Pessary during pregnancy: indications, installation, reviews

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

Pregnancy is an important and happy event in a woman's life. But sometimes this period can be overshadowed by premature birth. One of the causes of this condition is the failure of the cervix. This means that there is still a lot of time left before delivery, but the cervix begins to soften and open, which can provoke untimely birth. Previously, with such a diagnosis, the baby could not survive, but in modern times, a woman is offered to put in a device that will reduce the risk of premature birth to a minimum.

What is a pessary

The device used to prevent premature birth is called a pessary or uterine ring. A pessary during pregnancy is a device made of silicone or plastic that is worn on the cervix, supports some of the internal organs, including the uterus itself, the rectum and bladder. When used, internal tissues are not injured, as the product is made with perfectly even edges and is completely sterile. Suitable for individual repeated use. A pessary during pregnancy is basically in the form of a ring, bowl, mushroom or oval, but a prerequisite is a hole in the middle for the neck itself. In some models, there are additional holes along the edges for the release of vaginal secretions.

What specific type will be used, upon appointment, the attending physician will decide after the examination.

Types of pessary

There are three types of obstetric pessary during pregnancy, depending on the parameters of the cervix and vagina:

• 1st view. Used for women during the first and second pregnancy. The diameter of the cervix must not exceed 30 mm, and the dimensions of the upper third of the vagina must not exceed 65 mm.
• 2nd look. A device of this type is usually installed in women during their second or third pregnancy. The length of the cervix in this case should be no more than 30 mm, while the length of the upper third of the vagina should not be more than 75 mm.
• 3rd view. It is installed in the case when the upper third of the vagina is more than 76 mm in size, and the diameter of the cervix is more than 30 mm. Basically, this type is given to women with multiple pregnancies.

Indications for pessary placement

Pessary during pregnancy is recommended for women in the following cases:

• Isthmic-cervical insufficiency (ICI). In this case, the cervix, for some reason, cannot cope with the function given to it and begins to open under the weightfetus or amniotic fluid, which can lead to premature birth or waterborne infections.
• With a short cervix.
• For the prevention of CCI.
• In cases where the woman has already had a premature birth or miscarriage.
• Sometimes the installation of a pessary during pregnancy is performed in cases where the surgical treatment of isthmic-cervical insufficiency was unsuccessful. Also, a pessary can serve as a prophylaxis for the divergence of sutures after they are applied to the cervix.
• Multiple pregnancy.

Contraindications for installing the device

But there are situations in which it is strictly forbidden to put a pessary during pregnancy.

These include:

• bloody or sanious discharge;
• inflammatory processes on the cervix or vagina (in this case, the use of the device is possible after the removal of inflammation);
• suspected miscarriage;
• severe fetal malformations;
• diseases of a woman in which pregnancy is a contraindication;
• expressed degree of CCI;
• violation of the integrity of the amniotic sac.

Pessary installation principle

Installation of a pessary during pregnancy, as a rule, takes place after the 24-26th week, but according to indications, it can be used after the 13th week.

Before the manipulation, it is imperative to take smears for infections and pathological changes in the microflora of the vagina and completely cure them. This point of preparation is very important, because whenpregnancy, many women experience thrush.

Many are afraid of this procedure and wonder if it hurts during the installation of a pessary during pregnancy. Most doctors argue that the introduction of the device is not a painful procedure, it can only cause a little discomfort. It all depends on the degree of sensitivity of the uterus and cervix. In rare cases, local anesthesia may be used. The procedure is carried out during the appointment with your doctor.

• A few days before installation, it is advisable to use vaginal suppositories to cleanse the microflora of various bacteria.
• Approximately half an hour before the procedure, it is recommended to take an antispasmodic to prevent uterine contractions in response to medical manipulations.
• Then the doctor selects the optimal shape and type of device for the patient, since the insertion technique depends on this.

