Soft cervix

The cervix is a hollow organ that connects the vagina with the uterus itself. Its size parameters average 2.5 by 3 cm. In this article, we will try to figure out whether a soft cervix is a pathology or a natural physiological process.

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Causes of a soft cervix

When describing sources that can provoke softening of the cervix, it is worth noting that they may have physiologically justified causes, or may be caused by pathological changes in the female genital organs.

Known causes of a soft cervix include:

• Isthmic-cervical insufficiency is a decrease in muscle tone, the inability to resist intrauterine pressure, which leads to a weakening of their functions and the inability to hold the fetus inside the uterus. Late miscarriages are possible. This process mainly occurs between the twentieth and thirtieth weeks of gestation.
• Endocervicitis of the cervix is an inflammatory disease of the female genital organs. The most common source of female infertility.
• Congenital pathology.
• Hormonal imbalance in the female body. Under the influence of prostaglandins, the contractile ability of the uterus and its cervix is disrupted.
• The first weeks of pregnancy.
• Prenatal period. The uterus and its cervix are preparing for childbirth and the passage of the newborn through the birth canal.
• Previous curettage of the mucous membrane of the uterus and cervix, which are accompanied by mechanical dilation.
• Mechanical, physiological or other damage to the muscle tissue of the organ in question.
• Violation of the relationship between connective and muscular structures in the area of interest to us.
• Consequences of pathological births, which occurred with large and deep tears. Application of stitches.
• Taking medications that belong to a certain pharmacological group.

Pathogenesis

As medical practice shows, the causes of a soft cervix may have mechanical, medicinal and non-medicinal sources. At the same time, the pathogenesis of this phenomenon has not yet been fully studied.

Doctors believe that the appearance of this factor is the result of disturbances in the reaction of cellular structures to neurohumoral stimuli. Or the consequences of a mutual discrepancy in the amount of muscle and connective tissue.

Symptoms of a soft cervix

If we talk about preparation for obstetric activities, then at this stage the fetus begins to descend, preparing for childbirth, and the entire mother's body prepares for this. The baby's weight increases the pressure on the cervix.

At this time, the placenta ages, reducing the amount of hormone produced. The cervix begins to lose tone and softens. Symptoms of a soft cervix are expressed by the inability of the organ to retain the mucus plug, which is one of the first signs of approaching pregnancy.

In other cases, no specific pathological symptoms are observed, and this factor can only be identified during an appointment and examination with a gynecologist.

First signs

As already noted above, there is no specific obvious symptomatology of the factor considered in this article. Therefore, it is not possible to identify and describe the first signs of softening.

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Soft cervix before menstruation

The female body is unique. It is designed for a great mission - the release of an egg cell ready for fertilization, the bearing of an embryo and the birth of a strong and healthy, still small, but already human being.

A woman prepares for this mission every month. In each menstrual cycle, the female body goes through the same path. And if it does not end with ovulation and subsequent pregnancy, the fair sex will have her period - the release of an already unnecessary product (an unfertilized egg), renewal of the mucous membrane of the genitals, preparing it for the next cycle.

During this cycle, the density, texture, locality and position of the cervix and the uterus itself change. A soft cervix before menstruation is one of the primary signs of approaching menstruation. This fact is accompanied by the organ being lifted and partially opened.

This allows for easier sperm invasion and subsequent fertilization. If pregnancy does not occur, sticky discharge appears. During this period, a woman may feel more extensive discharge from the cervical canal.

If the fertilization of the egg does not occur, the uterus together with its cervix begins to descend, the canal expands, and softening occurs. This physiological change in the condition of the organ ensures the unimpeded discharge of the menstrual blood.

Thus, the female body regulates the process of conception or, in its absence, the cleansing of the body from “unused material”.

Soft cervix during pregnancy

The time after conception and before normal delivery is one of the most exciting periods in the life of the expectant mother. A woman has to go through many anxious moments if she is diagnosed with a soft cervix during pregnancy. Perhaps this situation is a normal physiological change that does not allow for worries, but in some cases, if ignored, this fact can lead to irreparable consequences.

As mentioned above, before the moment when the female body is ready for fertilization and the ovulation process has occurred, the cervix becomes softer and rises upward, which allows male sperm to more easily reach the egg and fertilize it.

Once conception has occurred, the cervix should become tighter again, sealing off the uterus. This allows the embryo to develop normally without fear of leaving the uterus.

Over time, the fetus develops, grows, gains weight, and begins to press more actively on the bottom of the uterus, and, consequently, on its cervix. If the muscle tone of the organ is insufficient, then the cervix begins to soften and open, which threatens (if this is not the prenatal period) the premature exit of the fetus from the uterus - a miscarriage.

