Cervical deformity

Cervical deformity is a disorder of the normal structure of the cervical canal and structures of the cervix, which has clinical significance. This pathology is not very common, and even more rarely it has symptoms that occur only under certain conditions, that is, they become clinically significant. There can be many reasons for the development of this pathology, and the correction of such a pathology is very problematic, so you should be careful about your health and prevent any complications.

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Causes cervical deformities

Cervical deformities may develop after certain conditions, and may also be a congenital pathology. It often happens that the development of the female reproductive system is disrupted at a certain point, and various anomalies in the structure of female organs develop, including the cervix. Congenital anomalies are usually accompanied by concomitant anomalies of other genital organs - the vagina, uterus. More often in women of reproductive age, acquired anomalies in the structure of the cervical canal occur, which occurs as a result of adhesions, scars, deformations after various surgeries. Cervical deformities include conditions that are accompanied by a violation of the structure and integrity of the cervix and cervical canal - this is a circular cervical canal, narrowing of the cervical canal and its obstruction, an elongated cervix, shortening of the cervix or isthmic-cervical insufficiency, cicatricial and post-traumatic deformations of the cervix.

Circular canal of the cervix is a pathology in which the canal has a funnel-shaped form due to the incorrect arrangement of muscle fibers in the circular direction. This pathology can occur with ruptures of the internal genital organs due to childbirth and their surgical treatment - suturing, in the future this can be the cause of such a process with incorrect tissue healing. In this case, the anatomical arrangement of the muscle fibers of the cervix is disrupted, and it can no longer contract as before, which contributes to the further manifestation of one or another clinical picture.

Narrowing of the cervical canal is its size less than 5 millimeters. In this case, a woman of reproductive age may already have symptoms in the form of menstrual cycle disorders such as oligomenorrhea, since a narrow cervical canal can interfere with normal menstruation, which prolongs the period of menstruation with a small amount of discharge. As for pregnancy, this can be a direct threat to normal labor, in the case of poor opening of the cervix and an indication for cesarean section. The extreme degree of narrowing of the cervical canal is its obstruction. Obstruction of the cervical canal of the cervix is when a mechanical barrier is formed in the cervical canal, which can cause further deformations.

An elongated cervix is a pathology in which the length of the cervix is more than 45 millimeters, and this is often accompanied by a change in the consistency of the uterus and the thickness of the cervical os.

Shortening of the cervix or isthmic-cervical insufficiency is a condition in which the length of the cervix is less than 35 millimeters, and this is often 20-25, which is a risk of miscarriage in the future and requires correction.

Cicatricial and post-traumatic deformations of the cervix are the most common cause of the development of various pathologies in the future. The most common cause is trauma to the genitals after childbirth, ruptures of the cervix, damage due to incorrect positions of the fetus, improperly applied sutures or the consequences of their scarring, violations of the technique of surgical interventions on the cervix.

All these reasons can disrupt the normal physiological structure of the cervix, and in response to such foreign bodies, regeneration and proliferation of connective tissue develops, and subsequently scar tissue develops, which contributes to tissue deformation.

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Symptoms cervical deformities

The clinical features of various cervical deformities are that the symptoms are often not expressed until complications occur and the course is asymptomatic. When certain problems arise with pregnancy, childbirth or the course of certain diseases, only then can this pathology be found. But there are some clinical features in some cervical deformities.

The circular canal of the cervix is a deformation that may not manifest itself in any way due to its insignificance, i.e. all physiological processes in the uterus and ovaries do not suffer. Problems may arise during the next pregnancy, when there may be a discoordination of labor due to improper contraction of the muscle fibers of the circular canal of the cervix, which prevents the normal opening of the cervix.

When the cervical canal is narrowed, the first signs of this pathology can manifest themselves in the form of a violation of the ovariomenstrual cycle due to the occurrence of a mechanical obstacle to the normal menstrual function of the endometrium. But such changes may not be frequent, and the narrowing of the canal may be asymptomatic. In the case when the deformation of the uterus, in this situation, narrowing, reaches an extreme degree, then obstruction of the cervix develops - this is a condition that can already have pronounced clinical manifestations. Symptoms of this type of deformation can be the formation of a mechanical obstacle, which in women of reproductive age can cause a delay in menstrual blood with its accumulation in the uterine cavity and the formation of an acute condition in gynecology - hematometra. Then there is a clinic of acute abdominal pain, tension of the anterior abdominal wall, and the anamnesis data indicate a delay in menstruation for several weeks or several times in a row.

