Suturing at tsn. Cervical closure during pregnancy
Sewing of the cervix during pregnancy is required when there is a possibility of premature opening of the pharynx. This situation often happens in the second or third trimester. The fetus grows and presses on the pelvic area, weakened muscles may not be able to withstand, which leads to premature labor activity, while the child is not fully formed, which poses a threat to his life.
When and why is the cervix sutured during pregnancy
If the pregnancy proceeds within the normal range, the cervix will open only after the child is ready for birth, when all organs can function independently. If the body has any pathological processes, which lead to premature opening of the pharynx, then suturing the cervix during pregnancy will be the best solution.Suturing during the period of gestation has strict indications and, first of all, the situation is determined by the diagnosis of isthmic-cervical insufficiency (ICN). Pathology is characterized by weak muscles of the uterine os, softening and shortening, which threatens the life of an unformed baby.
Reasons for the development of ICI:
- an excess of androgens;
- congenital malformation;
- the presence of previous births;
- numerous abortions.
When is surgery prescribed?
Cervical suturing is used as a result of long-term diagnostics and additional studies (ultrasound, transvaginal sonography). In order not to put the child inside the womb or the expectant mother at risk, many factors are taken into account when deciding on an operation:- length 20 mm or less;
- expansion and density of the internal pharynx;
- the gestation period is not earlier than 14 weeks and not later than 25;
- safety amniotic sac and no leaks amniotic fluid;
- absence of infectious diseases.
How is the cervix sewn up during pregnancy?
The operation to sew up the cervix during gestation at the present stage of development of medicine is carried out by two radical different methods: sutured external pharynx or internal. Stitching the outer edges can damage general condition increases the risk of infection.A few days before the start of the operation, the uterine canal and vagina are examined for the presence of harmful bacteria, therapy is carried out to reduce tone, and the vagina is treated with antibacterial agents.
Among all the methods, those that have minimal consequences for the body are distinguished:
- Circular silk sutures on the cervix, applied by the Lyubimova method and fixed with a wire in polyethylene, are applied after the cervix is moved closer to the exit with forceps.
- The Palmer method involves cutting through the walls of the vagina in order to displace Bladder and suturing.
- The Lasch method involves an incision from the external os to the isthmus.
- The operation according to the Shirocard method is performed using a nylon suture along the external pharynx.
- When using the Macdonald method, no excisions are made, it is required to make numerous piercings at the junction of the vagina and the pharynx and fix it with a purse-string suture.
minor discomfort, bloody issues and pain in the lower abdomen after suturing are considered normal and should disappear three days after the operation. After a week, at good health patients, pregnant women are discharged.
After this kind of intervention, the pregnant woman is not allowed to have sex, sit for a long time and it is required to exclude heavy lifting in order to avoid divergence of the seams before 37 weeks.
Video how to sew up the cervix during pregnancy
Pregnancy and its outcome depend on the condition of the woman's cervix. After all, it is she who holds the fetus, fencing it off from the world until the time comes to be born. If everything proceeds normally, before this event, the cervix gradually opens. But there are many reasons that cause the natural process of discovery to start earlier. Doctors come to the rescue by stitching the neck. This operation is also called cervical cerclage and sometimes saves the life of an unborn baby.
Causes of cervical insufficiency
Uterus - important organ woman's body. Here is the implantation of eggs, the development of embryos. During pregnancy, the cervix normally begins to slowly dilate from the 36th week. But sometimes the opening starts at an earlier date. This leads to miscarriage or isthmic cervical insufficiency(tsn), disclosure of the uterine pharynx prematurely. This happens when the neck is short. Its normal is 40 mm, but in some it reaches only 20 mm. In a dangerous situation, the poor condition of the fetal bladder, doctors decide to sew up the cervix. This could save the life of an unborn child.
