Cervical dilation before labor: how to stimulate with pills, exercises

The uterus is the most important organ in the female body, which is responsible for bearing and giving birth to a child. In essence, it is a muscular organ, a receptacle for the fetus. It is represented by three parts - the bottom, the body, and the cervix. The cervix is the part of the uterus that is responsible both for the onset of labor and for preventing it from occurring. First, it helps to hold the fetus, prevents descent and premature birth. Then the cervix opens before labor, which helps it move along the birth canal. This determines whether labor will proceed normally or pathologically. The uterus must be mature.

It is important for every woman to know and understand the causes, signs and mechanism of uterine dilation, which will make it possible to distinguish a pathological process from a natural one. With at least minimal knowledge, a woman can take timely measures. A lot also depends on the woman's actions - if you promptly inform your doctor about suspicions, point out pathological signs, you can ensure measures to prevent many pathologies. At later stages, you can take an active part in the preparatory process.

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Reasons

Traditionally, there is a division of all possible causes into natural and pathological. The normal course of pregnancy is accompanied by a closed state of the uterus, which contributes to the reliable retention of the fetus, ensures full development, and protection from impacts. Later, the canal is completely freed and ensures the exit of the fetus. The reason for this is changes in the cervix, leading to a partial replacement of muscle tissue with connective tissue. Collagen fibers are also actively formed, due to which the passage becomes softer and more elastic, as a result, the tissues acquire greater ability to stretch.

The reason for the opening is the reduction in the length and other parameters of the cervix, as a result of which the structure becomes loose, a lumen is formed. Preparation is a preliminary process, the beginning of which occurs at 33 weeks. The uterus becomes looser and softer, the position of the fetus decreases. From the inside, there is constant pressure on the uterus, it begins to gradually open.

But there are many reasons that contribute to the pathological process. If the opening occurs before the due time, there is a risk of premature birth, in which the baby is absolutely not mature.

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How to prepare the cervix for dilation?

In everyday practice, specialists increasingly encounter immaturity of the uterus. Therefore, preparatory measures are needed. This issue becomes especially important at 40 weeks, when labor should already have begun, and the placenta gradually dies. The risk of hypoxia increases sharply. In such a turn of events, artificial stimulation is used.

In many ways, the success of preparation for disclosure depends on the woman herself. She must maintain a high level of activity, be sure to do physical exercises. The load should be dosed. There are many programs for pregnant women that promote both physical and psychological preparation for childbirth. Physical exercises, specially developed complexes, stimulate the activity of the uterine muscles, receptors.

The effectiveness of physical exercise is explained by the fact that the uterus is a muscular organ that also requires training. It is necessary to practice breathing exercises, abdominal breathing, practice relaxation and meditation techniques that allow you to relax and concentrate. With the help of exercises, you can learn to control the relaxation of some muscles and the relaxation of others. Special means are also used that promote opening, such as suppositories, tablets. Their action is aimed at softening the tissues, forming connective tissue layers.

The uterus can also be prepared for childbirth using medication or non-medicinal methods. In the first case, the drugs are administered in various ways. Most often, local agents are used, the action of which is based on irritation and stimulation of receptors. For example, special medications are used, a stimulating catheter, and kelp sticks are used.

Symptoms

Once the process of dilation has started, it can go completely unnoticed. Often women arrive at the maternity hospital already having a dilation of 1-2 cm. It happens so unnoticed that the woman does not even suspect it. This is a sign of physiological maturity. Rarely, there is a pulling sensation, tingling, or a feeling of heaviness.

The sign that most accurately and reliably indicates the presence of dilation is the release of the mucous plug.

A dangerous symptom may be the discharge of amniotic fluid, which indicates the need for urgent hospitalization, delivery to the maternity hospital. If labor does not begin in 6-8 hours, it is necessary to stimulate dilation, since a long stay of the fetus without amniotic fluid is fraught with serious consequences for both the baby and the mother. Infection, hypoxia, and death are possible.

If the opening is pathological and occurs long before birth, the symptoms may also go unnoticed. Therefore, it is important to consult a doctor in a timely manner so that he can identify a possible pathology and prevent it.

The initial stages are completely unnoticeable. Only if the mucus plug has come off - this is considered an indicator that most accurately indicates the opening.

How long does cervical dilation last?