An elongated cervix is a pathology that is also often asymptomatic. Sometimes, in women who have not given birth before, the first signs of the disease may be dyspareunia - a disruption of the normal process of sexual intercourse, in which the woman does not receive pleasure and her sexual desire decreases. This happens because the elongated cervix does not have a sufficient number of receptors and may have poor blood supply, which disrupts normal sexual intercourse. There are no painful sensations, since the internal structure is not changed and there are no obstacles. Often, a symptom of this type of deformation can be infertility, since problems with conception arise due to the fact that the sperm cannot reach the fallopian tube for the normal fertilization process. Also, a dense mucous plug can form in the elongated cervical canal, which has an acidic environment, which also prevents the passage of sperm.

Symptoms of a long cervix may manifest for the first time during pregnancy or already during labor. During pregnancy, the normal attachment of the placenta may be disrupted, since the anatomical structure of the cervical os is disrupted and the placenta may have a central, lateral or low attachment. Problems may also arise during labor - there are obstacles to the normal passage of the baby through the birth canal, since the elongated cervix is not sufficiently dilated and the baby's head or the presenting part may be in one plane for a long time, which increases the risk of hypoxia and may require additional methods - the application of obstetric forceps. This can further traumatize the birth canal and lead to secondary deformations of the cervix.

Shortening of the cervix, as a type of deformation, has clinical symptoms during pregnancy, since there is a threat of termination of pregnancy. This is due to the fact that normally the length of the cervix throughout pregnancy should be at least 35 millimeters, then at 34-36 weeks the length of the cervix decreases, since it is preparing for childbirth, and its length is approximately 34-36 millimeters, but it can be 30 and this is considered a normative indicator. In case of discrepancy with these indicators, there may be pathological labor or complications in labor in the form of premature discharge of amniotic fluid, umbilical cord entanglement, therefore this type of deformation requires timely diagnosis and treatment.

Cicatricial and post-traumatic deformations of the cervix very often do not manifest themselves in any way, but they require increased attention in women of reproductive age. These deformations occur after traumatic births, and symptoms may appear already during the next pregnancy. In this case, the normal contraction and opening of the cervix will be disrupted, which can contribute to prolonged labor or, due to pronounced cicatricial changes, may become an indicator for a cesarean section. The first signs of such deformations may be painful sensations during sexual intercourse, which can be caused by cervical scars that disrupt normal contraction during arousal and disrupt the outflow of blood from the veins of the small pelvis. Congestion in the small pelvis may develop secondarily with further inflammatory or other diseases of the female reproductive system.

Cicatricial deformation of the cervix is most often seen with a large fetus or with abnormal fetal positions. Deformation of the cervix after childbirth can also be asymptomatic, so it is necessary to carefully examine the birth canal and properly manage the postpartum period.

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Complications and consequences

Considering the fact that cervical deformation is asymptomatic in most cases, these conditions are often diagnosed when complications arise. Such complications may arise during childbirth, and then it is very dangerous. Fetal hypoxia may occur due to a violation of its passage through the birth canal, as well as birth injuries, cephalhematomas, and other disorders on the part of the fetus.

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Diagnostics cervical deformities

The asymptomatic course of various types of cervical deformities complicates timely diagnostics. Such patients have no complaints, and no special changes are detected during examination.

But it is still necessary to carefully examine the woman even during a routine examination. When examining women with such deformations, there are no special changes: no complaints or symptoms are determined during a bimanual vaginal examination. Examination in mirrors is also uninformative because only the cervix itself is visible, but if the cicatricial deformations are very pronounced, then changes may be visible. Then it is not difficult to suspect the diagnosis. It is necessary to carefully collect a general anamnesis and obstetric anamnesis with details of the number of births, their course, consequences, because this will help to find out whether this woman has risk factors.

The tests do not allow us to suspect this pathology, since general clinical laboratory tests - general blood and urine tests - are normal. The absence of changes in the general blood test only allows us to exclude inflammatory diseases. Special laboratory tests - a smear of the cervical canal for flora and dysplasia - are also unchanged in the absence of concomitant pathology.

Instrumental diagnostics is the “gold standard” in diagnosing various types of deformation, as it allows visualization of any changes.

