Short cervix of the uterus

The short cervix of the uterus is common in women quite often, and the main feature of this pathology is that it has not been manifested for a long time.

In most cases, a woman learns about this problem from an obstetrician-gynecologist during the bearing of the child.

[1], [2], [3],

Causes of the short cervix

Short cervix is a very dangerous pathology, which has a negative impact on the process of bearing a child. Aggravating circumstances of this condition are a large fetus, polyhydramnios and multiple pregnancies. Many women who were diagnosed with this problem are asked what factors trigger the development of pathology.

Causes of a short cervix can be different:

• Congenital anomalies in the structure of the uterus, due to heredity (genital infantilism, malformations of the uterus or underdevelopment of the cervical canal).
• Hormonal disorders in the female body caused by pregnancy (asymptomatic).
• Hyperandrogenia (excessive production in the female body of androgens - male sex hormones).
• Cervical injuries (mechanical), obtained as a result of surgical operations, diagnostic curettage or abortion, etc.
• Damage to the organ during previous births.
• Dysplasia of connective tissue (pathological rise of relaxin).

Unfortunately, for a long time, most women do not suspect that they have a shortened cervix. Usually, this pathology is detected at the 15-20 week of pregnancy. The fact is that it is during this period that the active intrauterine development of the child is noted. The fetus begins to rapidly gain weight, which increases the load on both the isthmus and the uterine neck. As a result of hormonal changes in the body of a pregnant woman, the neck is shortened and becomes softer that it helps to open it. Naturally, this is dangerous for the child, since there is a risk of spontaneous miscarriage, and in the late term - premature birth.

[4], [5]

Pathogenesis

Deviation in the form of a short cervix can cause spontaneous miscarriage or the onset of labor before the expected time. This is due to ICN (ischemic-cervical insufficiency) - a condition in which the shortened cervix does not withstand the constantly increasing load as a result of the pressure of the fetus and amniotic fluid. Even with timely delivery, a short neck in most cases leads to an acceleration of labor.

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

The short neck of the uterus becomes an obvious "barrier" on the way to the normal carrying of the baby, as it causes a number of complications that can provoke miscarriage or premature birth.

Pathogenesis as a set of interrelated processes that determine the course of the disease can depend on both internal and external factors. Internal congenital anomalies (which happens rarely), to external - various aggressive interventions (scraping, abortion, hysteroscopy). Most often, the shortened uterine neck is the result of mechanical damage and surgical operations.

A short cervix can be diagnosed only by an experienced gynecologist during a vaginal examination. In this case, the final diagnosis will depend on the opinion of a specialist who will hold a woman with ultrasound using a special vaginal sensor.

To lead to such a pathology may both underdevelopment or the broken structure of the uterus, and hormonal failure, - the true cause of the pathology will be established by the doctor. If the gynecologist determines the friability of the uterine neck in a pregnant woman, then she will be prescribed medication.

Very often shortening of the neck contributes to the violation of the hormonal background, which is observed in the pregnant woman from about the 15th week. In the future child, the adrenal glands begin to function actively, resulting in the synthesis of androgens (male sex hormones). It is because of the increased amount of these hormones that the neck can soften and open without causing an increase in the tone of the uterus.

[6], [7], [8],

Symptoms of the short cervix

Which neck is considered short? If in normal this organ has a length of 3.5-4 cm, then in pathology this indicator is less than 2.5 cm. In shape, the cervix is similar to a truncated cylinder or cone. Conditionally it can be divided into 2 parts: vaginal and zagalaginal. One third of the body consists of a strong muscle tissue, which allows you to hold the fetus in the uterus throughout pregnancy.

What is dangerous is the shortened cervix of the uterus? This is one of the reasons for the development of ischemic-cervical insufficiency in pregnancy. This pathological condition leads to the fact that the ever-growing fetus is unable to stay in the uterine cavity. Sheika does not stand up and opens, causing early miscarriage, and later - premature or accelerated labor activity. In addition, because of this anatomical feature, the fruit is not sufficiently protected from the effects of infectious agents and various microorganisms, as the barrier function is impaired.

