Soft cervix of the uterus

The cervix is a hollow organ that connects the vagina with the uterus itself. Its dimensional parameters averaged 2.5 by 3 cm. In this article, we will try to understand, the soft cervix of the uterus is a pathology or a natural physiological process.

[1], [2], [3], [4], [5]

Causes of soft cervix

Describing sources that can provoke softening of the cervix, it is worth noting that they can have physiologically justified reasons, and can be caused by pathological changes in the sexual organs of a woman.

The known causes of soft cervix are:

• Isthmiko-cervical insufficiency - a decrease in muscle tone, the inability to resist intrauterine pressure, which leads to a weakening of their functions and the inability to retain the fetus inside the uterus. Late miscarriages are possible. Mostly this process occurs between the twentieth and thirtieth weeks of bearing the baby.
• Endocervicitis of cervix uteri - inflammatory diseases of female genital organs. The most frequent source of female infertility.
• Congenital pathology.
• Hormonal imbalance of the woman's body. Under the influence of prostaglandins, the contractility of the uterus and its cervix is impaired.
• The first weeks of pregnancy.
• The prenatal period. The uterus and her neck are prepared for the birth and passage of the newborn through the birth canal.
• Previous scraping of the uterine and cervical mucosa, which are accompanied by mechanical dilatation.
• Mechanical, physiological or other damage to the muscular tissue of the organ in question.
• Violation of the correlation of connective and muscular structures in the region of interest to us.
• The consequences of pathological births, which took place with large and deep ruptures. Stitching.
• Reception of medicines belonging to a certain pharmacological group.

Pathogenesis

As medical practice shows, the causes of a soft cervix can have mechanical, medicamentous and non-medicinal sources. At the same time, the pathogenesis of this phenomenon to the end has not yet been studied.

Doctors believe that the appearance of this factor is the result of violations of the response of cellular structures to neurohumoral stimuli. Either the consequences of a mismatch between the number of muscle and connective tissues.

Symptoms of soft cervix

If we talk about the preparation for obstetric activity, at this stage the fetus starts to fall down, getting ready for childbirth, the entire maternal organism prepares for this. The child's weight increases the pressure on the neck.

At this time, the placenta is aging, reducing the amount of hormone produced. The cervix begins to lose its tone, softens. Symptoms of the soft cervix are expressed not by the ability of the body to retain the slimy plug, which is one of the first signs of approaching the pods.

In other cases, there is no special pathological symptomatology, and this factor can be detected only at the reception and examination of a gynecologist.

First signs

As has already been noted above certain definite symptomatology of the factor considered in this article is not observed. Therefore, the first signs of softening can not be identified and described.

[6], [7], [8]

Soft cervix before menstruation

The female body is unique. It is designed for a great mission - the allocation of an egg, ready for fertilization, embryo-bearing and the birth of a strong and healthy, yet small, but already a little man.

A woman prepares for this mission every month. In each menstrual cycle, the female body passes the same path. And if he does not end with ovulation and subsequent pregnancy, the woman of the fair sex is expected to have a month-long term - dumping of an unproductive product (an unfertilized ovum), renewal of the mucous of the genital organs, preparation for the next cycle.

During this cycle, the density, texture, locality and position of the uterine neck and the uterus itself change. Soft cervix before the menstrual period is one of the primary signs of the approaching menstruation. This fact is accompanied by the lifting of the organ and its partial opening.

This allows to create conditions for easier invasion of spermatozoa and subsequent fertilization. If pregnancy does not occur, there are sticky secretions. In this period, a woman can feel more large-scale discharge from the cervical canal.

If the fertilization of the egg does not happen, the uterus begins to fall together with its neck, the channel expands, and softening occurs. This physiological change in the condition of the organ ensures unimpeded withdrawal of the excreted menstrual blood.

Thus, the female body regulates the process of conception, or, in its absence, purging the body of "unused material."