As statistics show, this pathological process most often occurs in the period from the twentieth to the thirtieth week of pregnancy, especially critical, obstetricians and gynecologists consider the 24th week of gestation.

During a normal pregnancy, the physiologically justified process of softening begins immediately before labor. This is how the woman's body prepares for the baby's passage through the birth canal at birth.

Soft cervix in early pregnancy

After conception, not only the uterus undergoes changes, but also the organ discussed in this article. It changes its hue, acquiring a bluish color. This is due to the formation of a more extensive network of glands and blood vessels, which must now feed not only the woman's body, but also the "new life that has emerged."

The density of the tissue changes: before fertilization it is softened, after pregnancy the cervix should become dense to create a plug effect. This allows the embryo to be retained in the uterus. Another function of the "rigid" cervix is a barrier that prevents the invasion of pathogenic flora and infectious strains into the uterine cavity.

During this period, a mucous plug is formed in the area of interest to us, which becomes the second barrier to invasion. Creamy discharges without a pathogenic odor may be observed. Their shade may vary: from transparent and pinkish whites to small bloody or brownish shades of liquid. These symptoms usually disappear by the third or fourth week after conception.

If a soft cervix is observed in the early stages of pregnancy, this is already a cause for concern. Since if the cervix does not become dense over time, there is a clear threat of spontaneous abortion. That is, the pregnant woman is at risk of miscarriage - loss of the child.

This clinical picture can arise against the background of a number of pathological changes. The most common cause of softening is isthmic-cervical insufficiency - decreased muscle tone of tissues. A number of factors can lead to such pathology. For example, this can be a pathology of the development of the uterus, a failure in the hormonal background, as well as trauma to the organ due to existing births or a number of abortions.

Soft cervix before labor

The cervix is one of the main organs in the female reproductive system that participates in the process of childbirth. A soft cervix before childbirth is a normal physiological process that promotes healthy childbirth.

Immediately before childbirth, the mother's body begins its preparation. The cervix also participates in this. It gradually becomes more pliable, which leads to the fact that it is no longer able to hold the mucus plug, which comes out. Doctors call this process the passage of the plug, which is the first sign of approaching labor.

Following this, the amniotic fluid also breaks and contractions begin. But at this point, the cervix is relaxed and has opened by about one centimeter, which is not enough for the baby to pass through the birth canal without trauma.

During the normal course of the prenatal process, the cervix continues to soften and increase the passage area. This course of the process will protect both the expectant mother and her child from possible injuries and ruptures during the birth period.

If the cervix is not sufficiently dilated and the labor process has already started, the obstetrician-gynecologist has to prescribe medications that, by acting on the cervix, will help it become softer, which will allow it to open more.

The softening process occurs at the hormonal level. Before birth, the placenta ages and stops producing the recent amount of hormones, which immediately provokes the appearance of antagonist hormones, which provoke softening and opening of the cervix, as well as spasms of the uterus (the beginning of contractions).

During this period, there is an increase in estrogens and a decrease in the amount of progesterone in the mother's body. Doctors note the accumulation of prostaglandins, serotonin, oxytocin and acetylcholine. The complex of these compounds significantly affects the naturalness of the process of childbirth, including the readiness of the cervix for childbirth.

This does not happen immediately. The process of softening muscle tissue and increasing the flow area occurs gradually and takes several hours.

If the process of childbirth has begun and the cervix is not open enough, the obstetrician-gynecologist has to resort to the help of certain medications that promote more active softening of the tissues. Until this moment, the cervix is called immature, but if the obstetrician-gynecologist is able to insert more than one finger, doctors say that the cervix is mature and the woman is physiologically ready for childbirth. But in this state, most women in this state can go on for another two weeks.

As a result, such a woman may go past her due date and give birth a week later.

The mucus plug coming out and amniotic fluid leaking is a signal that the pregnant woman needs to be hospitalized if she does not want to give birth at home.

Consequences

Drawing a conclusion from the above, the consequences of the process under consideration largely depend on the accompanying pathology or, if we are talking about pregnancy, on the period of bearing the baby, during which softening is diagnosed.

In some cases, this is a completely explainable physiological process, inherent in a woman by nature itself. In the case of a pathological manifestation of this factor, the consequences of changes in the structure of the organ may be the loss of the child (miscarriage) or further development of pathological changes.

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Complications

Any pathology entails disturbances in the functioning of the patient's body. Complications that a soft cervix entails may be the following.