Short cervix often does not manifest itself in any way, i.e. A woman does not feel any health problems. Usually, she does not bother, and the diagnosis is established by a gynecologist during the examination and additional examination (ultrasound, cervicometry). However, sometimes (in 20% of cases) there are a number of signs indicating a shortened cervix of the uterus.

Symptoms occur mainly against the background of ongoing pregnancy, - the future mother can detect watery or bloody discharge from her vagina, as well as a minor abdominal pain (below). With such symptoms, a woman needs to see her doctor as soon as possible for examination, counseling and determining the main cause of health problems. It is possible that because of a short cervix, Isthmico-cervical insufficiency developed - a condition that is 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 the use of medications will help to eliminate the problem and keep the pregnancy. Therefore, the pregnant woman should not neglect his doctor's consultations and planned examinations, this can save the situation in time.

First signs

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

The first signs of softening or opening of the shortened uterine neck are tingling pain in the vagina, in parallel, cramping pains in the lower back and in the lower abdomen can also be connected.

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

Unfortunately, it is impossible to identify pathology by yourself, for this purpose a purposeful study using ultrasound and special medical equipment is needed. The sooner the pathology is diagnosed, the faster the measures will be taken to preserve the pregnancy.

[9], [10],

Very short cervix

The short neck of the uterus does not cause a woman discomfort, but, of course, is a pathology, because it fixes the uterus in a closed state worse. This problem is especially acute in the period of bearing a child. Therefore, if the diagnosis is made to a pregnant woman, she should be under constant supervision of her obstetrician-gynecologist, since she is at risk.

A very short cervix (less than 2 cm), first of all, is dangerous because it can become the main cause of miscarriage and rapid delivery. With ischemic-cervical insufficiency, which develops due to hormonal changes in the body, a woman can be assigned glucocorticoids to correct the state of the uterine neck. If the condition worsens, the doctor puts temporary seams on the uterus. The future mum shows the limitation of physical activity and exercise.

To reveal a pathology it is possible by means of transvaginal ultrasound, on the basis of which the doctor will make conclusions about the condition of the cervix and the necessary measures to prevent dangerous consequences. Support a stable condition of the cervix and prevent its premature opening helps a special gynecological ring - pessary. Methods of treatment in each case are determined by the results of medical research.

Forms

Short cervix becomes the cause of various complications, especially when carrying a child. Therefore, it is so important to identify the pathology in time and take appropriate measures depending on the situation.

In the X International Classification of Diseases, which is considered a normative document and used to take into account the incidence, is class XV entitled "Pregnancy, childbirth and the puerperium".

Considering this issue, it is necessary to pay attention to the code for μB 10 O34.3 - "Isthmiko-cervical insufficiency", and also the code O34.4 - "Other anomalies of the cervix ..."

[11], [12]

Complications and consequences

The short neck of the uterus is common in women quite often, but the true danger of such a pathology is that in normal 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, it concerns the threat of miscarriage (in the early stages) or premature births against the background of a too shortened neck, which is unable to keep 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 method of treatment.

To start effective treatment, it is necessary to identify the prerequisites of the ICI - a condition in which cervical dilatation is observed. In addition to the threat of miscarriage and premature birth, it is necessary to note the consequences of this pathology, such as infection of the fetus as a result of its insecurity and rapid delivery, which are often accompanied by ruptures of the cervix, perineum and vagina.

Therefore, in order to avoid possible consequences, a future mother should regularly visit a women's consultation according to the established schedule. Only in this case, the NIH will be diagnosed on time. Every woman planning to have a healthy baby is also very important to undergo a pre-conception examination that includes ultrasound of the uterus body and pelvic organs. The diagnosis of the shortened neck is made if the length of the organ in diameter is less than 2 cm, and the internal pharynx is from 1 cm or more. In this case, the future mother is at risk, is placed by the doctor for special control, and also monitors the way of life in order to avoid increased stresses and to prevent the increase of the uterine tone.

[13], [14]

Complications

Short cervix is one of the main risk factors that affect abortion (miscarriage) or miscarriage. If in a normal life such a pathology does not cause a woman any problems, then during pregnancy it threatens with various complications up to the rapid delivery with their negative consequences and the loss of the baby.