Soft cervix in pregnancy

The time after conception and to normal delivery is one of the most exciting periods in the life of a future mother. A lot of disturbing minutes have to be experienced by a woman, if she claims a soft cervix in pregnancy. Perhaps this setting is a normal physiological change that does not allow experiencing, in some cases, if it is ignored, this fact can lead to irreparable consequences.

As it was already stated above, before the moment when the female organism is ready for fertilization and the process of ovulation has taken place, the cervix becomes softer and rises, which makes it possible for male spermatozoa to reach the egg and fertilize it.

After conception has occurred, the cervix should become again denser, as if clogging the uterus. This allows the embryo to develop normally, without fear of leaving the uterus.

Over time, the fetus develops, grows, gaining weight, and begins to press more actively on the lower part of the uterus, and, consequently, on its neck. If the muscle tone of the body is not enough, the cervix begins to soften and open, which threatens (if it is not the prenatal period) premature exit of the fetus from the uterus - a miscarriage.

As the statistics show, this pathological process is most often seen in the period from the twentieth to the thirtieth week of pregnancy, especially critical obstetricians - gynecologists consider 24 weeks of gestation.

In the normal course of pregnancy, the physiologically justified process of softening begins immediately before childbirth. So the woman's body prepares for the passage of the baby through the birth canals at his birth.

Soft cervix in early pregnancy

After conception, not only the uterus undergoes a change, but also the organ under consideration in this article. He changes his shade, acquiring a cyanotic color. This is due to the formation of a more extensive network of glands and blood vessels, which should now feed not only the body of a woman, but also the "new life that has arisen."

Density of tissues changes: before fertilization, it is softened, after the onset of pregnancy, the cervix should become dense, so that the effect of the plug is obtained. This allows you to hold the embryo in the uterus. Another function of the "hard" neck is a barrier that prevents the invasion of pathogenic flora and infectious strains into the uterine cavity.

During this period, a mucous plug is formed in the region of interest, which becomes the second barrier of invasion. Creamy secretions that do not have a pathogenic odor may be observed. Their shade can be different: from clear and pinkish leucorrhoea to small bloody or brownish hues of liquid. This symptomatology usually disappears by the third or fourth week after conception.

If further observed in the early stages of pregnancy soft cervix - then this is cause for concern. Since if the cervix does not become dense over time, there is a clear threat of spontaneous abortion. That is, a pregnant woman has a threat of miscarriage - a child's loss.

This clinical picture can arise against a background of a number of pathological changes. The most common cause of softening is ishmiko - cervical insufficiency - a decrease in the muscle tone of tissues. A number of factors can lead to such pathology. For example, it may be pathology of the development of the uterus, a failure in the hormonal background, as well as injury to the body due to already existing births or a number of abortions.

Soft cervix before childbirth

The cervix is one of the main organs in the reproductive system of the female body, which participates in the process of obstetrics. Soft cervix of the uterus before birth is a normal physiological process that promotes healthy childbirth.

Immediately before birth, the mother's body begins its training. Participates in this and the cervix. It gradually becomes more supple, which leads to the fact that it is not able to already hold the slimy plug, which goes out. This process physicians call the departure of the cork, which is the first sign of the approaching genera.

After this, the amniotic fluid also leaves, fights begin. But at the moment the cervix is relaxed and spread about one centimeter, which is not enough for the traumatic passage of the baby through the birth canals.

In the normal course of the prenatal process, the cervix continues to soften and increase the passage. Such a course of the process will make it possible to secure both the future mother and her child from possible injuries and disruptions during the birth.

If the cervix is not sufficiently opened, and the delivery procedure is already neglected, the obstetrician-gynecologist has to prescribe medications that, acting on the cervix, will help it become softer that it will allow it to open up more.

The process of softening occurs at the level of hormones. Before birth, the placenta grows old and ceases to produce a recent amount of hormones, which immediately provokes the emergence of hormone-antagonists, which provoke softening and opening of the uterine neck, as well as spasms of the uterus (the beginning of labor).

