Long cervix

The long cervix is a common pathology that is asymptomatic and therefore is diagnosed most often already during the onset of complications. This pathology does not pose a threat to life, but it can cause complications in childbirth or in conceiving a child. Statistically, this problem is not quite so frequent, because it is not always diagnosed. Therefore, do not be upset if you have this diagnosis, because it does not represent any danger. You should only remember about this condition when planning pregnancy.

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Causes of the long cervix

Long cervix as a primary diagnosis is an infrequent pathology, because it is more often secondary pathology.

Primary causes of this condition in nulliparous women are congenital anatomical and functional features of the structure of the reproductive system. Often, the long cervix is combined with other congenital anomalies of the uterus, such as the bicornylus, elongated uterus and others. But also it can be the only symptom when the length of the cervix is more than normal. This condition requires correction only in the case of pregnancy planning, unless of course there are concomitant anomalies in the development of tubes or uterus that interfere with pregnancy.

The causes of the long cervix can be varied. The highest risk of developing this condition in women who have a history of not just one birth. Then the elasticity of the cervix increases, and it is more flexible to stretch and change by adhesive processes or during trauma.

Frequent inflammatory diseases of the internal genital organs, such as endometritis, cervicitis, adnexitis can contribute to the development of abnormalities in the structure and length of the cervix. This is due to the development of adhesions after local inflammatory reactions and the deposition of filaments of fibrin, which in the future leads to the formation of tight adhesions.

Also, the cause of the long cervix can be trauma in childbirth, which is treated promptly. Sutures applied to the uterus, cervix or vagina can contribute not only to changes in the size of the cervix, but also the shape and structure of the uterus. This can often be an obstacle to the further process of embryo implantation and development of pregnancy, as well as the very process of sperm passage.  

Also, the reasons for lengthening the cervix can be frequent surgery, that is, frequent abortions can change the structure of the cervix. If diagnostic scraping of the uterine cavity is performed, it can also serve as an etiological factor of this condition. With regard to surgical interventions, such operations as conization of the cervix can be a direct cause of complications in the form of a long cervix, precisely because of the localization of this intervention. That is, excision of part of the epithelium of the cervix leads to a narrowing of the channel and its compensatory change.

These are the main reasons that can lead to lengthening of the cervix. But it should be remembered that any disease of the female reproductive system carries a potential threat of reproductive function.

[2], [3], [4], [5], [6], [7],

Pathogenesis

The pathogenesis of development of the long cervix is due to a number of primary changes, such as, for example, the development of adhesions. This contributes to the alteration of the epithelium and the intensification of proliferative processes, under the influence of which the number of cells increases and the basis for changing the structure of the cervix appears. A large number of cells contributes to lengthening the cervix on one side, and fibrin strands can stretch or vice versa to reduce the cavity of the cervical canal on the other side, and change the shape of the cervix.

[8], [9], [10], [11], [12], [13], [14],

Symptoms of the long cervix

Most often this disease is asymptomatic, which greatly complicates the timely diagnosis and treatment. This is due to the fact that there are no signs until the very appearance of serious complications.

Sometimes in previously unfertilized women, the first signs of the disease may be dyspareunia - a violation of the normal process of sexual intercourse, in which the woman does not enjoy and reduces sexual desire. This may be the only symptom and often no one pays attention to it, as women are not accustomed to complaining about this condition. This is due to the fact that the elongated cervix does not have a sufficient number of receptors and blood supply can badly occur, which violates normal sexual intercourse. There are no painful sensations, since the internal structure has not been changed and there are no obstacles.

Most often, the long cervix, as such, is diagnosed during pregnancy, since this concept can complicate both the process of fertilization and childbirth. This diagnosis can be established for the first time in a woman who is being treated for infertility. That is, a long cervix can lead to difficulty in conception, since the sperm can not reach the uterine tube for a normal fertilization process. Also in the elongated cervical canal a dense mucous plug can be formed, which has an acidic environment, which also prevents the passage of the sperm.

Symptoms of the long cervix can manifest for the first time during pregnancy or even during childbirth. In pregnancy, normal attachment of the placenta may be impaired, since the anatomical structure of the uterine throat is disturbed and the placenta may have a central, lateral or low attachment. During childbirth, a number of complications can also occur. One of the manifestations may be protracted labor, which last more than 12-14 hours in primiparas and more than 9-12 hours in the miscreant. This is due to the fact that the elongated cervix of the uterus is not prepared before delivery and slowly opens. The long and firm cervix of the uterus is not smoothed, which leads to the unreadiness of the birth canal. Therefore fights last a long time, lead to fatigue and exhaustion of a woman and this condition can lead to secondary weakness of labor activity, which requires an already active tactic in the form of stimulation of pregnancy.

