The desire to give birth to a child is peculiar to every woman, however, unfortunately, it is not always carried out. A frequent cause of spontaneous miscarriage is the inability of the cervix to cope with its blocking function: under the influence of intrauterine pressure, it is smoothed and opened, provoking a threat of termination of pregnancy . Doctors call such a violation of the ICI, or isthmico-cervical insufficiency.
Isthmiko-cervical insufficiency - the reasons
Most often, ischemic-cervical insufficiency is detected in the second trimester of pregnancy, when intensive fetal growth begins. Women who have undergone IVF or traumatized the cervix during abortion or previous births are at risk (for example, with manual removal of the placenta, the birth of a large child or the use of obstetric forceps).
In addition, the causes of ischemic-cervical insufficiency are:
- congenital malformations of the uterus (doubling of the uterus, bicorne uterus, etc.);
- infantilism of the uterus;
- Progesterone deficiency and excess of androgens;
- anatomical abnormalities of the cervix (congenital or acquired);
- altered ratio of connective and muscle tissue in the cervix.
Isthmiko-cervical insufficiency - symptoms
The danger of Isthmico-cervical insufficiency in pregnancy is that it is not accompanied by any external signs and pain sensations. To suspect the untimely opening of the cervix can be by rapid urination (atypical in the second trimester), sucritic secretions (the passage of the mucous plug during pregnancy ), discomfort in the vagina.
At any suspicion of istrmiko-cervical failure it is necessary to address immediately to the doctor and to be extremely cautious: in this situation, termination of pregnancy can provoke even sneezes.
Isthmiko-cervical insufficiency - diagnostics
Unfortunately, ICI is most often diagnosed only after a spontaneous miscarriage. Before pregnancy, the disease is extremely difficult to identify, except for cases of presence on the cervix of gross scars.
Before making a diagnosis, the doctor will necessarily ask about the miscarriages and injuries of the cervix, as well as the presence of endocrine disorders. During the gynecological examination, the possibility of an ischemic-cervical insufficiency is indicated by deformation, shortening and softening of the cervix, and sometimes its opening. In case of doubt, transvaginal ultrasound or hysterosalpingography (non-pregnant) is prescribed.
Isthmiko-cervical insufficiency - treatment
If a woman is diagnosed with ischemic-cervical insufficiency, it is recommended that bed rest and complete rest, including sexual intercourse, be observed.
For the treatment of NIC, surgical and conservative methods are used. Non-pregnant women, as a rule, carry out plastic surgery of the cervix. Conception in this case can be planned only six months after the operation, and the birth is performed with the help of caesarean section.
Surgical intervention in expectant mothers is the imposition of sutures on the cervix and is carried out until 16-18 weeks
A conservative method of treatment is the use of pessaries (rings of Goj, Meyer) - special obstetric devices made of silicone or plastic, which reduce the burden on the cervix. The pessary can be installed in a woman's consultation, usually it is done in the early stages of pregnancy and removed before delivery, at 37-38 weeks.
Pessary does not injure the cervix and does not pose a danger to the future mother and baby, but is ineffective when the cervix is opened and the prolapse of the bladder prolapses.