Changes in the size of the cervical canal can be diagnosed using ultrasound. A special method is used for this - cervicometry - this method consists of an ultrasound examination of the cervix with measurements of its size. This makes it possible to measure the length of the cervix, its width and the size of the uterine os, which allows us to judge the pathology of elongation, shortening of the cervix. Ultrasound also allows us to identify cicatricial deformations of the cervix, if they are significant, since the heterogeneous structure of the cervix is visualized.

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Differential diagnosis

Differential diagnostics of various deformations should be carried out primarily with various functional disorders during childbirth. Since the first signs of cervical deformation may occur during childbirth, it is necessary to clearly differentiate secondary weakness of labor with anatomical disorders of the cervix in the form of its deformation. With weakness of labor, the cervix opens, but its dynamics are insufficient for normal childbirth. With deformations of the cervix, it cannot open and its uneven structure is visualized.

It is also necessary to conduct differential diagnostics of cervical deformation that occurs with infertility. Then many inflammatory factors can be excluded, and the cause of infertility may be different. For this, it is necessary to carefully examine the woman with mandatory hysterography, which allows to identify defects not only of the cervix, but also of the uterine cavity itself.

Treatment cervical deformities

Treatment of cervical deformity in the period between births or in women of non-reproductive age is not required, as this condition is not dangerous. In case of infertility, preparation for pregnancy or during pregnancy, measures must be taken, as complications may arise.

Treatment of cervical deformation before childbirth can be conservative and surgical. It includes a complex action of massage to improve the outflow of blood and lymph, physical exercises to strengthen the muscles of the pelvis and perineum as a coordinated action of these muscles during childbirth, as well as medication methods.

Since deformations are anatomical disorders, drug treatment methods may be ineffective in radically correcting this pathology; there may only be symptomatic therapy for certain conditions caused by deformation of the cervix. For example, if the normal opening of the uterine os is disrupted due to a long cervix or deformation, labor is stimulated. This can be done using mechanical methods - a Foley catheter or by amniotomy or manual detachment of the placenta over a short distance. Labor can also be stimulated by using laminaria. Laminaria is a seaweed used to make special sticks that increase in size 5-6 times in the vagina and stimulate the opening and smoothing of the cervix. Prostaglandins E2 - misoprostol are also widely used. This drug called "Mirolyut" is available in tablet form, 4 tablets per pack at a dose of 200 mcg of the active substance, and 4 tablets are used rectally at once. This method of stimulating labor with a long cervix is widely used, as it is affordable and effective. You can use prostaglandins in the form of vaginal suppositories or ointments. Such stimulation methods are possible only in the absence of scars on the uterus, that is, when the previous birth was carried out naturally.

Surgical treatment methods are of priority importance in case of significant deformations of the cervix, since it is possible to correct such deformations. Different methods of surgical treatment are used, which depends on the type of pathology. Minimally invasive interventions are often performed for certain indications, since they are less traumatic, especially if pregnancy is also planned. In case of structural disorders of the cervix due to deformations, such as narrowing or obstruction of the cervical canal, a special procedure is performed - bougienage of the cervical canal. This intervention consists of widening the canal with a special instrument - a bougie. This is most often a metal instrument, which is selected by number, which corresponds to its size, and they start from the smallest to the widest. It is often necessary to repeat the procedure several times, since once is not enough. Such intervention is effective for small degrees of narrowing.

In case of more pronounced deformations and huge cicatricial changes of the cervix, open surgical interventions with subsequent plastic surgery of the cervix are performed. They can perform a small excision of the deformed part of the cervix and then suture such amputations with expansion of the cervix. The choice of the method of surgical treatment is carried out individually, taking into account the degree of deformation, age and purpose of treatment.

Traditional treatment of cervical deformity

Traditional methods of treating cervical deformities prevail, since they do not cause harm when planning a pregnancy and can reveal a pronounced effect in certain cases. Both herbal treatment methods and traditional methods are used. If cervical deformities interfere with normal opening of the cervix already during labor, then methods are used that help relax slightly deformed tissues of the cervix.