• As has been noted above more than once, this is a threat of not carrying the fetus to term, that is, a miscarriage.
• For the same reason, doctors may diagnose infertility.

Perhaps even this is enough for a woman dreaming of a child to think about it and seek help from an obstetrician-gynecologist.

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Diagnosis of soft cervix

The fact in question can be discovered directly by a gynecologist during a preventive examination, examination regarding the registration of a woman for pregnancy, or during pregnancy monitoring. Therefore, diagnostics of a soft cervix is an examination by an obstetrician-gynecologist, who states this fact.

Subsequently, he may prescribe additional examination if he suspects the existence of any disease, of which this fact has become a symptom.

The stages of the examination may be as follows:

• Clarification of anamnesis.
• Analysis of the patient's complaints (if any).
• A specialist examination on a gynecological chair, which is carried out after the end of menstruation. If there is a suspicion of pregnancy, such an examination is carried out only for serious medical reasons, so as not to disrupt the process of embryo development.
• Immediately before menstruation (if there is no fertilization of the egg), a woman can check the condition of her cervix herself. But this must be done while observing all the rules of hygiene. At the same time, a woman will hardly be able to adequately assess the situation. Therefore, it is better to leave this examination to specialists.
• Laboratory tests:
  • General and biochemical analysis of urine.
  • General and biochemical blood analysis.
  • Studies of secretions.
  • If necessary, histological examination.
• Examination using modern medical equipment.
• Differential diagnostics.

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Tests

The first thing that is prescribed to any patient who comes with one problem or another is the following laboratory tests:

• General and biochemical blood tests.
• General and biochemical urine analysis.

Additional studies may also be required:

• Blood to determine blood type and Rh factor.
• Bacteriological and bacterioscopic analysis of vaginal discharge, which answers the question about the presence of infection.
• Analysis of the level of hormones of the pituitary-gonadotropic system.
• PAP test - Pap smear. Cytological analysis of a smear from the vagina. The sample is examined in the laboratory under a microscope. If atypical cells are identified, the patient is sent for additional examination.
• If necessary, a biopsy can be performed. Testing for human papillomavirus (HPV). The material taken (smear) is sent for polymerase chain reaction (PCR). If HPV is recognized, its type is determined.
• Immunohistochemistry with tumor markers - this study is carried out only on those patients who are suspected of having a malignant pathology.

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Instrumental diagnostics

Today it is quite difficult to imagine a doctor who is not armed with modern diagnostic methods, produced with the help of innovative medical equipment. Instrumental diagnostics used in this case can be represented by:

1. Hysterosalpingography (HSG). A method of X-ray diagnostics using a contrast agent. The method allows assessing the condition of a woman's genitals.
2. Magnetic resonance imaging of the pelvic organs is a highly informative examination method with minimal radiation exposure.
3. Ultrasound examination of the pelvic organs (ultrasound). Echographic examination.
4. Endometrial aspiration biopsy is a microscopic examination of tissue samples.
5. By puncture of the retro-uterine space through the posterior vaginal fornix.
6. Scraping of the cervical canal and uterine cavity.
7. Endoscopy, hysteroscopy or colposcopy are research methods using an optical instrument equipped with a lighting device.

Differential diagnostics

After the specialist has the results of the entire complex of examinations in hand, they conduct differential diagnostics - an analysis of the results of the studies. It involves drawing up a complete clinical picture of the patient's health condition with subsequent differentiation of a specific disease. Based on this knowledge, diseases that are similar in symptoms but not confirmed by research are eliminated.

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Treatment of soft cervix

The physiological phenomenon considered in this article can be either a symptom of a number of diseases, in which case therapy for a specific disease should be carried out, or a natural process of the norm. Therefore, the treatment of a soft cervix is an ambiguous issue.

If we are talking about childbirth, the maturity of the cervix at this period is determined by specialists using a special Bishop scale. The obstetrician-gynecologist receives this indicator during the examination of the woman in labor.

In order for the birth to proceed without significant tears and other injuries to both the mother and her child, the diameter of the passage section of the canal at the first stage of obstetrics should be about ten centimeters.

But if the time of delivery has not yet come, and the woman is diagnosed with a soft cervix - this does not mean at all that she will not be able to carry and give birth to a healthy baby. Such a patient is prescribed bed rest and will have to lie in bed almost until the very birth. The legs of such an orthopedic bed are raised at an angle of 30 degrees.

Such women in labor should avoid strong overloads. This concerns both the physical and emotional aspects of life.

If, against the background of a soft cervix, uterine hypertonicity is also detected, this is a definite hospitalization of the pregnant woman - she is placed "on preservation".

