Among gynecological diseases, erosion in the cervical region is one of the most common. Many women who are planning a pregnancy go to the doctor with this problem, worried about the impact it can have on conception, gestation, and subsequent births. No less relevant is the question of whether it is necessary to remove erosion before pregnancy, what treatment is needed if it has already begun, and what risks this process may result in for the baby.
Where does erosion come from, what is it?
A normal cervix does not have defects, inflammatory lesions and other problems. In the presence of erosion, epithelial cells typical for this zone undergo transformation, forming areas of deformation and inflammation. The uterus itself does not change, it functions quite normally. Changes in the epithelium in the cervical region can occur for various reasons, which include past inflammatory processes, the consequences of hormonal disruptions, or mechanical damage. In this case, this defect is called pseudo-erosion, which requires the supervision of a doctor.
There is also true erosion, this is the destruction of a site in the mucosal area with the formation of a tissue defect, a wound surface that is sensitive to any external influences. The reasons why such erosion is formed are numerous — these are cervical injuries during abortions, interventions in the uterine cavity, difficult childbirth, too active sexual intercourse. In addition, various infections (herpes, mycoplasma, chlamydia, etc.) or hormonal disruptions of the body play a significant role in the development of erosion. In the area of erosion, inflammation is formed, which can be caused by the conditionally pathogenic flora of the vagina, which increases the risk of developing inflammatory processes in the area of the uterus and appendages. The prolonged existence of erosion can become an unfavorable background for tumor degeneration of tissues.
Pregnancy on the background of erosion
As such, erosion does not affect conception, if there are no other problems with the uterus or ovaries, and the course of pregnancy is quite normal, children are born quite healthy. However, there are certain nuances in the combination of erosion with pregnancy. First of all, during the gestation period, the degree of erosion may increase due to changes in the hormonal background, which creates a favorable background for the formation of infections in the vagina. The presence of an infection is always dangerous, since pathogenic microbes in the vaginal area and a damaged cervix can penetrate the area of the fetal bladder, destroying it and leading to the discharge of amniotic fluid with the start of premature labor or the onset of a miscarriage.
Other dangers of cervical erosion
If an erosive lesion is found in the cervical region, this threatens with the formation of such a complication as isthmic-cervical insufficiency. This is a violation of the locking ability in the cervical muscles, the inability of the cervical canal to be closed and to keep the fetus in the uterine cavity. Muscle failure leads to a gradual expansion of the cervical canal, and the pressure of the fetus and membranes with water leads to premature opening of the pharynx and the onset of labor (or late miscarriage).
Erosion also has a certain effect on childbirth, given the presence of a defect in the cervical region. Often, the inflammatory process leads to a decrease in tissue elasticity and a violation of the opening, elasticity of the neck, which leads to injuries and ruptures in childbirth, the formation of bleeding and suturing after the baby is born.
What to do during pregnancy and before childbirth?
If the pregnancy proceeds against the background of erosion, doctors during the entire period monitor the condition of the cervix, a special treatment is prescribed that prevents exacerbations, suppresses infection and inflammation. But the choice of drugs that would be effective, while not affecting the fetus, is significantly limited, local therapy is usually prescribed in the form of suppositories or capsules, solutions. If the presence of erosion leads to inflammation, according to the doctor’s prescription, depending on the cause, topical antibiotics or antifungal agents can be used to eliminate the inflammatory process of the cervix. Careful debridement before childbirth is especially important to improve the state of erosion to prevent problems with cervical dilatation. The birth itself is carefully controlled, since the opening of the affected cervix can occur with significant difficulty.
Treatment or removal of erosion?
In connection with such a possible influence of erosion, the question of treatment before pregnancy always arises. Among women, there is a well-established misconception that erosion in nulliparous is not treated, so as not to further complicate childbirth with scars on the neck. But doctors say that this is not quite the right opinion. The question of which principle of therapy to choose — conservative influences or removal of erosion, depends on the diagnosis itself and those processes that are hidden under the general term of erosion. In a nulliparous woman, in the presence of erosion without concomitant inflammation, one can limit oneself only to observation without taking any active action. Any inflammation in the cervical region must be treated so that there is no threat of infection and complications. If dysplasia is detected, the removal of erosion or the use of the «cauterization» technique is most often required. They are fraught with the fact that deformation is formed, scars of the cervix, which can become an obstacle to the normal opening of the cervix during childbirth. Today, erosion is removed using laser coagulation or cryodestruction. These methods are less traumatic for tissues, allow more local exposure, reducing the area of scar tissue. Erosion removal can be applied using chemical techniques, in which special preparations are used on the affected area that destroy the affected cells. The radio wave method of exposure is no less actively used, it leads to the evaporation of the affected area without involving healthy intact tissues in the process.
Obstetrics / Ed. Savelieva G.M. — 2000
Pregnancy planning and prevention of placental insufficiency in high-risk women / Gurieva V.M., Petrukhin V.A., Burumkulova F.F., Holdina M.A. // Issues of gynecology, obstetrics and perinatology — 2012 — T. 11 No. 3