To date, the most common types are:

• 

  Plastic "Juno" (made in Belarus). It has only three sizes, has high efficiency. But when it is displaced, a woman may experience pain. In this case, it is recommended to see a doctor as soon as possible.

• 

  "Pessary of Dr. Arabin" (made in Germany). Has the shape of a bowl. Painless insertion, does not cause irritation and discomfort when worn. Pessary Arabin during pregnancy has 13 sizes, which makes it difficult to buythe right size for the individual. Before purchasing, it is recommended to consult a doctor for help. It is worth noting that sometimes silicone can stick to tissues, causing pain and discomfort.

How to put a pessary during pregnancy?

• You must empty your bladder before the procedure.
• A woman sits on a gynecological chair, the doctor sanitizes the genital tract and the pessary itself.
• The pessary, previously lubricated with petroleum jelly or glycerin, is gently inserted into the vagina with a wide base.
• Then the device is turned so that the narrow part is under the pubic bones of the pelvis, and the wide part is deep in the vagina.

If a round pessary is used, then the doctor, having felt the cervix, carefully puts the ring on it.

The procedure in total lasts no more than 20-30 minutes, after which the woman will need to be under observation for some time. If nothing bothers her, she is allowed to go home.

When installing a pessary, the skill of the doctor is very important, since improper insertion and installation can greatly harm both the baby and the mother.

Recommendations after introduction

After installing a pessary during pregnancy, a woman's quality of life improves, as some restrictions on physical activity are removed. Despite this, she must adhere to certain rules:

• A categorical ban on sexual activity.
• Exclude physical activity, especially tilts and squats.
• Every2-3 weeks to be tested for infections.
• You can not swim in pools, open water.
• As a rule, the doctor prescribes the introduction of vaginal suppositories for the entire period of use of the pessary in order to exclude genital infections.
• Do not try to fix or remove the device yourself. If you experience any discomfort, seek medical attention immediately.

Possible complications after pessary insertion

The use of a pessary does not exclude side effects, as the body may react differently to a foreign body. Possible complications include:

• Selections. If you notice an increase in their number, do not immediately panic. Some increase in whites is a completely normal response of the body to the introduction of a foreign object. You should immediately consult a doctor if there is blood or blood discharge; yellowish or green (may indicate a bacterial infection); transparent, liquid with a slightly sweet odor (probability of violating the integrity of the amniotic sac).
• Development of inflammation, colpitis. Sometimes, when the pessary is displaced, colpitis can develop - inflammation of the vaginal mucosa. In this case, pain in the lower abdomen and itching, similar to thrush, can be felt. In this case, it is necessary to start treatment as soon as possible.

Removing the pessary

If the pregnancy was normal, the removal of the device occurs after 38 weeks of gestation, when the baby begins to be considered full-term. The procedure is carried out by a gynecologist strictly in a medical institution. Removing the pessary is very quick and usually painless. After that, the sanitation of the birth canal is carried out.

Reasons for premature removal of the device.

It happens that you have to remove the pessary urgently in the following cases:

• if labor activity has begun;
• if the amniotic fluid broke;
• with infection of amniotic fluid;
• if an emergency delivery is needed;
• if inflammatory diseases of the female organs of the mother were found.

Efficiency

Pessary during pregnancy reviews are mostly positive. Many women note its effectiveness, painlessness of administration. As a rule, the pessary very rarely displaces or causes inflammation. Unlike surgical suturing, the installation of this device does not require anesthesia and is less traumatic.

Conclusion

Summarizing, it is worth noting that after removing the pessary during pregnancy, childbirth does not necessarily occur in the coming days. Many women carry the baby to 40 weeks, and some give birth a couple of days after the withdrawal.

It is very important that the device is installed by a qualified doctor you can trust. From his actions and the correct selection of the size and type of pessary will depend on its effectiveness and the absence of side effects.

Childbirth after removing the device is no different from normal.

Expectant mothers should remember that in order to successfully passpregnancy one pessary will not be enough. It is necessary to follow all the doctor's recommendations and take the necessary tests on time.