It is determined by whether the woman is giving birth for the first time or repeatedly. In women giving birth for the first time, dilation is achieved after 8-10 hours. In women giving birth repeatedly, this process is reduced to 6-7 hours.

Periods and phases of cervical dilation

There are three known periods. The initial stage is latent. Contractions begin. They are usually irregular, not strong. Contractions are not painful, and no significant sensations occur. Often women who are not in the maternity hospital endure this period on their feet, doing their usual things and not noticing the contractions. The latent period can last from several hours to several days.

At this time, you should not listen to your feelings. Waiting for contractions is also not recommended. You should try not to notice them, but at the same time it is better to be under the supervision of medical personnel. At this time, you should try to relax as much as possible. You can meditate, do breathing exercises, listen to soothing music, or just sleep. You should not waste your strength in vain, you should try to save and increase it, since you will still need a lot of it. There is no need for medical assistance yet. But the doctor can take measures if there is a risk of complications. Most often, they resort to artificial stimulation of labor.

The second period is called the active opening phase and is accompanied by the rapidity of the process. The intensity of contractions increases and the interval between them decreases. It is at this stage that the amniotic fluid should flow out and the bladder should burst. The opening is 4-8 cm.

Gradually, and sometimes rapidly and quickly, the third stage comes, and the uterus opens up to its full extent. A doctor should be nearby to monitor.

Sensations during cervical dilation

Changes begin around 38-40 weeks. Aging of the placenta is observed, accompanied by the release of hormones that stimulate the cervix to open. Significant transformations occur in the body, but no new sensations are experienced. Sometimes pain, a feeling of pressure indicating lowering may be observed. Sometimes women feel a hormonal imbalance, which manifests itself in the form of sudden mood swings, irritability, anxiety, or, conversely, euphoria. But these sensations pass very quickly.

Later, after the fetus has descended sufficiently, painful sensations in the lower abdomen, false contractions, which represent pre-labor hypertonicity of the uterus, may be observed. During this period, the uterus begins to contract intensively, gradually opening. The first - latent period of opening usually passes without pain. In the second, active period, painful sensations arise.

Pain

The opening is divided into 2 phases: latent and active. Usually the latent phase is painless, while the second - active phase is already accompanied by a feeling of pain. In fact, this pain is natural, but at present not every woman can tolerate it, so doctors are forced to resort to pain relief. Usually intense pain occurs when the opening is over 5 cm.

Discharge

First, the plug comes off. Yellow mucous discharge is also possible. At the end of the active phase, amniotic fluid is released. If the cervix is dilated by about 8-10 cm, this is a timely effusion. If the dilation is about 7 cm, the effusion is early. If the cervix is dilated by 10 cm or more and there is no effusion, it is necessary to perform an amniotomy, during which the wall of the bladder is punctured.

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Nausea

Nausea is rare: as a reaction to hormonal changes. When the cervix opens, nausea rarely occurs. Sometimes it can be observed as a reaction to pain, or as a side effect of medications.

Blood

There is no blood when opening. The appearance of blood indicates a pathological process, perineal rupture, other injuries, bleeding.

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Cervical dilation without pain and contractions

Painlessness is observed in the latent phase. When the opening passes to the next stage, painful sensations arise. Pathological opening is usually painless, so it is necessary to undergo examinations in a timely manner. The cervix can open without contractions, especially in the latent period.

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Cervical dilation in primiparous women

The duration is determined by whether the woman is giving birth for the first time or for the second time. First-time mothers do not have such experience, the body is only adapting to new and unknown conditions. Changes in activity and new conditions cause additional stress in the body, like any other new and unexpected type of activity. The body spends some of its resources on adapting to new conditions. The muscular system and connective tissue are not trained, nerve impulses are more intensively transmitted to the uterus, stimulating its contractile activity. This somewhat increases sensitivity and pain.

Psychological readiness and self-regulation are at a lower level than in women giving birth for the first time. In addition, the lack of experience and ignorance of what actions to take have an effect. Therefore, you need to relax as much as possible and follow the doctor's recommendations. In women giving birth for the first time, it lasts up to 8-10 hours.

