Cervical incompetence ( CIN ) in pregnancy - Causes, Symptoms and Treatment .MF .
Istmikotservikalnaya failure (CIN) - a pathological condition characterized by failure of the isthmus and cervix, leading to spontaneous abortion in the II trimester of pregnancy and iii.In other words, it is the state of the cervix during pregnancy, at which it begins to thin, soft, shortened and disclosed, losing the ability to hold the fetus in the uterus up to 36 weeks.CIN is a common cause of miscarriage in the period from 16 to 36 weeks.
In accordance with CIN causes are divided into:
- organic CIN - as a result of previous cervical trauma during birth (breaks), scraping (abortion / miscarriage or for the diagnosis of certain diseases), for the treatment of diseasesFor example, erosion or cervical polyps conization method (excision of the cervix) or diathermocoagulation (cauterization).As a result, normal muscle tissue injuries as part of the cervix is replaced by scar, which is less flexible and more rigid (a hard, tough, inelastic).As a result, as the neck loses its ability
- functional CIN , which develops for two reasons: due to the disruption of the normal ratio of connective and muscular tissue as part of the cervix, or in violation of its susceptibility to hormonal regulation.As a result of these changes the cervix is too soft and pliable during pregnancy and revealed with increasing pressure from the growing fetus.Functional CIN can occur in women with impaired ovarian function, or may be congenital.Unfortunately, the mechanism of development of this type of CIN is still poorly understood.It is believed that in each individual case, and it is a combination of several factors.
In this and in another case, the cervix is not able to resist the pressure of the growing fetus inside the uterus that leads to its disclosure.The fruit falls to the bottom of the uterus department fetal bladder bulges into the cervical canal (prolapses), which is often accompanied by infection of the membranes and fetus.Sometimes, due to infection occurs rupture of membranes.
Fruit drops lower and even more pressure on the cervix, which opens more and more, which ultimately leads to a late abortion (from 13 to 20 weeks gestation) or premature birth (20 to 36 weeks gestation).
CIN CIN Clinical manifestations during pregnancy and it is not available.The consequence of CIN II and III trimesters of a spontaneous abortion, which is often accompanied by premature rupture of membranes.
Outside pregnancy istmikotservikalnaya failure does not threaten.
diagnosis CIN during pregnancy
The only reliable way to diagnose a vaginal examination and inspection of the cervix in the mirrors.the following symptoms (alone or in combination with each other) are found in vaginal examination: the shortening of the cervix, in severe cases - a sharp, softening it and thinning;outer mouth can be either closed (often in nulliparous) and gape;cervical (cervical) channel can be closed or missing fingertip, one finger or two, sometimes with breeding.When viewed in the mirrors can be found gaping external cervical os with prolapses (acting) membranes.
sometimes under questionable data vaginal study in the early stages of development, helping to diagnose CIN ultrasound, which can be found at the expansion of the internal os.
CIN Complications during pregnancy
The most severe complication is the termination of pregnancy on different terms, which may begin with rupture of membranes, or without it.CIN often accompanied by infection of the fetus due to lack of pathogenic microorganisms barrier in the form of a closed cervix and cervical mucus, which normally protects the uterine cavity and its contents of bacteria.
Treatment of CIN in pregnancy
treatment methods are divided into operational and non-operational / conservative.
Surgical treatment of CIN
operational method is suturing of the cervix with a view to narrowing, and is carried out only in a hospital.There are various methods of suturing, their efficiency is almost the same.Prior to treatment, produce ultrasound of the fetus, estimated his natal state, the location of the placenta, the state of the internal os.From the laboratory analysis is required to appoint a smear on flora and when detected inflammatory changes in it, spend treatment.The operation is performed under local anesthesia, after surgery the patient is prescribed antispasmodic and pain medication as a prophylactic measure for several days.
2-3 days estimate consistency seams and their patient with a favorable condition prescribed under medical surveillance antenatal clinic.Complications of the procedure may be: increased tone of the uterus, prenatal rupture of membranes, infection of the joints and intrauterine infection of the fetus.
the absence of effective and progression of CIN to prolong the pregnancy is not recommended, because the seams can be cut, causing bleeding.
Contraindications for sutures on the uterus are:
- untreated infections of the genitourinary system;
- availability of abortions in the past in the II and III trimester (recurrent miscarriage);
- the presence of intrauterine fetal malformation incompatible with life;
- uterine bleeding;
- severe concomitant diseases that are contraindications for pregnancy prolongation (severe cardiovascular disease, renal failure and / or liver disease, some mental disorders, severe gestosis II half of pregnancy - Nephropathy II and iii degrees, eclampsia and pre-eclampsia);
- increasing the tone of the uterus, are not amenable to medical treatment;
- the progression of CIN - rapid shortening, softening of the cervix, the opening of the internal os.
Conservative treatment of CIN
non-operative method is the cervical narrowing and obstruction of its disclosure installing pessary.Pessary - a ring of rubber or latex which is "worn" on the cervix so that its edges it rested against the vaginal wall by holding the ring in place.This method of treatment can be used only in those cases where the cervical canal is closed, ie. E. The early stages of CIN or suspected to it, and may be in addition to suturing.
every 2-3 days pessary removed, disinfect and set again.The method has a lower efficiency, in contrast to the first, but has several advantages: bloodless, ease of implementation and lack of need for hospitalization.
forecast the outcome of pregnancy in CIN
Prognosis depends on the stage and form of CIN, of the presence of opportunistic infections and the duration of pregnancy.The lower the gestational age and the more open the cervix, the worse the prognosis.As a rule, the early diagnosis of pregnancy is unable to roll over 2/3 of all patients.
Lies in carrying out careful scraping examination and suturing of cervical tears after childbirth, conducting plastics cervical detection of old breaks outside of pregnancy, treatment of hormonal disorders.
Obstetrician-gynecologist Kondrashov D.