a subsequent pregnancy.

Therefore, those mothers who want another child need good preparation. First of all, you need to get rid of chronic endometritis (if any) and normalize the microflora of the vagina. During the violation of the protective function of the cervix, pathogens of various infectious diseases can enter her body.

In this regard, it is necessary to take a course of antibiotics, and since all women have different body characteristics, the medication is prescribed on a strictly individual basis. The effectiveness of such therapy is evaluated on the basis of bacteriological examination of the sample taken.

Prevention measures

As many reviews of the treatment of ICI during pregnancy note, the effectiveness of the procedure depends on whether the pregnant woman observes caution in everything. It is necessary to refrain from heavy physical exertion, sexual intercourse, avoid stressful situations, do not ignore doctor visits and take the necessary medications.

During pregnancy, it is important to rest as much as possible, and close people can do all the housework. It is also important to keep emotions positive and set yourself up in advance for the successful birth of a baby without any complications!

To prevent preterm birth for the period from the 20th to the 40th week of gestation, the doctor may prescribe medications that contain progesterone. One of these means is Utrozhestan. With ICI during pregnancy, it is prescribedoften. The specified hormone is produced by the placenta, and it is simply vital for the proper development of pregnancy. In this connection, "Utrozhestan" is well known to many gynecologists and women who have already gone from conception to the birth of a child.

To comfort expectant mothers, there are many cases when a woman loses her child due to ICI, but in the end she has a he althy and fully developed baby. This proves in practice that much depends on the efforts of doctors, the mother herself and the timeliness of the treatment.