Short cervix

A short cervix is quite common in women, and the main feature of this pathology is that it does not manifest itself for a long time.

In most cases, a woman learns about this problem from an obstetrician-gynecologist during pregnancy.

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Causes short cervix

A short cervix is a very dangerous pathology that has a negative impact on the process of bearing a child. Aggravating circumstances of this condition are a large fetus, polyhydramnios and multiple pregnancy. Many women who have been diagnosed with this condition wonder what factors provoke the development of the pathology.

The reasons for a short cervix can be different:

• Congenital anomalies in the structure of the uterus caused by heredity (genital infantilism, malformations of the uterus or underdevelopment of the cervical canal).
• Hormonal disorders in the female body caused by pregnancy (asymptomatic).
• Hyperandrogenism (excessive production of androgens – male sex hormones – in the female body).
• Cervical injuries (mechanical) resulting from surgical operations, diagnostic curettage or abortions, etc.
• Damage to the organ during previous births.
• Connective tissue dysplasia (pathological increase in relaxin).

Unfortunately, for a long time, most women do not suspect that they have a shortened cervix. Usually, this pathology is detected at 15-20 weeks of pregnancy. The fact is that it is during this period that the child's active intrauterine development is observed. The fetus begins to rapidly gain weight, which increases the load on both the isthmus and the cervix. As a result of hormonal changes in the pregnant woman's body, the cervix shortens and becomes softer, which facilitates its opening. Naturally, this is dangerous for the child, since there is a risk of spontaneous miscarriage, and in the later stages - premature birth.

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Pathogenesis

A deviation in the form of a short cervix can cause a spontaneous miscarriage or the onset of labor before the expected date. This occurs due to ICI (isthmic-cervical insufficiency) - a condition in which the shortened cervix cannot withstand the ever-increasing load as a result of the pressure of the fetus and amniotic fluid. Even with timely labor, a short cervix in most cases leads to acceleration of labor.

The primary cause can be considered a genetic deviation, i.e. the natural structure of the uterus, an innate feature of the female body. If a pregnant woman is diagnosed with this pathology, a repeated consultation with a gynecologist is necessary to make the right decision.

A short cervix becomes a clear “obstacle” to the normal bearing of a baby, as it causes a number of complications that can provoke a miscarriage or premature birth.

Pathogenesis as a set of interrelated processes that determine the course of a given disease may depend on both internal and external factors. Internal factors include congenital anomalies (which happen quite rarely), external factors include various aggressive interventions (curettage, abortions, hysteroscopy). Most often, a shortened cervix is a consequence of mechanical damage and surgical operations.

A short cervix can only be diagnosed by an experienced gynecologist during a vaginal examination. The final diagnosis will depend on the opinion of the specialist who will perform an ultrasound on the woman using a special vaginal sensor.

Such pathology can be caused by both underdevelopment or abnormal structure of the uterus, and hormonal imbalance – the true cause of the pathology will be determined by the doctor. If the gynecologist determines the looseness of the cervix in a pregnant woman, then she will be prescribed medication.

Very often, the shortening of the cervix is facilitated by a hormonal imbalance, which is observed in a pregnant woman from about the 15th week. The adrenal glands of the future child begin to function actively, resulting in the process of synthesizing androgens (male sex hormones). It is because of the increased amount of these hormones that the cervix can soften and open, without causing an increase in the tone of the uterus.

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Symptoms short cervix

What is considered a short cervix? If normally this organ has a length of 3.5-4 cm, then in pathology this figure is less than 2.5 cm. The shape of the cervix is similar to a truncated cylinder or cone. Conventionally, it can be divided into 2 parts: vaginal and vaginal. A third of the organ consists of strong muscle tissue, which allows the fetus to be held in the uterus throughout the pregnancy.

What is the danger of a shortened cervix? This is one of the reasons for the development of isthmic-cervical insufficiency during pregnancy. This pathological condition leads to the fact that the constantly growing fetus is unable to stay in the uterine cavity. The cervix cannot withstand and opens, causing a miscarriage in the early stages, and premature or accelerated labor in the later stages. In addition, due to this anatomical feature, the fetus is not sufficiently protected from the effects of infectious agents and various microorganisms, since the barrier function is impaired.

A short cervix most often does not manifest itself in any way, i.e. the woman does not feel any health problems. Usually nothing bothers her, and the diagnosis is established by a gynecologist during an examination and additional research (ultrasound, cervicometry). However, sometimes (in 20% of cases) there are a number of signs indicating a shortened cervix.

