In some cases, pregnancy is complicated by the development of isthmic-cervical insufficiency (ICN). This nosology is a condition that threatens the successful continuation of pregnancy, namely, the threat of abortion. We will tell you how to prevent this complication and what to do if it has already arisen.

What is isthmic-cervical insufficiency?

So doctors call the failure of the cervix, which develops as a result of the action of various kinds of etiological factors. As a result, the cervix is ​​unable to provide a closing function to hold the fetus in the womb of the expectant mother.

In addition to the threat of abortion, isthmic-cervical insufficiency can lead to spontaneous miscarriage, premature birth, and infection of the membranes.

The structure of the female reproductive system

The structure of the female reproductive system

In order to understand the cause of isthmic-cervical insufficiency, as well as to better understand the mechanism of its occurrence, it is necessary to have an idea of ​​how the female reproductive system works.

The complex structure of the reproductive system is explained by the important function that it performs — the ability to conceive, bear and give birth to a child, and at the same time be as safe and protected from the outside world and infections. The reproductive system of a woman is represented by external and internal genital organs. One of the components of the internal organs is the cervix, and the area between the body of the uterus and the cervix is ​​called the isthmus.

The uterus is a muscular organ, a container for the fetus. The failure of the isthmus-cervical part of the uterus leads to the development of isthmic-cervical insufficiency, when the cervix is ​​​​not able to cope with its main task — to keep the fetal egg together with the membranes inside the uterine cavity.

Symptoms of cervical insufficiency and threatened miscarriage

Among the clinical manifestations of the pathological condition, there are symptoms that will differ in different trimesters of pregnancy.

Until the twelfth week of gestation (first trimester of pregnancy), clinical manifestations of isthmic-cervical insufficiency are usually absent. This is due to the fact that the uterus at this stage of pregnancy increases slightly — the fetus is small and the pressure on the cervix is ​​minimal. However, given the absence of clinical manifestations at this stage of pregnancy, one should regularly attend appointments with the attending physician for a timely and thorough examination, as well as the selection of adequate therapy if a threatened abortion is suspected.

In the second and third trimesters of gestation, when ICI occurs, the following are characteristic:

  • Discomfort and pain in the lower abdomen or in the lumbosacral region, most often aching, pulling
  • Feeling of pressure and fullness in the vagina
  • Discharge from the genital tract — light mucous or streaked with blood

Why does cervical incompetence occur?

Why does cervical incompetence occur?

Knowledge of the classification allows us to answer this question.

  • Congenital insufficiency of the cervix is ​​associated with abnormalities (malformations) of the development of the uterus
  • Acquired isthmic-cervical insufficiency occurs as a result of tissue trauma. During surgical procedures, the muscular layer of the uterus is injured. As a result, the tissue is replaced by connective tissue, which does not have elasticity and resilience, and most importantly, is not able to keep the fetus in the womb.

How to suspect isthmic-cervical insufficiency?

  • Listen to your feelings. If at least one of the clinical symptoms appears, you should immediately contact your doctor.
  • Careful planning of pregnancy and identification of risk groups for the occurrence of this nosology.
  • Gynecological examination — examination of the cervix in the mirrors and bimanual (two-handed) examination — allows you to determine the presence of characteristic changes in the cervix.
  • Ultrasound examination is a highly informative method in the diagnosis of this pathology, which makes it possible to accurately assess the length of the cervix, clarify the state of the internal os and isthmus, the location of the fetal egg and membranes, the presence of placental abruption and their localization, as well as the size of hematomas.

How to reduce the risk of cervical insufficiency?

How to reduce the risk of cervical insufficiency?

  • Regular visits to the doctor

Isthmic-cervical insufficiency is dangerous because the cervix does not have nerve endings, which is why a pregnant woman may not feel the changes taking place — softening, shortening and opening of the cervix. Regular visits to an obstetrician-gynecologist will allow you to track the dynamics of changes and take timely measures if cervical insufficiency occurs.

  • Dosed load mode

Throughout pregnancy, in the absence of contraindications, dosed physical activity is indicated. Cardio load will help maintain muscle tone, health and endurance, and stretching exercises will add flexibility to a woman’s body. However, in the event of isthmic-cervical insufficiency, in most cases, all types of physical activity should be abandoned — strict bed rest is recommended until the diagnosis of threatened miscarriage or the occurrence of premature birth is removed.

  • sexual rest

Coitus causes mechanical irritation of the cervix, and reaching the peak of pleasure (orgasm) causes spastic contractions of the uterus. As a result, the risk of spontaneous miscarriage and the development of premature regular labor activity increases. During ejaculation without the use of barrier methods of contraception, sperm enters the vagina and cervix. At the same time, semen prostaglandins cause softening of the cervix, preparing it for childbirth. That is why, if a woman is diagnosed with isthmic-cervical insufficiency, it is advisable to forget about sexual intercourse before the birth of a child.

Treatment of threatened miscarriage

Treatment of threatened miscarriage

In the event of isthmic-cervical insufficiency, it is first necessary to provide the pregnant woman with complete rest.

The impact of stressful situations, nervous strain, can cause an increase in the tone of the uterus, as well as the occurrence of uterine contractions. In the presence of isthmic-cervical insufficiency, that is, the almost complete readiness of the cervix for childbirth, the threat of miscarriage increases significantly.

Peace implies not only emotional balance and inner harmony, but also bed rest. Pregnancy with isthmic-cervical insufficiency is a very fragile state of the body. Sometimes doctors do not recommend women to get up even to perform their physiological functions, and then the woman is forced to use a medical duck to relieve herself.

  • Conservative treatment

Pregnant women who are in storage are prescribed a complex of drugs — primarily progesterone drugs. The list of drugs prescribed for women who are maintaining pregnancy is extensive — these are drugs that have both antispasmodic and sedative effects, and hemostatic drugs, as well as many other drugs prescribed by the attending physician.

  • Surgical treatment

Surgical treatment of cervical insufficiency is the suturing of the cervix so that the cervix can fulfill its main function — to keep the fetus with membranes in the womb. Surgical treatment of ICI is carried out strictly if there are indications for the implementation of this method of research and the absence of contraindications.

Despite the ongoing set of measures, the threat of miscarriage often persists until the baby is born. The threat of miscarriage is a critical condition for the fetus, which is why it is necessary to take all precautions so that the child is born viable and healthy.

The frequency of antibodies to progesterone in sporadic spontaneous miscarriage / Mandrykina Zh.A., Menzhinskaya I.V., Ozerova R.I., Rora L.S., Dobrokhotova Yu.E. // obstetrics and gynecology 2009 #5

Etiological factors of habitual miscarriage / Airapetov D.Yu. // obstetrics and gynecology 2011 #8