Diagnostics
When examining a pregnant woman, the doctor cannot see that the cervix is shortened. Therefore, it is impossible to predict a miscarriage, guided only by an examination.
by the most informative method diagnosis of pathology is. This research method allows you to determine the size of the neck. A shortening of the cervical canal up to 25 mm signals the danger of miscarriage and helps confirm the diagnosis with ultrasound. Sometimes the patient is offered to cough a little or lightly press on the bottom of the uterine cavity. In this case, an increase in the lumen of the cervix occurs, which is a sign of cervical insufficiency. It is possible to establish a shortening of the neck from the 20th week, when the fetus begins to grow rapidly. It is during this period that most miscarriages occur. For this reason, pregnant women are advised to undergo an ultrasound examination.
How is the suture applied?
The operation is done for a period of 14-21 weeks, it is not recommended to take in later, because a strong stretching of the tissues can lead to eruption and.
The operation is carried out in stationary conditions under general anesthesia. Depending on the condition of the uterus, a stitch is applied inside the neck or outside with a strong thread. Seams are applied in different ways. One surgeon "tightens" the cervix with special stitches to prevent the uterus from opening. Another does it by laparoscopy.
After the suturing operation, the woman stays in the hospital for some time to avoid complications. She is prescribed antispasmodics to reduce the muscle tone of the uterus, and drugs in order to avoid infection. Vaginal sanitation is also carried out daily to prevent infection. On the fifth or sixth day, the patient is allowed to go home if her condition is normal.
- unacceptable physical exercise and long walking
- lifting weights is also impossible;
- you can only stand or sit for a short time;
- a few days before the birth, go to the hospital.
Sex after suturing
Often, women have a question about whether it is possible to have sex after the operation. The neck after suturing becomes hyperactive. To “calm” her, special drugs are prescribed. Sexual life excites the uterus. For this reason, sex with a seam on the cervix can lead to miscarriage, and if the period is short, to premature birth or eruption of the uterus. Even with a calm after suturing, sexual activity should be abandoned until the very birth.
How does the water come out at the seams?
There is a flow of water after the operation, not associated with labor. This phenomenon occurs when there is an infection in the vaginal cavity. Then you need to contact the attending gynecologist. He will prescribe the appropriate treatment.
Usually bursts at the onset of labor amniotic sac, contractions begin. The woman can feel the cotton. But it happens that only cracks form on the bubble, and the water leaves before the start of contractions. When the neck is open, the water flows out in a stream, and the woman cannot do anything to stop the water. With stitches on the cervix, the water may break earlier, and they are not so plentiful.
If they started to move away medical institution and maternity hospital, you should call an ambulance. But first you should check if it is water. Indeed, after the installation of seams, there are often leaks. To do this, you can purchase an amniotest in a pharmacy in order to determine the nature of the liquid at home. The test is similar to a panty liner with two strips. How to use such a test is described in the attached instructions. The result is 100 percent.
If there is no test, and the pharmacy is far away, you can perform the test yourself. For such a check, you need to wash yourself, lie on your back, placing a clean napkin on your panties. If the rag gets wet quickly, it's water. The discharge will be stronger if you turn lying from side to side.
Usually, the sutures are removed before the start of the discharge of water and labor, but sometimes it happens that childbirth occurs earlier. If the pregnancy is already 36-37 weeks, the stitches are removed directly in the delivery room. This is done quickly and painlessly.
amniotic fluid quality
Under whatever circumstances the waters begin to break, it is necessary to pay attention to them, this is important. The color of the waters is especially important in cervical cerclage. It depends on how the birth proceeds:
- colorless - childbirth is normal;
- yellow water also occurs during the normal course of labor;
- a green tint indicates oligohydramnios and fetal hypoxia or that the baby has emptied the intestines;
- streaks of blood are always present when the waters pass, because the neck opens;
- there is a lot of blood in the waters, this is possible when the placenta has exfoliated and you need to urgently call an ambulance.
Cork at the seams
Often, women who have or are about to have stitches are worried about the cork coming out, they are afraid that it will not come out on time. You should not be afraid of this. The cork after the cervical cerclage departs in the same way as during a normal pregnancy. If the stitches on the uterus were not removed before the cork was released, the doctor will remove them after contacting him.