In this period, there is an increase in estrogen and a decrease in the amount of progesterone in the maternal body. Physicians note the accumulation of prostaglandins, serotonin, oxytocin and acetylcholine. The complex of these compounds significantly influences the naturalness of the process of obstetric delivery, including the readiness of the cervix for delivery.

It does not happen immediately. The process of softening of muscle tissues and the increase in the flow section proceeds gradually and takes several hours.

If the process of obstetrics has gone, and the cervix is not sufficiently open, the obstetrician-gynecologist has to resort to the help of certain medications that promote more active softening of the tissues. Up to this point, the cervix is called immature, if the obstetrician-gynecologist is able to push more than one finger - physicians talk about the maturity of the cervix and the physiological readiness of the woman for childbirth. But in this condition, most women in this state can walk around for another two weeks.

As a result, such a woman can go over her term and give birth a week later.

Dismissing the cork and leakage of amniotic fluid is a signal that a pregnant woman needs hospitalization if she does not want to give birth at home.

Effects

Drawing a conclusion from the above, the consequences of the process under consideration, largely depend on the concomitant pathology, or, in the case of pregnancy, the period of gestation of the baby, on which the softening is diagnosed.

In a number of cases - this is a completely understandable physiological process, laid down by the woman by nature itself. In pathological manifestation of this factor, the consequences of organ structure changes can be the loss of a child (miscarriage) or the further development of pathological changes.

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

Complications

Any pathology entails irregularities in the work of the patient's body. The complications that the soft cervix entails can be as follows.

• As has already been noted more than once - it is a threat of not bearing a fetus, that is, a miscarriage.
• For the same reason, doctors can diagnose - infertility.

Probably, even this is enough for a woman dreaming of a child, think about it and ask for help from an obstetrician-gynecologist.

[15], [16], [17], [18], [19]

Diagnosis of soft cervix of the uterus

This fact can be detected directly by a doctor - a gynecologist, during a preventive examination, an examination of the woman's registration for pregnancy, or during the course of pregnancy observation. Therefore, the diagnosis of the soft cervix is an examination of the obstetrician-gynecologist, who ascertains this fact.

Already in the future, he can prescribe an additional examination if he has a suspicion of the existence of any disease, the symptom of which is this fact.

The survey stages can be as follows:

• Clarification of anamnesis.
• An analysis of the patient's complaints (if any).
• Examination of a specialist on a gynecological chair, which is carried out after the end of menstruation. If there is a suspicion of pregnancy, such an examination is carried out only for serious medical reasons, so as not to disrupt the development of the embryo.
• Immediately before menstruation (if there is no fertilization of the egg), the woman herself can check the condition of her cervix. But it is necessary to do this, following all the rules of hygiene. At the same time, the woman is unlikely to adequately assess the situation. Therefore, this examination is best left to specialists.
• Laboratory research:
  • General and biochemical analysis of urine.
  • General and biochemical analysis of blood.
  • Isolation studies.
  • If necessary, histological examination.
• Examination, using modern medical equipment.
• Differential diagnostics.

[20], [21], [22], [23]

Analyzes

The first thing that is assigned to any patient who has dealt with a particular problem is the following laboratory tests:

• General and biochemical blood tests.
• General and biochemical analyzes of urine.

You may also need additional research:

• Blood to determine blood type and Rh factor.
• Bacteriological and bacterioscopic analysis of vaginal discharge, which answers the question of the presence of infection.
• Analysis of the level of hormones in the pituitary-gonadotropic system.
• PAP test is a Pap smear. Cytological analysis of the smear from the vagina. The sample is examined in a laboratory under a microscope. If atypical cells have been recognized, the patient is referred for an additional examination.
• If necessary, a biopsy can be performed. Research on human papillomavirus (HPV). Taken material (smear) is sent to the polymerase chain reaction (PCR). If the HPV is recognized, its type is set.
• Immunohistochemistry with oncomarkers - this study is conducted only for those patients who have a suspicion of a malignant nature of the pathology.

