Labour Process: The Cervix Explained
How does the cervix change during pregnancy?
The lowest part of the uterus that extends into the vagina is called the cervix. On examination, the gynecologist sees only its end, which looks like a cutaway tube. This part of the organ in a healthy state has a shiny surface and a pale pink color.
The inner part of the cervix can only be seen with the help of an ultrasound examination and during laparoscopic surgery - it is also pink, only in appearance it looks velvety, as it is a little loose.
Changes in the cervix occur in the early stages of pregnancy and with the appearance of various pathologies. For example, if a patient has erosion, then the doctor during the examination will see damage to the cervical epithelium, in the form of irregular redness.
At early stages, signs of pregnancy are indicated by changes in the cervical epithelium.
First signs of pregnancy
In a woman's body, after conception, many changes occur due to the increased production of a special hormone. It is called - hCG - human chorionic gonadotropin. The body begins to produce it immediately after the introduction of a fertilized egg into the wall of the uterus.
Under the influence of a special hormone, the blood supply to the main female organ increases, the tissues swell. How does the cervix become in early pregnancy?
Her first changes concern coloring. It turns from pale pink to purple-cyanotic.
Its appearance changes due to increased blood filling of gynecological organs and the appearance of new vessels - the laying of the placenta has already begun - in the future, food will be supplied to the fetus through it and the products of life activity will be taken from it.
In early pregnancy, the cervix becomes softer and displaces easily. This condition was first described by gynecologists Gaus and Gubarev. The isthmus, which is located between the cervix and the uterus itself, softens, which creates the possibility of painless movement of the usually motionless part of the organ from its place.
The onset of conception can also be diagnosed by Genter's sign. In the early stages of pregnancy, the position of the cervix changes - since the uterus itself is displaced anteriorly, due to the softening of the isthmus. Because of this, the cervix, which is open and lifted up during ovulation, drops.
On palpation, the uterus itself at this stage of pregnancy becomes convex, a thickening appears on its front surface along the midline, which can be characterized as comb-like. It must be said that this sign is optional,sometimes the thickening cannot be felt.
Since the uterus itself is tilted forward, the cervix begins to bend back. As soon as the embryo is fixed, the soft cervical structure changes, it becomes hard - or better to characterize - dense.
In addition to shifting the position of the organ, it also changes its shape. If the pregnancy is the first, then the cervix is flat, wide and has a cylindrical shape. In women who have already given birth, the organ takes on the shape of a cone - that is, it protrudes.
This occurs if the previous pregnancy ended in miscarriage.
Gynecological examination when registering for pregnancy
When women register, they are always asked whether pregnancy is desirable or not, describe the anamnesis:
- what was sick before pregnancy, and the doctor is interested not only in gynecological diseases;
- inquire about previous pregnancies and abortions;
- the date of the first menstruation and the cycle of the subsequent ones.
Ask to remember family history - the presence of hereditary diseases, they are asked whether external changes have appeared: pigmentation on the skin, swelling of the nipples and mammary glands. When examining the mammary glands, the nipples are pressed to determine if colostrum is being released.
During the examination, the chair describes:
- a hard or soft cervix in early pregnancy;
- what are its dimensions and shape;
- as located.
Be sure to take a swab from the pharynx - the quality and consistency of cervical mucus also assess the condition of the future mother.
When visiting an antenatal clinic in the future, gynecological examinations on a chair will be carried out only in emergency cases - when the patient complains of an incomprehensible condition or malaise. All changes in internal organs are monitored using ultrasound - it is safer than examination on a chair.
During the examination, the doctor makes sure that the condition and size of the neck changes in accordance with the duration of pregnancy. Until 20 weeks, there should be no changes in this organ. The length of the cervix corresponds to its size before pregnancy - from 4 to 4.5 cm, both throats - the inner one, which goes into the uterine cavity, and the outer, protruding into the vagina, must be completely closed.
Acceptable shortening of the cervix occurs in the second trimester - from 20 to 28 weeks. The change in size is insignificant - only 0.5 cm, no more, the pharynx remain closed.
By 36 weeks, the cervix is shortened by another half a centimeter, and then continues to rapidly shorten in size, soften and ripen. If shortening does not occur, an unscheduled emergency caesarean section may be necessary, as a ruptured cervix that is too long can cause profuse bleeding. Normally, the length of the neck before childbirth is about 1 cm, and the internal pharynx is narrowershould be ajar, and the fetal head should be fragmented into the small pelvis.
It should not be surprising that cervical monitoring begins at 24 weeks, and not from the very beginning of registration. The fetus begins to gain weight intensively at this very time, the uterus increases, respectively, the change affects all its parts, including the peripheral. If the ultrasound control reveals unfavorable changes, then the woman is sent to the hospital, where she is monitored - sometimes until the very birth.
Pathologies during pregnancy
Doctors are especially closely monitoring pregnant women at risk.
Patients are taken on special account:
- who have already had abortions;
- those who underwent a difficult labor during which forceps were used for emergency treatment;
- if hormonal insufficiency was diagnosed during gestation, there was not enough progesterone hormone and the woman was prescribed an artificial analogue;
- with a large fetus or multiple pregnancies;
- with low placenta previa;
- if diagnosed with cervical erosion in early pregnancy.
If you suspect isthmic-cervical insufficiency, a woman is sent to a hospital. ICI refers to conditions when the risk of miscarriage increases.
One of the main symptoms of ICI is a condition when the cervix opens in early pregnancy - in the first trimester - at 8-11 weeks. This is a fairly rare case of this pathology - it usually develops in patients at the beginning of the second trimester - from 16 weeks.
What is the danger of isthmic-cervical insufficiency?
- Due to the slightly open neck, the risk of infection of the fetus from the external environment increases;
- The fetal membrane descends into the cervical canal and can burst with sudden movement.
When an ICI appears in the early stages, hormone therapy is usually prescribed or the pharynx of the uterus is sutured. A woman has to stay in bed until the end of pregnancy.
Sutures are applied in a hospital, this procedure requires preliminary diagnosis for gynecological infections and is performed under anesthesia.
If a woman follows the recommendations of a gynecologist, then ICI is not a contraindication for natural childbirth. However, one should expect that childbirth will take place quickly, and the obstetrician should be warned about the diagnosed pathology in advance.