Teething seams
It is usually prescribed to remove stitches at 37 weeks, although it happens that a pregnant woman comes to give birth with a stitch not yet removed, and it does not cause her any inconvenience. Removal is painless.
A cut seam sometimes delivers more than just discomfort. Pain in the lower abdomen, inflammation begins.
If the sutures on the cervix erupted, then you should immediately consult a doctor. They will be removed and new ones put in if necessary.
Eruption occurs if:
- the technique of the operation was violated;
- the doctor damaged the tissues of the cervix;
- vaginal hygiene was not respected, which led to infection, fistulas;
- greatly increased the tone of the uterus;
- there was inflammation inside the vagina or pharynx.
Sometimes the suture eruption occurs when it is installed at a long gestation period and during contractions, when the doctor did not have time to remove it. But all these complications after surgery rarely occur. It is enough for a woman to follow all the doctor's recommendations.
If such a diagnosis is made and an operative cervical cerclage is proposed, you should not be upset. The main thing is to set yourself up for a positive outcome, and the birth will be successful.
Video: suturing the cervix. Not an operation
Video: isthmic-cervical insufficiency during pregnancy
Sometimes a long-awaited pregnancy is complicated by the threat of not carrying the baby to the due date. Various pathologies cervix can cause cervical insufficiency. In some cases, the expectant mother is recommended suturing the cervix. About why this is done and how this manipulation takes place, we will tell in this material.
What it is?
The suturing of the cervix is a forced necessity, which gives a real chance to maintain and prolong the pregnancy if the cervix cannot cope with its direct duties for some reason. After conception has taken place, the cervix closes tightly. The cervical canal closes and fills with mucus. The task before this part of the reproductive female organ is large and important - to keep the growing fetus in the uterine cavity, to prevent it from leaving it ahead of time.
In addition to retention, the cervix with a mucous plug prevents pathogenic bacteria, viruses, and other unpleasant uninvited "guests" from entering the uterine cavity from the vagina, which can cause intrauterine infection of the baby. This is dangerous, because infections transferred in the embryonic and later periods usually end in malformations and severe pathologies of a congenital nature, intrauterine death of the crumbs.
If the cervix does not provide proper protection to the growing baby, then the likelihood of miscarriage and premature birth increases. If the baby by this time is not yet able to survive on its own in this world, then such childbirth will end tragically. In order to strengthen a weak neck, doctors recommend certain situations sew it in so that the mechanical barrier in the form of seams does not allow it to open ahead of time.
Indications
For this kind of surgical intervention during the bearing of a baby, there must be strict indications and unambiguous recommendations from the attending physician. These factors include:
- high risk of miscarriage or premature birth due to the presence of similar cases in history;
- habitual miscarriage in the 1st and 2nd trimesters of pregnancy;
- miscarriage in the third trimester;
- earlier shortening and opening of the neck, expansion of the internal or external pharynx;
- doubtful scars left as a “memory” from previous births, in which cervical ruptures occurred;
- any destructive changes in the cervix in the process of bearing a child, which are prone to further development.
To make a decision that there is a need for such an extreme measure as suturing, on the basis of a single examination on the gynecological chair, the doctor cannot. He needs comprehensive information about the state of the lower segment of the uterus, which is the cervix. For this, it is assigned complete biometric examination which includes colposcopy and ultrasound diagnostics, as well as laboratory research smear.
Only after all risk factors have been identified, the length and width of the cervix have been measured, and the condition cervical canal inside it, as well as the patient's personal history, a decision may be made to suture the neck.
Contraindications
Sewing up this organ during pregnancy is possible only if, in addition to a weak neck, other global problems not found in this pregnancy. If some concomitant pathologies are found, the operation will have to be abandoned. Contraindications include:
- diseases of the heart and blood vessels, kidneys, which have become aggravated in the expectant mother due to pregnancy, the risk of death of a woman in the event of a mechanical prolongation of pregnancy;
- bleeding, increasing in strength and character, as well as recurrent bleeding when threatened;
- gross malformations of the baby;
- hypertonicity of the uterine muscles, which cannot be reduced with the help of medical conservative treatment;
- chronic inflammation reproductive organs women, sexually transmitted infections, STDs;
- late detection of cervical pathologies - after 22 weeks of pregnancy ( best time for a successful intervention, the period from 14 to 21 weeks is considered).