[24], [25], [26]

Instrumental diagnostics

Today it is quite difficult to imagine a doctor who is not armed with the methods of modern diagnostics, produced with the help of innovative medical equipment. Instrumental diagnostics, applied in this case, can be represented by:

1. Hysterosalpingography (GHA). X-ray diagnostics using contrast medium. The method allows to assess the condition of the sexual organs of a woman.
2. Magnetic resonance tomography of the pelvic organs is a highly informational method of examination, weighed down with minimal radiation load.
3. Ultrasonic examination of pelvic organs (ultrasound). Echographic investigation.
4. Aspiration biopsy of the endometrium is a microscopic examination of tissue samples.
5. Puncture of the anterior space behind the vagina.
6. Scraping the cervical canal and uterine cavity.
7. Endoscopy, hysteroscopy or colposcopy - research methods, using an optical device equipped with a lighting device.

Differential diagnostics

After the results of the whole complex of examinations are on the hands of a specialist, differential diagnostics is carried out by him - analysis of the results of the research. It involves the compilation of a complete clinical picture of the patient's state of health with the subsequent differentiation of a specific disease. On the basis of this knowledge, diseases that are similar in symptomatology, but not confirmed by studies, are cut off.

[27], [28], [29], [30], [31], [32], [33], [34]

Treatment of soft cervix

The physiological phenomenon considered in this article can be both a symptom of a number of diseases, then therapy of a particular disease should be conducted, and a natural norm process. Therefore, the treatment of a soft cervix is a mixed question.

If we are talking about childbirth, the maturity of the cervix in this period is determined by experts on the special scale of Bishop. This indicator the obstetrician-gynecologist receives at survey of the woman in childbirth.

In order for labor to pass without significant disruptions and other injuries, both the parturient woman and her child, the diameter of the channel cross-section at the first stage of obstetrics should be about ten centimeters.

But if the time of delivery has not yet come, and a woman has a soft cervix diagnosed - this does not mean that she can not report and give birth to a healthy baby. This patient is attributed to bed rest and almost to the birth itself will have to lie in bed. The legs of this orthopedic bed rise to an angle of 30 degrees.

Such women in labor should avoid strong overloads. This applies to both the physical and emotional aspects of life.

If the uterine cervix is also recognized, and uterine hypertension is an unambiguous hospitalization of a pregnant woman, it is put "for preservation".

In such a situation, the patient will be prescribed drugs that relax the muscles of the uterus, in some cases they work as a stimulus to the neck, strengthening it.

In a number of cases, the softening of the organ under consideration is accompanied by the observation of its small size. This clinical picture is designated by doctors as an inconsistency of the cervix, which can lead to the loss of the fetus already in the late stages of pregnancy (20 - 30 weeks of gestation). In this case, the obstetrician-gynecologist can resort to the help of a pessary. This is a special medical device representing the shape of the ring. It is fixed on the neck, not allowing it to disperse before the due time. It also protects the organ in question from the excessive pressure produced by the growing fetus.

The installation procedure is fast enough, without causing any special discomfort to the pregnant woman. Take it off immediately when the term of childbirth approaches: after 37 - 38 weeks. This procedure of setting and removing is carried out only in the conditions of a specialized hospital (maternity home). This is due to the possibility of the onset of labor activity immediately after removal of the device.

This innovation allows the child to reach the due date and produce a strong and healthy baby.

Another method of solving the problem that has been created by physicians is the imposition of surgical sutures on the cervix. The essence of the technique is the contraction of the organ considered in this article by special surgical sutures, using catgut.