Complications can concern fetal rejection, pathological births, premature birth, which, naturally, negatively affects the health of the child and the mental state of the woman. How to prevent possible complications? A short neck of the uterus can be identified on examination with a gynecologist, starting from the 11th week, but most often this change is diagnosed at later periods.

The most common complication is ismiko-cervical insufficiency, which, with timely detection, is successfully treated and blocked. It is important to simply follow the doctor's instructions and not let the situation drift. Constant monitoring of the obstetrician over the course of pregnancy and timely treatment will allow the woman to inform the baby and safely give birth to it. If the cervix begins to shorten well before the 37-38 weeks, the pregnant woman needs constant monitoring and special observation. Control of the length of the uterine neck is carried out throughout the entire pregnancy. At each ultrasound examination the doctor conducts its obligatory measurement, since the success of the gestation depends on this indicator.

[15], [16], [17],

Diagnostics of the short cervix

The short neck of the uterus is a pathology that can cause a lot of trouble to a woman during the period of gestation. From this indicator (the size of its length) will depend on the health of the mother and child, as well as the outcome of pregnancy.

Diagnosis of the short cervix is usually carried out from the 11th week, when a woman is examined by a gynecologist and becomes registered for pregnancy. The main problem of this 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. Complex diagnosis includes:

• finger examination of the vagina (helps to assess the length of the cervix, patency and the condition of the cervical canal);
• Ultrasound (considered the main method of diagnosis and control of the development of NIH);
• mirror examination of the cervix (allows to determine the condition of the external throat);

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

[18],

Analyzes

Short cervix is a pathology that can be detected only during vaginal examination (most often by transvaginal ultrasound). In ordinary life, a woman does not even suspect such a problem, and only during pregnancy the obstetrician-gynecologist will be able to diagnose on the basis of a survey (a more accurate result can be obtained at the period of 18-22 weeks, when the ICS is shortened because of the shortened neck). 

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

• research of a smear and blood on different bacterial sexual infections (a clamidiosis, a gonorrhea, a mycoplasmosis, etc.);
• blood test for antibodies to hCG and intrauterine infections (herpes, rubella virus, cytomegalovirus, toxoplasmosis);
• urine test for keto-steroids;
• the determination in the blood of the pregnant level of hormones (estrogen, testosterone and progesterone);
• coagulogram (determination of blood clotting level);
• a blood test 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 can serve as a short cervix (congenital or acquired). Isthmiko-cervical insufficiency, leading to premature shortening and opening of the neck, occurs if the length of the organ is less than 2 cm, and the internal throat diameter is no more than 1 cm. This condition is explained by the physiological impossibility of the cervix to retain 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. Suspicion of a short neck is the appearance of a woman's abundant watery discharge during pregnancy (often with a trace of blood), as well as pain in the lower abdomen.

[19], [20], [21], [22], [23], [24], [25]

Instrumental diagnostics

"Short neck of the uterus" - this diagnosis can be established during a gynecological examination with the use of mirrors, as well as with a finger vaginal examination. If the women with nulliparous women have a closure of the external throat, the development of the ICI in pregnant women shows an enlargement of the cervical canal and internal pharynx, as well as the prolapse of the fetal bladder. Such methods of research are sufficient for the detection of pathology, but in doubtful cases, a woman is prescribed ultrasound of the uterine cavity.

Instrumental diagnostics includes the following research methods:

• transvaginal ultrasound;
• tomography for determining the tone of the uterus and the presence of fights;
• transvaginal echography to determine the length of the neck (at an index of 2-2.5 cm there is a threat of miscarriage or premature birth);
• dynamic echography (carried out in the presence of signs of the threat of miscarriage);
• cardiomonitoring (appointed to determine the intrauterine state of the fetus);
• dopplerometry blood flow (fruit and utero-placental) - is conducted to determine the condition of the fetus.

As a result of a premature decrease in the uterine neck in the first trimester of pregnancy, the risk of miscarriage is significantly increased. Cervix, which does not meet the standards, practically does not protect the fetus from penetration of infections. Therefore, timely detection of pathology and the use of effective measures aimed at solving the problem are very important.