In such a situation, the patient will be prescribed drugs that relax the muscles of the uterus; in some cases, they also work to stimulate the tone of the cervix, strengthening it.

In some cases, softening of the organ in question is accompanied by the observation of its small size. Such a clinical picture is designated by doctors as cervical insufficiency, which can lead to the loss of the fetus already in the late stages of pregnancy (20-30 weeks of gestation). In this case, the obstetrician-gynecologist can resort to the help of a pessary. This is a special medical device in the form of a ring. It is fixed on the cervix, preventing it from diverging before the due time. It also protects the organ in question from excessive pressure exerted by the growing fetus.

The installation procedure is fairly quick, without causing any particular discomfort to the pregnant woman. It is removed immediately when the due date approaches: after 37–38 weeks. This procedure of installation and removal is carried out only in a specialized hospital (maternity hospital). This is due to the possibility of labor starting immediately after the device is removed.

This innovation allows the mother to reach the due date and give birth to a strong and healthy baby.

Another method of solving the problem that doctors call the application of surgical sutures to the cervix. The essence of the method is to tighten the organ considered in this article with special surgical sutures, using catgut.

This method of channel closure is performed only in a hospital setting under anesthesia. The most suitable time for the procedure is the period from the 14th to the 20th week of gestation. Before undergoing the procedure, the pregnant woman must undergo the necessary examination. Such a patient remains under constant monitoring by the attending physician almost until the very birth. Like any operation, this method can lead to a number of complications or not give the expected result. But still, in most cases, such measures allow a woman to successfully carry the fetus to term and give birth to a healthy baby.

In case of functional insufficiency of the cervix, the patient receives medicinal support of the body. These are mainly drugs made on the basis of progesterone. They do not allow premature weakening of the muscle tissues of the cervical canal.

If pregnancy has not yet occurred, the question of cervical plastic surgery may be raised. In this case, the woman's medical history is necessarily taken into account: the number of births, terminations of pregnancy, the presence of gynecological diseases, etc. Although such correction does not exclude the presence of pregnancy.

Medicines

Perhaps, almost none of the diseases can be cured without the use of medicinal methods of influencing the patient's body. The drugs used in the case under consideration are classified as progesterone-containing drugs. We can note, for example, such as: progesterone, progestogel, utrogestan.

The drug progesterone can be given to the patient in the form of injections, either under the skin or into the muscle.

The dose of the administered drug in this case is prescribed by the attending physician individually within the range from 5 to 25 mg. The injection schedule can be daily or can be taken every other day. The duration of administration is until the signs of a threatened miscarriage are completely relieved. Contraindications to the prescription of this medication may be moderate or severe liver or kidney dysfunction, a history of breast cancer, hepatitis, increased thrombus formation, a tendency to nervous disorders, and the lactation period. Traditional medicine

It should be noted right away that any treatment, whether traditional or non-traditional methods of therapy, should only be carried out under the monitoring and with the consent of the attending physician. As practice shows, folk treatment of a softened cervix does not bring positive results.

This unconventional method can be an auxiliary method for solving the problem: increasing the immune forces of the woman's body, stopping inflammatory processes in the body, etc. Most of these recipes are based on the use of minerals, herbs, and other plants.

Herbal treatment

Modern healers are ready to offer a great variety of traditional medicine recipes that will support the body and allow you to solve your health problem faster. But using them as the only method of treatment is strictly prohibited.

Herbal treatment for soft cervix is not used. We can only offer a number of recipes that will increase the body's defenses, as well as conduct antibacterial and anti-inflammatory therapy.

Homeopathy

Unfortunately, modern homeopathy is not able to help expectant mothers with the issue of a soft cervix.

Surgical treatment

Modern classical medicine is equipped with a number of techniques that allow surgical treatment of a softened cervix (isthmic-cervical insufficiency).

If the cause of this factor is ruptures and trauma of the cervix - a consequence of previous births, then plastic surgery of the organ in question can be performed as a surgical treatment. The operation is performed before the planned pregnancy. This method gives a woman a chance to become a mother again in the future.

If a woman is already expecting a child, the only indication for surgical treatment may be the threat of spontaneous termination of pregnancy, or a history of premature birth in the pregnant woman.

Another reason that can raise the question of surgical treatment is isthmic-cervical insufficiency of the muscular tissues of the organ in question.

Surgical treatment of this pathology is not performed if the woman’s medical history includes diseases that become a contraindication to conception, bearing and giving birth to a baby: severe pathology of the cardiovascular, renal system, liver and a number of other diseases.

