Cervical canal of the cervix

The cervical canal of the cervix is an anatomical formation of the internal genital organs, which has an important function in the process of gestation and childbirth. Various changes and deformations of this channel can contribute to the pathology of gestation, as well as the very process of fertilization. Therefore, it is important to have an understanding of anatomy and physiological characteristics, as well as possible pathological changes that may be the cause of the disease.

[1], [2],

Anatomy of the cervical canal of the cervix

The cervical canal of the cervix is an education that is located in the thickness of the cervix and it performs many functions, the main one of which is the connection between the external and internal sexual organs. At the girl it develops gradually, and reaches the normal sizes already closer to puberty. Normally, the anatomy of the internal female genitalia is placed as follows: the vagina passes into the cervix, which begins with the external uterine yawn, then the cervical canal of the cervix begins, which ends with the internal uterine yawn and passes into the uterine cavity. This anatomy makes it possible to regulate the process of opening the cervix in the first stage of labor. Due to the uterine throat, the cervical canal opens from the inner uterine throat, and then by the hourglass type, the external pharynx opens. During the involution of the uterus, the inner uterine pharynx closes for 5-7 days in the postpartum period, and then on the 21st day the external cervical canal is closed.

Such anatomical features contribute to these physiological changes already in the postpartum period, while the external yawn after the first birth is not completely closed and this helps to ensure that repeated births pass faster.

As for the histological structure of the cervical canal of the cervix, there also have their own characteristics. The vagina, which is also called exocervix, is lined with multilayer, flat, nonkeratinized epithelium, and the cervical canal, or endocervix, is constructed from a single-layered cylindrical epithelium. Between these zones there is normally a small border, called the transition zone, and it is normally located at the level of the external pharynx. Such a structure must be known in order to further understand the concept of "dysplasia" and a real threat to such a condition.

When examining a woman in the mirror, you can see the cervix, or rather her external pharynx, and knowing the anatomical features of this site and the physiological changes, one can assume a violation of the function. It is also important for the woman herself to understand what this or that diagnosis implies, in comparison with normal values.

Cervical canal during pregnancy has its own characteristics, which is associated with both the influence of hormones, and with the further preparation of the birth canal to the birth of the fetus. Normally, the length of the cervix is 35-45 millimeters, and the diameter of the canal is 5 millimeters, any deviations in this or that direction represent a danger of complications. The length of the canal of the cervix closer to 32-35 weeks of pregnancy can decrease to 35 millimeters, and this is considered a physiological indicator, which is due to the preparation for childbirth. If the length of the cervix is less than 35 millimeters, which is often 20-25, before the 30th week of pregnancy, then talk about such a concept as istmiko-cervical insufficiency. This is the risk of premature birth, therefore, an operative treatment is performed in the form of an obstetric suture - pessary - which circularly fixes the cervical canal and prevents its premature opening. At 35-36 week, the seam is removed. Undiagnosed in time, this condition can lead to premature birth. If the length of the cervical canal during pregnancy and in childbirth is more than 45 millimeters, then they talk about the long cervix, which also has its negative consequences. 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 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.

Another important feature of the cervical canal during pregnancy is its important protective function: in the normal functioning of the epithelium of the cervical canal gland secrete a huge amount of secretion, resulting in a mucous plug that prevents the entry of pathogenic microorganisms into the uterine cavity. Before the very birth, this mucous plug disappears.

Thus, it becomes clear that any violations of the anatomical structure of the cervical canal cervix can cause complications in the future, and therefore require timely diagnosis and treatment.

[3], [4], [5], [6]

Diseases of the cervical canal

The pathology of the cervix can play a big role in the development of diseases, both during pregnancy and out of pregnancy, even with possible infertility.

Conditionally, the pathologies of the cervical canal can be divided into:

1. anomalies in the structure and structure of the cervical canal;
2. inflammatory diseases;
3. neoplasms of the cervical canal.

Anomalies of the structure and structure of the cervical canal can be both congenital and acquired. Congenital anomalies, as a rule, are accompanied by concomitant anomalies of other genital organs - the vagina, the uterus. More often in women of reproductive age, there are acquired anomalies in the structure of the cervical canal, which results from adhesions, scarring, deformities after various surgical interventions. Among such pathologies is the circular channel of the cervix, the narrowing of the cervical canal and its obstruction.