This method of closing the canal is carried out only in a hospital under anesthesia. The most suitable time for the procedure is the period from the 14th to the 20th week of gestation. Before the procedure, the pregnant woman must undergo the necessary examination. Such a patient remains under constant monitoring of the treating doctor almost to the birth itself. Like any operation, this method can lead to a number of complications or not to give the expected result. But still, in most cases, such activities allow a woman to successfully deliver the fetus, and give birth to a healthy baby.

With functional insufficiency of the cervix, the patient receives medical support of the body. These are mainly preparations based on progesterone. They do not allow premature weakening of the muscular tissues of the cervical canal.

If the pregnancy has not yet occurred, the question of the plasticity of the cervix can be raised. At the same time, anamnesis of a woman is necessarily taken into account: the number of births, pregnancy interruptions, the presence of gynecological diseases and so on. Although such a correction does not exclude the presence of pregnancy.

Medications

Perhaps, almost none of the diseases can be stopped without the use of medicamental methods of affecting the patient's body. Medications used in this case are referred to progesterone-containing drugs. You can note, for example, such as: progesterone, progestogen, morning.

The progesterone drug can be given to the patient in the form of injections, both under the skin and into the muscle.

The dose of the injected drug in this case is prescribed by the attending physician individually in the range from 5 to 25 mg. The schedule of injections can be daily, and can be taken in a day. Duration of admission - until complete relief of signs of a threatening miscarriage. Contraindications to the appointment of this medication can be an average or severe degree of hepatic or renal dysfunction, the presence in a woman's history of a cancerous growth in the mammary gland, hepatitis, increased thrombosis, a predilection for nervous disorders and lactation. Alternative treatment

It should immediately be noted that any treatment, be it traditional or nontraditional methods of therapy, should only take place under monitoring and with the consent of the attending physician. As practice shows, an alternative treatment for a softened cervix does not bring a positive result.

This unconventional technique can be an auxiliary method of solving the problem: increasing the body's immune forces, stopping inflammatory processes in the body, and so on. Most of these recipes are based on the use of minerals, herbs, other plants.

Herbal Treatment

Modern healers are ready to offer a great many recipes of alternative medicine that will support the body and allow you to quickly solve the health problem. But applying them as the only method of treatment is strictly prohibited.

Treatment with herbs with a soft cervix is not applied. You can offer only a number of recipes that will increase the body's defenses, as well as conduct antibacterial and anti-inflammatory therapies.

Homeopathy

Unfortunately, modern homeopathy is not able to help future mothers in the matter of the soft cervix.

Operative treatment

Modern classical medicine is equipped with a number of techniques that allow for operative treatment of the softened cervix of the uterus (istmiko - cervical insufficiency).

If the cause of this factor are ruptures and trauma to the cervix - a consequence of previous births, then the plastic of the organ in question can be done as a surgical treatment. The operation is performed before the planned pregnancy. This technique gives the woman a chance in the future to become a mother again.

If a woman is already waiting for a child, then the only indication for surgical treatment may be a threat of spontaneous abortion, or already available in an anamnesis of pregnant premature births.

Another reason that can raise the issue of surgical treatment is ismiko - cervical insufficiency of the muscular tissues of the body in question.

Surgical treatment of this pathology is not carried out if a woman's history includes diseases that become contraindications to conception, bearing and childbirth: severe pathology of the cardiovascular system, renal system, liver and a number of other diseases.

In the soft uterus, the blocking ability is broken, which removes the barrier that prevents the invasion of pathogenic flora and infection into the genital organs of the body.

Another method of surgical treatment is the application of catgut sutures. They tighten the neck, not allowing it to open, even with increasing loads received from the growing fetus.

The most optimal time for this operation is the thirteenth - seventeenth week of pregnancy. Although the term of such intervention, the attending physician appoints individually, based on the timing of the manifestation of pathology.

At the same time, as the pregnancy period increases, the pressure on the cervix increases, which leads to an even greater opening, increasing the risk of miscarriage. Drawing a conclusion from the above, it can be understood that surgical treatment at later terms of gestation is less effective.