Symptoms occur mainly during pregnancy – the expectant mother may notice watery or bloody vaginal discharge, as well as minor abdominal pain (below). With such symptoms, a woman needs to see her doctor as soon as possible for examination, consultation and determination of the main cause of health problems. It is quite possible that due to a short cervix, isthmic-cervical insufficiency has developed – a condition characterized by the inability of the cervix to hold the growing fetus in the uterine cavity. Accordingly, this can lead to the worst – miscarriage or premature birth, which is extremely undesirable for both the woman and her baby.

Timely treatment with medications will help eliminate the problem and save the pregnancy. Therefore, a pregnant woman should not neglect her doctor's consultations and routine examinations - this can save the situation in time.

First signs

A short cervix is a pathology that practically does not give any signs, i.e. women in most cases do not suspect the presence of such a serious problem. Serious because it threatens negative complications, primarily affecting the health of the woman who is expecting a child. Usually the diagnosis is made during pregnancy, when a weak, shortened cervix causes a dangerous condition - isthmic-cervical insufficiency, as a result of which the expectant mother may lose the child.

The first signs of softening or opening of the shortened cervix are a tingling pain in the vagina, and cramping pains in the lower back and abdomen may also “join in” at the same time.

In addition, a pregnant woman may experience bloody discharge, which signals a threat of termination of pregnancy. Whatever the signs (pain, discharge from the genital tract, tingling in the vagina), the woman must immediately consult a gynecologist, and if necessary, call an ambulance.

Unfortunately, it is impossible to detect the pathology on your own – this will require a targeted study using ultrasound and special medical equipment. The sooner the pathology is diagnosed, the faster measures will be taken to preserve the pregnancy.

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Very short cervix

A short cervix does not cause discomfort to a woman, but it is certainly a pathology, since it fixes the uterus in a closed state worse. This problem is especially acute during pregnancy. Therefore, if a pregnant woman is diagnosed, she should be under constant supervision of her obstetrician-gynecologist, since she is in the risk group.

A very short cervix (less than 2 cm) is primarily dangerous because it can become the main cause of miscarriage and rapid labor. In case of isthmic-cervical insufficiency, which develops as a result of hormonal changes in the body, a woman may be prescribed glucocorticoids to correct the condition of the cervix. If the condition worsens, the doctor puts temporary stitches on the uterus. The expectant mother is shown to limit physical activity and stress.

The pathology can be detected using transvaginal ultrasound, based on which the doctor will draw conclusions about the condition of the cervix and the necessary measures to prevent dangerous consequences. A special gynecological ring, a pessary, helps maintain a stable condition of the cervix and prevent its premature opening. Treatment methods in each case are determined based on the results of medical examinations.

Forms

A short cervix causes various complications, especially when carrying a child. Therefore, it is so important to promptly identify the pathology and take appropriate measures depending on the situation.

The X International Classification of Diseases, which is considered a normative document and is used to record morbidity, includes class XV called “Pregnancy, childbirth and the postpartum period.”

When considering this issue, it is necessary to pay attention to the ICD-10 code O34.3 - "Isthmic-cervical insufficiency", as well as the code O34.4 - "Other anomalies of the cervix..."

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Complications and consequences

A short cervix is quite common in women, but the real danger of this pathology is that in everyday life it does not manifest itself in any way, does not cause discomfort and does not have any pronounced symptoms. Only when a woman becomes pregnant, an obstetrician-gynecologist can identify this problem during a medical examination.

The consequences of the diagnosis, unfortunately, can be very serious. First of all, this concerns the threat of miscarriage (in the early stages) or premature birth against the background of an excessively shortened cervix, which is not able to hold the uterus with a growing fetus. Therefore, it is extremely important to diagnose the problem at an early stage in order to take timely measures to solve it, i.e. to establish the correct treatment method.

To begin effective treatment, it is necessary to identify the prerequisites for ICI - a condition in which the cervix is dilated. In addition to the threat of miscarriage and premature birth, it is necessary to note such consequences of this pathology as infection of the fetus as a result of its vulnerability and rapid labor, which is most often accompanied by ruptures of the cervix, perineum and vagina.

Thus, in order to avoid possible consequences, the expectant mother should regularly visit the antenatal clinic in accordance with the established schedule. Only in this case will the ICI be diagnosed in time. It is also very important for every woman planning to give birth to a healthy child to undergo an examination before conception, which includes an ultrasound of the body of the uterus and pelvic organs. The diagnosis of a shortened cervix is made if the length of the organ in diameter is less than 2 cm, and the internal os is 1 cm or more. In this case, the expectant mother is at risk, is put on special monitoring by the doctor, and also monitors her lifestyle in order to avoid increased stress and prevent an increase in uterine tone.

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Complications

A short cervix is one of the main risk factors affecting the termination of pregnancy (miscarriage) or miscarriage. If in everyday life such a pathology does not cause any problems for a woman, then during pregnancy it threatens various complications up to rapid labor with its negative consequences and loss of the baby.