Circular canal of the cervix is a pathology in which the canal has a funnel-like shape due to the misposition of the muscle fibers in the circular direction. This pathology can occur with ruptures of internal genital organs due to childbirth and their surgical treatment - suturing, in the future this can be the reason for this process with improper tissue healing. This pathology can not be manifested in any way because of its insignificance, that is, all the physiological processes in the uterus and ovaries do not suffer. Problems can arise in the next pregnancy, when there can be discoordination of labor activity due to an abnormal reduction in the muscle fibers of the cervical canal, which prevents the normal opening of the cervix. Treatment of this pathology as such does not exist, as these are structural changes that can not be corrected. Treatment may be symptomatic if complications occur.

The narrowing of the cervical canal is less than 5 millimeters in size. Moreover, women of reproductive age may already have symptoms, in the form of a disorder of the menstrual cycle as oligomenorrhoea, since a narrow channel of the cervix can interfere with normal menstruation, which prolongs the period of menstruation with a small amount of secretions. With regard to pregnancy, this can be a direct threat to normal labor, in case of poor opening of the cervix and indication for cesarean section. But there may be a sufficient hormonal background with a good dynamics of cervical opening and labor, then this condition is not dangerous. The extreme degree of narrowing of the cervical canal is its obstruction. Obstruction of the cervical canal of the cervix is a condition that requires intervention because there are complications. With this pathology, a mechanical obstruction is formed, which in women of reproductive age can cause the delay of menstrual blood with its accumulation in the uterine cavity and the formation of acute conditions in the gynecology - the hematometer. Then there is a clinic of acute pain in the abdomen, anterior abdominal wall tension, and anamnesis indicates a delay in menstruation for several weeks or several times in a row. When examined, you can determine the intensity and tenderness of the uterus. This is a condition that requires immediate surgery.

Among the inflammatory diseases of the cervical canal of the cervix, endocervicitis is the most common - a pathology that is characterized by focal inflammation of the cervical canal. The etiologic cause can be any pathogenic or conditionally pathogenic microorganism that gets in the ascending way. In this case, in the cervical canal there is inflammation with symptoms local in the form of purulent discharge from the vagina, pain during intercourse and at rest, menses. In addition to local symptoms, general symptoms appear in the form of fever, intoxication, changes in blood test. Treatment should be complex - local and general. Local treatment is douching with antiseptics, a suppository with an antibiotic, hygiene of the genitals. The general treatment involves the systematic use of antibiotics for a course of 7-10 days, as well as symptomatic therapy. At the time of the disease and treatment, it is necessary to exclude sexual relations and treat a partner better than at the same time, especially in the case of verification of a specific urogenital flora.

Neoplasms of the cervix can be benign and malignant. Among benign diseases, polyps of the cervical canal of the cervix are most common. This pathology, which is characterized by the formation of a characteristic structure in the form of cauliflower on a stem or broad base. This structure is visible to the naked eye. The cause of this formation is most often the human papillomavirus, which affects epithelial cells of the genital organs due to high tropism. Polyposis of the cervical canal of the cervix is often multiple and is combined with another localization of polyps - in the cervix, vagina.

Among benign cervical canals of the cervix, a cyst is also found. This formation with a thin wall, which has a thin capsule, liquid contents inside and a tendency to grow. Since the cervical canal has a limited diameter, complications often occur as a rupture of the cyst or its infection. Then, complex treatment is also necessary. The flow of such a cyst at a small size can be asymptomatic, then it can be just an accidental finding on ultrasound. Sometimes the contents of the cyst can be menstrual blood, then talk about the endometrioid cyst. Tactics of treatment can be operative in case of accidental finding of such education.

Among malignant tumors can be cancer of the cervical canal of the cervix. This pathology does not occur as often as cancer of other localization, but it is quite dangerous in terms of asymptomatic flow. Therefore, often such a cancer is diagnosed already at the stage of metastasis in other organs. In the first-second stage of the disease, radical surgical treatment with extirpation of the uterus and regional lymph nodes, as well as preoperative and postoperative radiotherapy. In the later stages, the treatment is combined.