In a soft uterus, the locking ability is impaired, which removes the barrier that prevents the invasion of pathogenic flora and infection into the genital organs of the body.

Another method of surgical treatment is the application of catgut sutures. They tighten the cervix, preventing it from opening even under increasing loads from the growing fetus.

The most optimal time for this operation is the thirteenth to seventeenth week of pregnancy. Although the attending physician prescribes the time of such intervention individually, based on the time of manifestation of the pathology.

At the same time, as the pregnancy period increases, the pressure on the cervix increases, which leads to its further opening, increasing the risk of miscarriage. Drawing a conclusion from the above, it can be understood that surgical treatment at later stages of gestation is less effective.

This operation is performed only in a hospital setting at a specialized clinic.

The first two days after the stitches are applied, the site of the intervention is sanitized with specially prescribed antiseptics. The duration of inpatient treatment is usually five to seven days. Everything depends on the existing threat of complications.

In the future, such a patient undergoes medical monitoring every two weeks on an outpatient basis with her obstetrician-gynecologist.

She needs to periodically submit a vaginal discharge smear for analysis. This examination is carried out at least once every two to three months.

The stitches are removed in a hospital setting without anesthesia after 37-38 weeks of gestation. After this, the woman must be under the supervision of a doctor for at least 24 hours. This is done because contractions and labor may begin during the first 24 hours after the catgut is removed.

If the woman in labor begins to feel contractions and the stitches have not yet been removed, she needs to call an ambulance or a taxi and go to the nearest maternity hospital.

At the emergency room, the medical staff should be told immediately that the cervix has been stitched. In such a situation, the catgut must be removed without fail, regardless of the week of pregnancy. Since during contractions, the surgical thread can cause injury to the organ in question by cutting it.

In recent years, modern medicine has increasingly begun to use another, less traumatic method of eliminating softening of the organ - the placement of a special fixator on the cervix - a Meyer ring, which also has another name - a pessary.

The obstetrician-gynecologist places a special ring on the organ in question, which prevents the cervix from opening until a certain time, thereby removing the threat of miscarriage.

All the above mentioned methods should be applied at the early stages of pathological manifestations. This will protect the expectant mother and her fetus from infection, which can only add to the problems.

Prevention

In order to give specific effective recommendations, it is necessary to study the causes and mechanism of development of pathology well. Therefore, prevention of soft cervix can be expressed by a number of recommendations:

• If a woman has already had precedents, she was diagnosed with isthmic-cervical insufficiency, had miscarriages or this was discovered earlier, then first of all, before planning the next conception, it is necessary to seek help from a doctor and undergo a comprehensive examination. If the diagnosis is confirmed, in most cases the specialist will offer reconstruction of the cervix, after which the woman can fearlessly become pregnant, bear and give birth to a healthy baby. The obstetrician-gynecologist will prescribe therapeutic treatment if necessary.
• If a woman already has a child, then it is worth waiting at least two years before the next birth. During this time, the mother's body will have time to fully recover.
• You should not delay registering for pregnancy, but do it as early as possible.
• It is necessary to follow all requirements and recommendations of doctors.
• It is necessary to lead a healthy lifestyle, including sexual: avoid casual sex, the more sexual partners you have, the higher the risk of “catching” a sexually transmitted infection.
• Do not ignore vaccinations and regular preventive examinations.

Forecast

If a woman has consulted a specialist in a timely manner and the correct diagnosis has been made, the prognosis for a soft cervix is quite optimistic. After completing a course of treatment, she is able to conceive, carry and give birth to a strong and healthy child.

When the necessary measures are taken, the probability of miscarriage in such patients decreases by two to three times. Therefore, after conception, it is necessary to register for pregnancy as soon as possible. The obstetrician-gynecologist should pay closer attention to such women in labor.

The time of bearing a baby makes the expectant mother especially susceptible to words and actions. Therefore, if she is diagnosed with a soft cervix, and the birth is still far away, she should not despair. Modern medicine is ready to help in this matter. You just need to let specialists do this as early as possible, when the cervix, the uterus itself and the fetus have not yet been infected. The main thing is not to lose faith and accept the help of doctors. Then there is a high probability of fulfilling the desire to become a mother, giving birth to a healthy baby.

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ICD-10 code

In world medicine, there is a so-called registry of diseases - "International Classification of Diseases, Tenth Revision" (ICD code 10). In it, the changes in the physiology of the uterus that interest us have their own coding and can be designated by an individual code - D26 - other benign neoplasms of the uterus, D26.0, which is called cervix.

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