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Cervical dilation in multiparous women

In those who have given birth before, the uterus is more prepared, stretched, and activated. In addition, muscle memory is preserved, which reproduces the process of pushing out the fetus, similar to the previous experience. Contractile activity is better regulated by nerve impulses, since the reflex arc has already been laid and there is experience on which the nervous system can rely to produce reflexes. The process becomes more regulated and automatic with the simultaneous activation of the body's self-regulation mechanisms. The muscles of the uterus and pelvic area are also better prepared, developed, and activated. Therefore, in women giving birth again, full dilation takes about 6-7 hours, of which the latent phase accounts for 5-6 hours, and the active phase lasts only 1-2 hours. The process is less painful, including due to physical and psychological readiness for the upcoming pain.

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Premature dilation of the uterus in early pregnancy

It often happens that the uterus does not cope with its functions and can open prematurely. This is fraught with premature birth and miscarriages. This pathology is called isthmic-cervical insufficiency, in which the functional activity of the cervix and isthmus of the uterus is impaired. The locking function is not performed, as a result of which the cervix softens and shortens, losing the ability to support the fetus. Most often, this phenomenon is observed in the 2-3 trimester. If at 20-30 weeks the cervix is shortened to 25 mm, we are talking about cervical insufficiency.

In this case, it is necessary to take measures to preserve the pregnancy. Usually, measures are taken to prolong the pregnancy. This is a wait-and-see tactic, which allows you to wait for the maturity of the fetus and the possibility of its existence outside the uterus. Traditional and non-traditional therapy is used.

Cervical dilation at 30, 40 weeks of pregnancy

The closer the birth, the more likely it is that the fetus is ripe. Accordingly, even premature birth carries less danger. The cervix should gradually open. The ideal option is when labor begins immediately after opening, but in practice it often happens that the cervix opens, but labor has not yet begun. Many women do not even know about the opening when they get to the maternity hospital. At the same time, most births end well. The degree to which the uterus was opened when you got to the maternity hospital does not affect the labor process itself. It is important that it opens during labor. Usually, the opening occurs at a rate of 1 cm per hour, in women who have given birth for the first time, the rate of opening is higher. Usually the cervix becomes soft and is ready for labor already at 37 weeks, and the uterus begins to prepare for this as early as 30-32 weeks.

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Degrees of cervical dilation

The initial stage is painless, with contractions. The second stage is the degree of dilation of approximately 6-8 cm. It lasts 4-5 hours and ends with a gradual transition to the third stage, during which full rapid dilation occurs. This stage symbolizes the beginning of labor. Accordingly, there are 3 degrees of dilation - initial (1-4 cm), average (4-8 cm), full dilation (8-10). Sometimes dilation up to 12 cm is required.

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Cervical dilation by half a finger, 1, 2, 3, 4 fingers

Indicators of 10 cm are considered normal for childbirth, which corresponds to 5 fingers. If the uterus is closed, there is no lumen, during palpation the doctor cannot move the finger deeper. Opening by half a finger means the possibility of passing half of the obstetrician's finger, by 1, 2, 3, 4 fingers - respectively, there is space for the passage of 1, 2, 3, 4 fingers. In the event that it passes at least one finger, the uterus can be considered mature.

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Full dilation of the cervix

Full dilation is the third phase, which ensures the unimpeded exit of the child. Dilation of 10 cm can be considered complete. Sometimes ruptures occur, which require stitches. If there is a threat, an emergency cesarean section is performed.

Consequences and complications

Opening may be complicated by weak contractions, during which the cervix practically does not open, remains at the prenatal stage. This often happens with polyhydramnios and multiple pregnancy. If the uterus is overstretched, its ruptures, decreased tone and contractile activity are possible. This also leads to weakening of labor, risk of fetal hypoxia.

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How is cervical dilation determined and checked?

Since the dilation is asymptomatic, an examination is required. The examination is mainly carried out by palpation - the obstetrician probes with a finger. Dilation is determined by the number of fingers that can freely pass through the cervix. This method is outdated, but is still used today in almost all institutions. A more accurate measurement is considered to be in centimeters. Usually, if 1 finger passes freely, this indicates a dilation of 2-3 centimeters, respectively, 2 fingers are equal to 3-4 cm. They say that the uterus is fully dilated when it opens by 4 fingers or 8 cm. Full dilation is confirmed visually: when the cervix is smoothed, the edges are thin and 5 fingers can pass freely.

To assess the opening, the Bishop scale is used, a gynecological examination during which measurements are taken. Then the obtained data is presented in the form of a graph, which visualizes the birth process. The graph is called a partogram of labor. It clearly demonstrates changes, a sharp rise indicates the effectiveness of labor.