These are the main diseases that can be localized in the cervical canal of the cervix.

[7], [8],

Diagnosis of cervical canal pathology

Diagnosis of these pathologies should be complex to exclude other conditions and proper treatment.

First of all, you need to listen to complaints with full details of the symptoms. It is also necessary to clarify the anamnestic data with the date of the last menstruation. Inspection in the mirrors allows you to see only the external cervical canal, but if there are polyps in the vagina, then we can assume that there is polyposis of the cervical canal of the cervix. There may also be bloody discharge when the cervical cyst of the cervix ruptures or purulent discharge when it is suppurated.

An important step in vaginal examination of a woman in mirrors is taking two types of smears - bacterial flora and histological examination. A smear from the cervical canal is taken by screening each woman with a special brush. Be sure to observe the right technology - a swab is taken from three zones of the cervix - endocervix, intermediate zone and cervical canal, that is, all three types of epithelium should be present. Then all the smears are sent to the laboratory for cytology and histology.

Cytological examination of the cervix and cervical canal allows diagnosing such a dangerous condition as metaplasia of the cervix uteri - a background precancerous disease. Behind the results of histology, a possible disease is judged. There are six basic types of smears:

1. histological picture of a healthy woman;
2. inflammatory and benign changes in the smear;
3. cervical intraepithelial neoplasia
   1. mild metaplasia (CIN-I) - altered dysplastic cells extend deep into not more than one-third of the epithelial cover;
   2. Moderate metaplasia (CIN-ІІ) - altered dysplastic cells extend deeper into not more than two-thirds;
   3. severe metaplasia (CIN-III), altered dysplastic cells extend inward by two-thirds or more, but without invasion of the basal membrane;
4. suspected cancer;
5. cancer;
6. a non-informative smear (not all types of epithelium are represented).

If there is a suspicion of metaplasia, that is, if a third type of smear is used, then additional research methods are carried out. During pregnancy, with the third planned ultrasound, all women undergo a special ultrasound examination - cervicometry - measuring the length and thickness of the cervical canal of the cervix. If the indicators are out of the norm, then they decide about the possible tactics of correction.

[9], [10], [11], [12], [13], [14], [15], [16],

Operations on the cervical canal

Operative interventions on the cervical canal are not very frequent, as this is a very difficult place. Most often, minimally invasive interventions for certain indications. With anomalies in the structure of the cervical canal of the cervix, such as constriction or obstruction of the cervical canal, a special procedure is performed - bougiezing of the cervical canal. This intervention, which consists in expanding the channel with a special tool - buzhom. This is most often a metal tool that is matched to a number that corresponds to its size, and starts from the smallest to the widest. It is often necessary to repeat the procedure several times, because one time is not enough. Such intervention is effective at small degrees of constriction.

Among operative methods of treatment of pathologies of the cervical canal of the cervix, in this case, with polyps of the canal, cryodestruction is used, burning out with liquid nitrogen, burning out with a laser. The method of cryodestruction is to use a cold that freezes polyps and they disappear. This procedure is repeated 1-2 times a week until the polyp completely disappears. Cauterization with liquid nitrogen acts on the same principle.

Laser therapy is the use of a laser beam with a mechanism of action as a scalpel.

Scraping of the cervical canal can be carried out with both diagnostic and therapeutic purposes. Diagnostic curettage of the cervical canal is carried out with suspicion of ectopic pregnancy or suspected of a foreign body. It is important to send all the material received for histological examination. Therapeutic curettage of the cervical canal is carried out in the postpartum period with the appearance of complications or with suspicion of the inflammatory focus in the uterus. Also, this method of treatment can be performed with ineffectiveness of more minimally invasive methods in the treatment of polyposis or its multiple nature.

The cervical canal of the cervix is an education that has important functions in the process of fertilization, vynashivaniya and birth of a child, as well as in the pathology of the female reproductive system. It is necessary to know some features of the anatomical structure of the cervical canal cervix for timely diagnosis of pathology and determine the tactics of possible treatment.