There may also be obstacles to the normal passage of the child through the birth canal, since the elongated cervix of the uterus is not sufficiently expanded and the baby's head or the presenting part may be in the same plane for a long time, which increases the risk of hypoxia and may need additional methods-the imposition of obstetric forceps.

Other symptoms are of little concern, since this condition does not have any peculiarities. The main symptoms are associated with pregnancy and childbirth.

Complications and consequences

Complications of the long cervix develop mainly during pregnancy. This is directly related to the process of passing the child through the birth canal. Such complications include weakness of labor, pregnancy retention, postpartum haemorrhage, fetal hypoxia. Also, a dense mucous plug can form in the narrowed cervical canal, which does not retreat and delay the onset of labor. These complications arise from the violation of normal opening and smoothing of the cervix, which is elongated.

Another important consequence may be infertility, which arises from an elementary mechanical obstruction to the movement of spermatozoa.

[15], [16], [17], [18]

Diagnostics of the long cervix

The asymptomatic course of the disease complicates timely diagnosis. Complaints in such patients are absent, and when examined, no particular changes are detected. Therefore, pregnancy should be planned with a thorough examination of the future mother.

When examining women with this pathology, there are no special changes: in a bimanual vaginal examination, no complaints or symptoms are detected. Inspection in the mirrors is also uninformative due to the fact that you can see only the neck itself, which is not changed. Thus, using simple methods of special gynecological examination, this diagnosis can not be established.

Analyzes do not allow to suspect this pathology, as general clinical laboratory tests - the general analysis of a blood, urine - in norm. The absence of changes in the general analysis of blood can only exclude inflammatory diseases. Special laboratory studies - the smear of the cervical canal on the flora and on the dysplasia - also remained unchanged in the absence of concomitant pathology.

Instrumental diagnostics is the "gold standard" in the diagnosis. Colposcopy allows to increase the image of the cervix with the study of the structure of the epithelium of the cervical canal. This can help to conduct differential diagnosis, as it eliminates erosion, polyps, dysplasia and other diseases.

The only method that can confirm the diagnosis is ultrasound. This method allows not only to establish an accurate diagnosis, but also to conduct differential diagnosis.

Ultrasound diagnosis is a mandatory method for pregnant women and is conducted at least three times per pregnancy as a screening method for detecting the main pathologies, both mother and child. Even with the first ultrasound, which is carried out at 11-13 weeks of gestation, in addition to the main indicators, measurements of the cervical parameters, cervicometry, are also performed. In this case, the normal indices of the length of the cervix should not be less than 35 millimeters, but should not exceed 45 millimeters. In the case of an increase in the latter, they speak of a long cervix. But this is not a definitive diagnosis, because by the end of the pregnancy period the cervix is gradually smoothed out and reduced, so you should look at these indicators in dynamics. The third ultrasound is performed after the 30th week of pregnancy, when the length of the cervix is already measured, should decrease. Thus, at 34-36 weeks the length of the cervix should be 34-36 mm, respectively. If this figure is still greater than even 40 millimeters, then only one can speak of a long cervix. This is taken into account in future when administering labor.

Thus, the conduct of cervicometry allows you to establish this diagnosis and further navigate in the management of pregnancy and childbirth.

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Differential diagnosis

Differential diagnosis of the long cervix can be carried out with other pathologies already directly during childbirth, in the event that previously this condition has not been diagnosed. Then there is a weakness of labor and it is necessary to carry out diagnostics with hormonal disorders or other abnormalities of labor.

Also, the long cervix of the uterus must be differentiated with other conditions that can cause infertility. These are infectious diseases of the genital organs, which are excluded in the study of the vaginal smear, as well as anomalies in the development and structure of the fallopian tubes and uterus.

Precisely establish the diagnosis and conduct differential diagnosis allows ultrasound.

Treatment of the long cervix

Treatment of the long cervix in between births or in women of unproductive age is not required, since this condition is not dangerous. In the case of infertility, preparation for pregnancy or during pregnancy, it is necessary to take measures, since complications can arise.

Treatment of the long cervix before birth includes a complex massage action to improve the outflow of blood and lymph, physical exercises to strengthen the pelvic muscles and perineum as a coordinated action of these muscles in childbirth, as well as medical methods.