Complications may include fetal rejection, abnormal labor, premature birth, which naturally has a negative impact on the child's health and the woman's mental state. How to prevent possible complications? A short cervix can be detected during a gynecological examination starting from the 11th week, but most often this change is diagnosed at a later stage.

The most common complication is isthmic-cervical insufficiency, which, if detected in time, can be successfully treated and blocked. It is important to simply follow the doctor's instructions and not let the situation slide. Constant monitoring of the pregnancy by an obstetrician and timely prescribed treatment will allow a woman to carry the baby to term and give birth safely. If the cervix begins to shorten long before the 37-38 week period, the pregnant woman needs constant monitoring and special observation. Monitoring of the length of the cervix is carried out throughout the pregnancy. At each ultrasound examination, the doctor takes its mandatory measurement, since the success of bearing a child depends on this indicator.

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Diagnostics short cervix

A short cervix is a pathology that can cause a lot of trouble for a woman during pregnancy. The health of the mother and child, as well as the outcome of pregnancy, will depend on this indicator (its length).

Diagnosis of a short cervix is usually carried out from the 11th week, when a woman is examined by a gynecologist and registered for pregnancy. The main problem of such pathology (when the cervix is less than 2 cm) lies in the threat of spontaneous miscarriage (in the first months of gestation) or premature birth. Comprehensive diagnostics includes:

• digital examination of the vagina (helps to assess the length of the cervix, patency and condition of the cervical canal);
• Ultrasound (considered the main method of diagnosis and monitoring the development of cervical insufficiency);
• mirror examination of the cervix (allows you to determine the condition of the external os);

Signs of ICI (a dangerous condition in which premature softening of the cervix is observed) are a decrease in the length of the organ to 25-20 mm, as well as the opening of the cervical canal by more than 9 mm. Such pathology requires immediate intervention (prescription of effective treatment methods), since this is a poor diagnostic sign that threatens the loss of the child. It should be noted that natural opening of the cervix occurs only immediately before the birth process, but not earlier than the time established by nature.

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Tests

A short cervix is a pathology that can only be detected during a vaginal examination (most often by transvaginal ultrasound). In ordinary life, a woman does not even suspect such a problem, and only during pregnancy can an obstetrician-gynecologist make a diagnosis based on an examination (a more accurate result can be obtained at 18-22 weeks, when ICI develops due to a shortened cervix).

The tests required to clarify the dangerous condition (threat of miscarriage due to ICI) are prescribed by a doctor. Usually, this is a comprehensive examination, which includes:

• examination of smears and blood for various bacterial sexually transmitted infections (chlamydia, gonorrhea, mycoplasmosis, etc.);
• blood test for antibodies to hCG and intrauterine infections (herpes, rubella virus, cytomegalovirus, toxoplasmosis);
• urine test for ketosteroids;
• determination of the level of hormones (estrogen, testosterone and progesterone) in the blood of a pregnant woman;
• coagulogram (determination of the level of blood clotting);
• Blood tests for lupus anticoagulant and thyroid hormone levels.

Such a comprehensive medical examination is necessary to identify and clarify the exact cause of the threat of miscarriage, one of which may be a short cervix (congenital or acquired). Isthmic-cervical insufficiency, leading to premature shortening and opening of the cervix, occurs if the length of the organ is less than 2 cm, and the diameter of the internal os is no more than 1 cm. This condition is explained by the physiological inability of the cervix to hold the growing fetus in the uterine cavity.

In general, the diagnosis of such a dangerous condition is based on clinical, anamnestic, instrumental and laboratory data. A suspicion of a short cervix is the appearance of abundant watery discharge in a woman during pregnancy (often with an admixture of blood), as well as pain in the lower abdomen.

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Instrumental diagnostics

"Short cervix" - such a diagnosis can be established during a gynecological examination using speculums, as well as during a digital vaginal examination. If nulliparous women have a closure of the external os, then pregnant women with the development of ICI have an expansion of the cervical canal and internal os, as well as prolapse of the fetal bladder. Such research methods are sufficient to identify pathology, but in doubtful cases, the woman is prescribed an ultrasound of the uterine cavity.

Instrumental diagnostics includes the following research methods:

• transvaginal ultrasound;
• tocography to determine uterine tone and the presence of contractions;
• transvaginal ultrasound to determine the length of the cervix (if the length is up to 2-2.5 cm, there is a risk of miscarriage or premature birth);
• dynamic ultrasound (performed if there are signs of threatened miscarriage);
• cardiac monitoring (prescribed to determine the intrauterine condition of the fetus);
• Doppler blood flow (fetal and uteroplacental) – is performed to determine the condition of the fetus.