Cervical dilation on ultrasound

The opening may be visible on ultrasound. It is necessary to attend routine examinations, which will make it possible to identify pathology and take the necessary measures.

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Stimulation of cervical dilation

This involves the use of various methods that speed up the process of disclosure. There are medicinal and non-medicinal methods.

How to speed up cervical dilation at home?

A high level of physical activity contributes. The diet should contain a large amount of fresh vegetables and fruits. You need to take a decoction of raspberry leaves or tea with the addition of raspberry leaves. It is important to stimulate the nipples, massage the earlobe, little finger. Sex helps to open the cervix, as it is a natural stimulant. In addition, sperm contains a large amount of prostaglandins, which are also strong stimulants.

Physical exercises are important. Squats make a huge contribution. Exercises with special balls and gymnastics equipment have a positive effect. Breathing exercises are very important, they not only stimulate the uterus, improve blood circulation, but also trigger a number of biochemical transformations. The hormonal background and neuropsychic state change. At the same time, tense areas relax, and relaxed ones become toned. Correct regulation of contractile activity of muscles, including uterine muscles, occurs. Breathing, especially with the abdomen, stimulates the production of prostaglandins and nerve impulses, which directly affect the activity of the uterus. Smooth muscles are also trained and strengthened.

Meditation, relaxation practices, staying in silence, concentrating attention and internal contemplation are important. These are the main techniques of hatha yoga, which allow you to control your own body, consciously regulate your feelings and sensations. Breathing and relaxation practices relieve excess tension and stress. As a result, muscle tension is relieved, and pain goes away. Mental attitude plays a crucial role. Many women are afraid of pain and consciously or unconsciously slow down the process of childbirth. Breathing and relaxation make it possible to get rid of internal blocks, block fear and reduce the threshold of pain sensitivity.

Aromatherapy sessions, warm baths with essential oils, color therapy, water treatments, music therapy, and sound-vibration therapy are also recommended.

Methods of cervical dilation

There are conservative methods, which use pharmaceuticals aimed at stimulation. Radical methods can be used in emergency cases: amniotomy, perineal incision. There are also non-medicinal means: kelp sticks, special catheters, gels and oils, suppositories. Physical exercises, sex, meditation, breathing techniques, local suppositories work well.

Catheter and Foley balloon for cervical dilation

A special catheter, which is presented in the form of a tube with a balloon. It is inserted into the cervix for 24 hours. The balloon is gradually filled with air, it expands the walls of the uterus. It has many disadvantages.

Can be described as a catheter containing a balloon. It is filled with air. It is inserted for a day, and gradual opening occurs due to the expansion of the cervical wall. The likelihood of infection increases significantly.

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Cervical dilation gel

A special gel containing prostaglandins is introduced into the cervical canal. Hormonal stimulation occurs, the effect is achieved after 2-3 hours.

Physical exercise

Of the physical exercises, squats are effective. Twists and jumps are contraindicated. At the same time, during the practice, you need to strive for maximum relaxation, control your breathing. You need to do static exercises that train willpower and endurance. It is better to do the exercises in a calm environment, with relaxing music. There are many video tutorials for pregnant women, where all the exercises are shown clearly, selected in the optimal sequence, smoothly flowing from one to another. Such video tutorials effectively combine static and dynamic complexes, breathing exercises and meditative practices.

The best option is to do yoga, pranayama (breathing exercises and inner contemplation), qigong, meditation, swimming, and aqua aerobics. You can sign up for special preparatory courses for pregnant women, where physical and psychological preparation of expectant mothers is carried out, training takes place under the supervision of experienced specialists who can select an individual pace and exercise regime. Special gymnastic balls and fitballs are used. At home, you can even train using a regular staircase, making frequent ascents and descents.

Physical exercises will be more effective if you start preparing early. And even better - long before pregnancy. Trained muscles are the key to a quick and successful opening of the uterus, since it is also essentially a muscle. But if the preparation was not started when planning a pregnancy, it is okay. It is better to start later than not to do physical exercises at all. They are beneficial even if you start regular practice in the last weeks.