Medication is not used widely because they are harmful during pregnancy and excessive relaxation of the cervix can lead to premature birth or premature or early discharge of amniotic fluid. Therefore, with a long cervix and with a violation of the normal opening of the uterine throat, stimulation of labor is carried out. This can be done using mechanical methods - Foley's catheter or with the help of amniotomy or manual detachment of the placenta on a short distance. It is also possible to stimulate labor by applying laminaria. Laminaria - seaweed, from which special sticks are made, which in the vagina increase in size 5-6 times and stimulate the opening and smoothing of the cervix. Prostaglandins E 2 - misoprostol are also widely used. This drug, called "Mirolut" is released in the form of tablets of 4 tablets in a pack at a dose of 200 μg of active ingredient, and is used rectally at once 4 tablets. This method of stimulation of labor with the long cervix is widely used, since it is affordable and effective. You can use prostaglandins in the form of vaginal suppositories or ointments. Such methods of stimulation are possible only in the absence of scars on the uterus.

Surgical treatment of the long cervix is not widespread, because it is not a serious diagnosis and does not have effective surgical techniques that would help to remedy this condition. Just need to know about this disease and prevent possible complications in childbirth.

Alternative treatment of the long cervix

Alternative treatments for the long cervix prevail, since they do not have any harmful effects on pregnancy. They use both herbal treatments and alternative methods.

The folk method of treating the long cervix is a way that before pregnancy helps to soften the cervix and open it up to a certain level. These include the use of a large ball for fitball - exercises on it help to increase the production of their own prostaglandins, which reduce the length of the cervix. It also helps to relax the cervix of having sex.

Among other alternative therapies, the main ones are:

• Treatment with honey - one tablespoon of honey should be diluted in liter of boiled water and douching twice a day. This course must be completed within 7-10 days. Honey has a pronounced relaxing effect on the uterine myometrium, and it also has a bacteriostatic and immunomodulating effect.
• Use celandine - a tablespoon of dried celandine leaves should be poured a glass of boiled water and boil for another five minutes, then let cool and strain. This broth should be drunk half a cup three times a day for about a week.
• Nettle has curative properties and at the same time promotes softening of the firm cervix of the uterus. For the treatment use juice from the stems of nettle, freshly squeezed, which is impregnated with a tampon and inserted into the vagina for 2 hours in the evening for not less than five days.
• Sea buckthorn oil also has an anti-inflammatory effect. Sea-buckthorn oil, which can be purchased at a pharmacy, dips a tampon and injected into the vagina for 2 hours, which is best done before bedtime. The course is at least ten procedures.
• Recommend a soothing and firming tea-decoction of herbs, which has a hysterotropic effect. For this, leaves of raspberries, strawberries and hawthorn insist in boiled water and boil for five to ten minutes, after which they drink tea instead of tea up to four times a day.

Such alternative treatments should be used outside of pregnancy, as they can cause excessive expansion of the cervix, so during pregnancy, you should consult a doctor.

Homeopathic treatments also have a fairly common use.

The most famous homeopathic preparation that has an effective effect is Kaulofillum - an extract of a plant that is released in the form of homeopathic granules. During pregnancy, two weeks before the birth, it is used for the preventive purpose with a long cervix for 3 pellets two times a day. Already during labor with discoordination or weakness of labor, the drug is used 3 capsules every half hour.

Another drug used in this case is Pulsatilla. In addition to pronounced myotropic action, it also has a relaxing and analgesic effect. This effect contributes to the normalization of the tone of the uterus and the normal dynamics of cervical dilatation. The drug is produced in homeopathic granules and is used in the same dosage and according to the same principle.

Arnica - has the same effect, but apart from the analgesic and hysterotrophic action, its additional function is revealed - this is the prevention of postpartum bleeding. These three main homeopathic remedies are used as ways to treat the long cervix not only before childbirth, but also when problems arise in the birth itself.

These are the main methods of treating this pathology and their timely use makes it possible to avoid complications.

[20], [21], [22]

Prevention

Prevention of this condition is non-specific and includes all methods of preventing any other diseases of female genital organs: correct sex life, avoidance of abortion, trauma, timely treatment of urogenital infections, use of barrier methods of contraception, and a correct lifestyle and nutrition. These methods strengthen the entire body of a woman and prevent any disturbance of the normal cycle and reproductive function.

[23], [24], [25], [26], [27], [28],

Forecast

The prognosis of this pathology is favorable, both for life and for normal reproductive function, because today there are many methods of correction of this condition, both medicamentous and folk.

The long cervix is a common pathology, which is diagnosed most often during pregnancy during ultrasound examinations. The results of cervicometry in dynamics allow us to establish this diagnosis and prevent complications in childbirth. But one should not be upset if this diagnosis is established, since this condition has many correction methods and does not lead to significant complications. It is necessary to remember this condition and in case of complications with conception of the child, it is also necessary to take into account this fact. Therefore, one should take care of your health, and the health of future children, by preserving your health in advance.

[29], [30], [31],