Differential diagnosis

The short neck of the uterus is dangerous because it can provoke the development of a dangerous condition when carrying a child. This is an istrmico-cervical insufficiency, which results in spontaneous miscarriage or premature birth, which is highly undesirable for a future mother. It is almost impossible to diagnose independently. Sometimes the symptoms are so mild and invisible 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 diagnosis is used as a technique aimed at excluding the patient from possible diseases that are not suitable for any symptoms, and establishing the only true diagnosis. The success of such diagnostics is determined only by a thorough complex examination.

Differential diagnosis of such pathology is carried out with other factors provoking a threat of termination of pregnancy. Thus, with palpation, softening and shortening of the uterine neck to 25-20 cm is noted, as well as a V-shaped extension of the cervical canal. However, it should be noted an important detail: for women who become pregnant for the first time, there may be a closure of the external pharynx, which confuses the doctor in the diagnosis. In this case, an additional study is needed in the form of ultrasound with a transvaginal sensor.

When there is a threat of premature births, differential diagnosis is performed with pathologies of the abdominal organs: in particular, cystitis, acute appendicitis, septic colitis, diseases of the urinary tract. Such a dangerous condition also differentiates with food poisoning, acute pyelonephritis, intestinal and renal colic, the presence of uterine fibroids. For the accuracy of differential diagnosis (when observing companion pathologies) often require qualified help from doctors of other specialties. Hospitalization of a pregnant woman is performed against a backdrop of negative dynamics of the cervix (a sharp shortening and smoothing), as well as anamnesis of premature birth. After relief of premature birth signs, the patient is transferred to the pathology department for further treatment.

[26], [27], [28], [29], [30], [31]

Treatment of the short cervix

 If the changes in the cervix are small, then they resort to conservative treatment. Pregnant women are prescribed medications, whose action is aimed at reducing the tone of the uterus and bringing the neck to a physiologically normal state. To this end (to prevent the threat of premature births), the patient is shown intravenous (drop) administration of such drugs as Magnesia and Ginipral (can be taken in tableted form).

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

Prevention

Short cervix is most often diagnosed with pregnancy, when a woman becomes registered. After the diagnostic measures, if the situation is serious (ie, there is a threat of miscarriage), the gynecologist appoints effective methods aimed at maintaining the pregnancy. To avoid unpleasant consequences of such pathology, it is necessary to think about early prevention of the disease. Thus, it is easier to prevent complications that can lead to the threat of termination of pregnancy.

Prevention should focus on the following recommendations and rules:

• regular (1-2 times a year) visit to a gynecologist for timely detection of problems with women's health and taking measures to eliminate them;
• the use of reliable contraception to protect against unplanned pregnancy and its consequences - abortion;
• correct planning of pregnancy (especially important for women who have a history of miscarriages or premature births);
• maintaining a healthy lifestyle in a sexual way (having one partner);
• constant control over health (for any symptoms that indicate "women's" problems, you need to immediately contact a doctor-gynecologist).

If the pathology was found after the onset of pregnancy, the expectant mother should closely monitor her condition and follow the doctor's recommendations. Most often, such recommendations are associated with the restriction of physical exertion, wearing a bandage, abstaining from sexual intercourse (with the threat of miscarriage).

[32], [33], [34], [35],

Forecast

"Short neck of the uterus" - many women who have decided to become mothers face this diagnosis, since this pathology is usually found on the first or second examination with a gynecologist when registering for pregnancy. Often to confirm the diagnosis, women are assigned other methods of research, in particular, transvaginal ultrasound, which gives a better visualization of the female organs being examined.

The prognosis for a well-thought-out treatment of such a pathology is positive. This is due to the use of the most effective methods of treatment aimed at reducing the tone of the uterus, as well as holding the fetus in its cavity (using obstetric pessaries 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.

Short cervix during pregnancy is a fairly common problem today. Due to the inability to maintain the pressure of the uterus with the growing fetus, the neck is gradually shortened, softened and opened. If you do not take any measures to eliminate this pathology, the most dangerous consequences of it will be miscarriage and premature birth. That is why it is extremely necessary to monitor the condition of the uterine neck and timely started therapy to eliminate possible complications.

[36], [37], [38]