As a result of premature reduction of the cervix in the first trimester of pregnancy, the risk of miscarriage increases significantly. A cervix that does not meet the norms practically does not protect the fetus from infection. Therefore, it is very important to promptly identify the pathology and use effective measures aimed at solving the problem.

Differential diagnosis

A short cervix is dangerous because it can provoke the development of a dangerous condition during pregnancy. We are talking about isthmic-cervical insufficiency, which results in spontaneous miscarriage or premature birth, which is extremely undesirable for the expectant mother. It is almost impossible to diagnose on your own. Sometimes the symptoms are so weakly expressed and unnoticeable that they can be ignored by both the patient and the doctor. It is very important to conduct a comprehensive examination, which includes palpation and examination of the cervix in gynecological mirrors.

Differential diagnostics is used as a method aimed at excluding possible diseases in a patient that do not match any symptoms and establishing the only correct diagnosis. The success of such diagnostics is determined only by a thorough comprehensive examination.

Differential diagnostics of such pathology is carried out with other factors that provoke the threat of termination of pregnancy. Thus, during palpation, softening and shortening of the cervix to 25-20 cm, as well as V-shaped expansion of the cervical canal are noted. However, an important detail should be noted: women who have become pregnant for the first time may experience closure of the external os, which confuses the doctor when making a diagnosis. In this case, additional research is necessary in the form of ultrasound with a transvaginal sensor.

In case of a threat of premature birth, differential diagnostics are carried out with pathologies of the abdominal organs: in particular, cystitis, acute appendicitis, septic colitis, diseases of the urinary tract. Such a dangerous condition is also differentiated from food toxic infection, acute pyelonephritis, intestinal and renal colic, the presence of uterine fibroids. For the accuracy of differential diagnostics (when observing concomitant pathologies), qualified assistance from doctors of other specialties is often required. Hospitalization of a pregnant woman is carried out against the background of negative dynamics of the cervix (sharp shortening and smoothing), as well as anamnesis data on premature birth. After stopping the signs of premature birth, the patient is transferred to the pathology department for further treatment.

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Treatment short cervix

If the changes in the cervix are minor, then conservative treatment is used. The pregnant woman is prescribed medications, the action of which is aimed at reducing the tone of the uterus and bringing the cervix to a physiologically normal state. For this purpose (to prevent the threat of premature birth), the patient is shown intravenous (drip) administration of such drugs as Magnesia and Ginipral (can be taken in tablet form).

Treatment of a short cervix requires strict supervision by a gynecologist, who will determine the most effective methods.

Prevention

A short cervix is most often diagnosed in the presence of pregnancy, when a woman registers. After diagnostic measures, if the situation is serious (i.e. there is a threat of miscarriage), the gynecologist prescribes effective methods aimed at preserving the pregnancy. To avoid unpleasant consequences of such a pathology, it is necessary to think about early prevention of the disease. Thus, it is easier to prevent complications that can lead to a threat of termination of pregnancy.

Prevention should be aimed at compliance with the following recommendations and rules:

• regular (1-2 times a year) visits to a gynecologist for timely detection of problems with women's health and taking measures to eliminate them;
• the use of reliable contraceptives to protect against unplanned pregnancy and its consequences – abortions;
• proper pregnancy planning (especially important for women with a history of miscarriages or premature births);
• maintaining a healthy lifestyle in sexual terms (having one partner);
• constant monitoring of health (if any symptoms indicate “women’s” problems, you must immediately contact a gynecologist).

If the pathology was discovered after pregnancy, the expectant mother should closely monitor her condition and follow the doctor's recommendations. Most often, such recommendations are related to limiting physical activity, wearing a bandage, and abstaining from sexual intercourse (if there is a risk of miscarriage).

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Forecast

"Short cervix" - many women who have decided to become mothers face this diagnosis, since this pathology is usually detected during the first or second examination by a gynecologist when registering for pregnancy. Often, to confirm the diagnosis, a woman is prescribed other research methods, in particular, transvaginal ultrasound, which provides a better visualization of the female organs being examined.

The prognosis for properly thought-out treatment of such pathology is positive. This is due to the use of the most effective treatment methods aimed at reducing the tone of the uterus, as well as holding the fetus in its cavity (using an obstetric pessary or suturing). It is very important to start therapy on time and strictly follow all the instructions and recommendations of the doctor, who will take measures to prolong the pregnancy.

A short cervix during pregnancy is a fairly common problem today. Due to the inability to maintain the pressure of the uterus with a growing fetus, the cervix gradually shortens, softens and opens. If no measures are taken to eliminate this pathology, then its most dangerous consequences will be miscarriage and premature birth. This is why it is extremely necessary to monitor the condition of the cervix and promptly begin therapy to eliminate possible complications.

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