This operation is carried out only in a hospital of a specialized clinic.

The first two days after suturing, the place of intervention is sanitized by specially appointed antiseptics. The duration of inpatient treatment is usually five to seven days. Everything depends on the threat of complication.

In the future, such a patient undergoes medical monitoring every two weeks outpatiently with her obstetrician-gynecologist.

Periodically, she needs to take a swab of vaginal discharge for analysis. Such a study is conducted at least once every two to three months.

The applied seams are removed in a hospital without anesthesia after the expiration of 37 to 38 weeks of gestation. After this, a woman should be under medical supervision for at least 24 hours. This is done because during the first day after removal of the catgut, contractions and labor can begin.

If the mother is beginning to feel contractions, and the seams have not been removed, she should call an ambulance or taxi and go to the nearest maternity hospital.

At the waiting room, medical staff should immediately say that seams have been placed on the cervix. Catgut is necessary in such a situation to remove necessarily, without looking back for a week of pregnancy. Since during fights, a surgical thread can injure the organ in question by cutting it.

Modern medicine in recent years has increasingly begun to use a different, less traumatic organ to eliminate softening - the placement on the cervix of a special fixator - the ring Meyer, which has another name - pessary.

The obstetrician-gynecologist wears a special ring for the organ under consideration, which does not allow, until a certain time, the opening of the cervix and thereby removes the threat of miscarriage.

All the above methods should be applied in the early stages of pathological manifestations. This will protect the future mother and her fetus from infection, which can only add problems.

Prevention

To give concrete effective recommendations, it is necessary to study well the causes and mechanism of the development of pathology. Therefore, the prevention of soft cervix can be expressed by a number of recommendations:

• If a woman already had precedents, she was diagnosed with ischemic-cervical insufficiency, had miscarriages or it was found earlier, then it is more important than planning the next conception to seek help from a doctor and undergo a comprehensive examination. If the diagnosis is confirmed, in most cases, the specialist will suggest the reconstruction of the cervix, after which, a woman fearlessly can become pregnant, bear and give birth to a healthy baby. Obstetrician - gynecologist will appoint if necessary and therapeutic treatment.
• If a woman already has a child, then it is worth keeping the interval of the next birth for at least two years. During this time, the maternity body will be fully restored.
• It should not be delayed with registration for pregnancy, and do it as soon as possible.
• It is necessary to comply with all requirements and recommendations of physicians.
• You should lead a healthy lifestyle, including sexual: exclude casual relationships, the more sexual partners, the higher the risk of "catching" a sexually transmitted infection.
• Do not ignore the vaccination and regularly undergo a routine checkup.

Forecast

If a woman promptly turned to a specialist and was diagnosed correctly, the prognosis of the soft cervix is optimistic enough. After the course of treatment, she is able to conceive, endure and reproduce a strong and healthy child.

When carrying out the necessary measures, the probability of miscarriage of such patients decreases two to three times. Therefore, after conception should be as soon as possible to register for pregnancy. Such obstetrician - gynecologist should give more attention to such women in labor.

The time of bearing a baby makes the future mommy especially receptive to words and actions. Therefore, if she is diagnosed with a soft cervix of the uterus, and before the birth is still far enough - despair should not be. Modern medicine is ready to help in this matter. We should only allow specialists to do this as early as possible, when the cervix, the uterus and the fetus have not yet been infected. The main thing is not to lose faith and take the help of medics. Then the likelihood of fulfilling the desire to become a mother is great, having produced a healthy baby.

[35]

ICD-10 code

In the world of medicine, there is a so-called register of diseases - "International Classification of Diseases of the Tenth Revision" (code for μb 10). In it, the changes we are interested in in the physiology of the uterus have their own coding and can be denoted by an individual code - D26 - other benign neoplasms of the uterus, D26.0, which is called the cervix.

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