Fitball for cervical dilation

Modern clinics have long recommended taking a vertical position instead of the traditional horizontal one. A sitting position is also recommended. But the surface should not be hard. The ideal option is a fitball - a large inflatable ball used in sports and gymnastics. If you sit on it and do special exercises, you can relax tense areas and tense those areas that will be in good shape. It is better to spread your legs apart. Nervous and hormonal activity is activated, the uterus is more strongly stimulated. In preparatory courses, you can undergo special training in exercises and positions on a fitball.

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Squats to open the cervix

Squats stimulate the neck, both by activating nervous activity and mechanically. You need to do regular squats, or squats according to a special scheme. The time is gradually increased. At first, you need to do each stage for 10 seconds. Then increase the time to 1 minute for each stage. At the first stage, we squat slowly. The duration of the squat should be 10 seconds, that is, we should completely lower ourselves in 10 seconds. Then we sit in this position for another 10 seconds, begin to relax as much as possible. Then we rise partially. You need to stop in such a position that the thighs are parallel to the floor. We stay in this position for 10 seconds, then slowly, over the next 10 seconds, we lower ourselves down. We rest, relax in a squat for another 10 seconds. We begin a slow rise for 10 seconds. Then we rest for 10 seconds and begin to squat again. After you have managed to do 10 of these squats in one approach, we move on to the next stage - the duration of each stage increases to 20 seconds, then to 30, 40, 50 seconds and one minute. After squatting 10 times at a slow pace, you must definitely squat at a fast pace. The speed should reach 50 squats per minute. If this does not work, it is better not to squat completely, you can only partially go down. Gradually, you need to increase the depth of the squats.

Meditation for Cervical Dilation

The Shavasana pose used in yoga is effective. You need to lie on your back, legs and arms slightly apart. Eyes are closed. You can turn on relaxing music, an aroma lamp. Sounds of nature are good, especially the sound of sea waves, rain, a waterfall. Birdsong, animal sounds, instrumental music can be suitable. You need to try to relax as much as possible, not to think about anything. Muscles should be relaxed consciously, directing attention to them. First, slide your attention down your legs. Feel how the leg muscles relax, become soft, heavy. Relaxation covers the tips of the fingers, extends down the shin, down the thigh. The kneecap drops. The pelvic area, perineum, and uterus relax. Both legs are relaxed, the pelvic area is relaxed, gradually relaxation covers the stomach, back, relaxes the lower back, the muscles along the spine. The chest and arms relax. Relaxation of the hands rises from the fingertips, slides along the wrist, elbows, forearm, relaxes the elbow, shoulder, collarbone.

Once again, move your attention throughout your body, feel relaxation in every area. Pay special attention to your face: feel how your forehead, nose, eyes, ears, and cheeks relax. The chin is relaxed, the lower jaw is relaxed and can be slightly open. The eyes are closed. You are motionless and relaxed, the whole body is heavy. There are no thoughts in your head. There is only silence. If thoughts come, they should be let go, not held back. Such meditation should last at least 30 minutes. There are no restrictions for the maximum. Ideally, you should bring it up to three hours. After that, you need to lie down, do not rush to get up. You can drink tea, herbal infusion. Raspberry leaf tea is ideal.

There are also video lessons and audio materials for meditation, which explain all the nuances in detail and provide accompaniment to the meditation. The slow, calm voice of the specialist smoothly controls your attention, directing it to the right areas, reminding you of the need to relax and have no thoughts. The voice does not accompany the entire meditation: it is effectively combined with moments of silence, a special background and musical accompaniment are selected. The rhythm increases, dies down, which creates the necessary tonality.

Cervical dilation drugs

Various drugs are used. Oxytocin, intramuscular injection of sinestrol, suppositories with prostaglandin have proven themselves well. Enzaprost is also administered intravenously. The use of synthetic prostaglandin is allowed. The dosage and frequency of administration can only be determined by a doctor, since it is strictly individual and is determined by the results of the partogram.

Pills

Mifepristone is used. It stimulates contractile activity of the myometrium. It is taken 1 tablet at intervals of 24 hours, under strict medical supervision.

Oxytocin-MEZ is often used to stimulate uterine dilation and labor induction. This is a solution for intramuscular and intravenous administration.

The opening can be facilitated by no-shpa, which is an antispasmodic drug, relaxes muscles and makes them more elastic. It is prescribed 1-2 tablets 2-3 times a day or as injections.