The main methods used for this are:

• Sea buckthorn oil also has an anti-inflammatory effect in addition to its relaxing effect. Sea buckthorn oil, which can be purchased at a pharmacy, is soaked in a tampon and inserted into the vagina for 2 hours, which is best done before bedtime. The course is at least ten procedures.
• Treatment with honey - one tablespoon of honey should be diluted in a liter of boiled water and douching should be done twice a day. This course should be completed over 7-10 days. Honey has a pronounced relaxing effect on the myometrium of the uterus, and also has a bacteriostatic and immunomodulatory effect.
• Using celandine - a tablespoon of dried celandine leaves should be poured with a glass of boiled water and boiled for another five minutes, then allowed to cool and strained. This decoction should be drunk half a glass three times a day for about a week.
• Acacia shows good results in treating cervical deformities. To prepare the tincture, you need to collect acacia flowers, dry them, pour alcohol over them and leave them in a dark place for at least a day, then dilute with boiled water and take one tablespoon three times a day. The course of treatment lasts one month.
• Burdock juice is excellent for relieving irritation, swelling and has a healing and antispasmodic effect, which enhances the regeneration of the myometrium and improves its ability to relax. To prepare a healing solution from pre-washed burdock leaves, squeeze out the juice and take one teaspoon three times a day for five days, and then one teaspoon twice a day for another five days.

Herbal infusions are also widely used in the treatment of cervical deformities, as they promote normal nervous regulation of the processes of contraction and relaxation of the cervix.

Basic recipes using herbs:

• A soothing and strengthening herbal tea is recommended, which has a hysterotropic effect. To do this, raspberry, strawberry and hawthorn leaves are infused in boiled water and boiled for another five to ten minutes, after which they drink it instead of tea up to four times a day.
• Plantain leaf, horsetail, nettle and lemon balm leaves, dandelion root should be poured with one liter of water and boiled. After this, the decoction should be infused for 3-4 hours and taken in the morning before meals, one teaspoon.
• Oregano herb, birch buds, St. John's wort leaves, calendula, chamomile, celandine, linden and succession are poured with boiling water, infused and drunk half a glass 4 times a day.
• Hop cones, valerian, linden, coriander, motherwort and oregano should be poured with a liter of hot water and after it has steeped, drink 2 teaspoons in the morning and evening.
• blackberry inflorescences and fruits, you can also use blueberries, pour boiling water over them and let it brew, add honey for taste and drink a teaspoon three times a day.

The use of homeopathic remedies can be effective if the deformations of the cervix are combined with other hormonal disorders. Homeopathic remedies are also used to treat this pathology. Their main effect is aimed at regulating the normal hormonal background and this contributes to the normalization and tone of the cervix, especially with its deformations.

The most famous homeopathic preparation that has an effective effect is Caulophyllum, a plant extract that is produced in the form of homeopathic granules. During pregnancy, two weeks before delivery, it is used for prophylactic purposes for deformation of the cervix in the form of 3 granules twice a day. Already during labor, with discoordination or weakness of labor, the preparation is used 3 capsules every half hour.

Another drug used in this case is Pulsatilla. In addition to its pronounced myotropic effect, it also has a relaxing and analgesic effect. This effect contributes to the normalization of the uterine tone and the normal dynamics of the opening of the cervix in the case of its cicatricial changes. The drug is available in homeopathic granules and is used in the same dosage and according to the same principle.

The drug Arnica has the same effect, but in addition to the analgesic and hysterotropic effect, its additional function is revealed - it is the prevention of postpartum hemorrhage. This prevents secondary traumatic injuries.

These are the main methods of treating this pathology, both folk and herbal preparations, and their timely use allows you to avoid complications.

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Prevention

As for the prevention of this disease, there are only non-specific methods. This includes:

• hygiene of sexual life with prevention of genital infections;
• timely treatment of inflammatory and non-inflammatory diseases of the female genital organs;
• annual preventive examination by a gynecologist;
• pregnancy planning with mandatory comprehensive examination of the woman;
• correct childbirth tactics and timely qualified obstetric care during childbirth.

These are the main preventive measures not only for this disease, but also for a group of others that are dangerous for women and that can be prevented even before they begin to develop.

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Forecast

The prognosis for life of cervical deformities is favorable, since there are no pronounced clinical symptoms that threaten life. The prognosis for complete recovery is also favorable, since today there are a huge number of different methods of surgical treatment, after which the deformities can be completely corrected.

Cervical deformity is a pathology that occurs in every fifth woman who has had a traumatic birth. This pathology does not cause discomfort until another pregnancy occurs, when complications may arise. Therefore, it is important that there is a timely and correct labor management tactic on the part of doctors, as well as compliance with all non-specific prevention rules on the part of the woman.

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