Papaverine can be used both as injections and as tablets. The dosage depends on the speed of opening and the condition of the uterus, and is determined exclusively after palpation and gynecological examination. It helps reduce pressure and relax smooth muscles.

Caulophyllum 30 is a homeopathic remedy used to stimulate labor. It makes childbirth much easier, and reduces the pain threshold. A remedy of Indian origin that has long been used in Indian medicine. Significantly reduces the risk of cesarean section, and eliminates the need for oxytocin. Eliminates tremors, fatigue, and thirst, and gives strength.

Castor oil, when taken orally, promotes rapid dilation. In the early stages, it has abortive properties.

Many women after being discharged from the maternity hospital say that they were given too many injections. And no one knows what drugs are used for this. In order to avoid unnecessary fears, it is better to understand this.

First of all, drugs are administered for pain relief. These are narcotic drugs that are administered in various ways. Most often - intramuscularly, intravenously. Epidural anesthesia (an injection in the back) is also used. It is the safest type of pain relief, since it does not affect either contractile activity or the fetus, the drug does not enter the blood. Other types are usually used only if there are 2-3 hours left before the birth of the baby, this eliminates the risk of hypoxia.

In case of labor weakness, drugs are used for stimulation. Amniotomy – puncture of the fetal bladder – is often mistaken for an injection. Depending on the situation, symptomatic means are used – to reduce swelling, pressure, heartbeat, to stimulate the fetus.

If the contractions are long and painful, but unproductive, the woman weakens. She is given a drug for sleep-rest, which allows her to quickly regain strength. Such sleep lasts 2 hours. After it, labor intensifies.

Injections are often used to prevent or stop bleeding. In the case of surgical intervention, many injections are also used. Injections are also given for the removal of the placenta, postpartum rest.

To stimulate the opening, a drip is used. Its basis is a physiological solution or glucose, which provide support and nourishment to the body. If necessary, drugs of various effects are added to the drips.

Suppositories for opening the cervix before childbirth

They are used for intravaginal administration with a high content of synthetic prostaglandin. Their effectiveness is high: the result is achieved in 2-3 hours.

Laminaria sticks for opening the cervix before childbirth

They are sticks made from sea kelp. The dried algae, small in size, is inserted into the cervix. It gradually absorbs moisture and expands, the cervix also expands. As many sticks are inserted as are required for complete filling.

Manual dilation of the cervix

Involves artificial dilation by inserting and widening a finger during a gynecological examination.

Pessary and ball dilation of the cervix

It is used to prevent early disclosure and maintain pregnancy. The pessary is a plastic device that provides support for the organs. It is formed from several rings that connect to each other. It provides reliable support and can even be performed on an outpatient basis. It takes several minutes. To insert the ring, lubricate it with gel and insert it into the vagina. Sex is contraindicated after the procedure. Every 2-3 weeks, it is necessary to monitor the state of the vaginal microflora and perform an ultrasound.

To mechanically open and stimulate the uterus, a special plastic ball is inserted into the cervix and left for 24 hours.

Raspberry leaf for cervical dilation

Raspberry leaves are very effective in opening the cervix. Can be used as part of a tea or as a decoction.

Cervical dilation according to Rogovin

The full name is the Rogovin-Zanchenko method. This is an external measurement method that allows you to assess the degree of opening of the external os. At the height of the contraction, the distance from the xiphoid process to the bottom of the uterus is measured, in centimeters. The obtained indicators are subtracted from 10 cm, and the height indicators are obtained. The method is approximate.

How to prevent cervical dilation during pregnancy?

The following means of prolongation are used: bed rest. Emotional rest, medications, especially sedatives. Treatment aimed at producing surfactant in the fetal lungs is mandatory, which accelerates their maturation. Surgical treatment methods are also possible, in particular, suturing the cervix, or using a special obstetric pessary.

Cervical ring against dilation

To prevent premature opening, a special plastic ring is inserted into the uterus. It reduces the load. The insertion can be done on an outpatient basis, on an empty bladder. To prevent the uterus from contracting, you can take an antispasmodic before the procedure. The ring is lubricated with glycerin and inserted into the vagina. Then it is turned in the right direction. The doctor will do everything necessary. The patient will only need to come to an appointment every 2-3 weeks for a bacteriological examination. Sex is also prohibited. The opening of the cervix before childbirth occurs naturally, since the ring is removed beforehand.