How is the operation going?
The timing of the operation is of great importance. From 14 to 21 weeks, the baby is not so big that it strongly stretches the walls of the uterus and cervical muscles, for more later dates suturing is not recommended due to the fact that highly stretched tissues may not withstand and eruption of the sutures will occur, followed by rupture.
The operation, which in medical language is called "cervical cerclage" carried out only in the hospital. It is not considered painful and painful, since the woman is given epidural or intravenous anesthesia.
You should not be afraid of him, because experienced anesthesiologists will calculate the dosage of drugs solely taking into account the gestational age, physique, weight and health of the expectant mother herself and the developmental features of her baby. The dose will be safe for mother and fetus.
The duration of the entire manipulation does not exceed a quarter of an hour. According to the condition of the cervix, the doctor will suture either the external or internal pharynx of the cervix. The outer one will not be touched if there is erosion, dysplasia, pseudo-erosion on the neck. The technique is very simple - surgeons suture the edges of the outer part of the neck with strong surgical threads.
This method requires careful preparation. If there is an infection in the uterus, then the consequences will be more than deplorable. Stitching will create a closed space inside the reproductive female organ in which any microbe can begin to multiply rapidly. Previously, the woman is treated with antibiotics, a thorough sanitation of the vagina is done. Not always, however, it helps.
There will be no closed space if the doctor decides to sew up the internal pharynx of the cervix. In this case, specialists leave a small drainage hole. The sutures themselves are applied in different ways, each surgeon has his own favorite, besides, a lot depends on anatomical features this patient.
The cerclage itself can be held laparoscopic method. It has many advantages - speed, light enough postoperative period, low blood loss, lower risk of complications.
Laparoscopic cerclage is indicated for women with congenital shortening of the cervix and those who have undergone unsuccessful vaginal suture surgery.
Possible problems and complications
Like any surgical intervention, cerclage can also have its complications. The most dangerous are the accession of infection, the development inflammatory process and increased tone of the uterine muscles. Inflammation may develop due to an internal infection that could not be “winned” in the preoperative period. Sometimes a woman has an individual allergic reaction on the suture material used by doctors.
Possible problems can be discussed prolonged discharge after surgery, the appearance of burning, mild pain. Moreover, inflammation can appear not only immediately after surgery, but also a few weeks after suturing. That is why it is important to visit the doctor more often and monitor any changes.
Hypertonicity is also a reaction of the uterus to surgical intervention. and a suture material foreign to its structures. Some heaviness in the abdomen, slight pulling sensations can be quite normal at the first time after the operation, but subsequently they should disappear. If this does not happen, you should inform your doctor about it.
Infrequently, but it also happens that a woman’s body categorically refuses to take foreign body, which are surgical threads, a violent immune process of rejection begins, which may be accompanied by high temperature, atypical discharge, pain.
In the later stages, the cerclage can have another unpleasant consequence - the sutured cervix can suffer greatly if the birth has already begun, and the stitches have not yet been removed. Therefore, it is important not to ask the doctor to “stay at home for another week”, but to go to the hospital in advance.
After the intervention, the woman needs to be under the round-the-clock supervision of doctors in the hospital for several more days. She is prescribed antispasmodic drugs to reduce the muscle tone of the uterus, as well as strict bed rest. Vaginal sanitation is carried out daily to avoid infection. After that, the pregnant woman can be released home. Allocations after the intervention last about 3-5 days.
The stitches on the neck will require the expectant mother to reconsider her lifestyle until the very birth. Physical activity, prolonged standing in an upright position, prolonged walking are contraindicated. Under no circumstances should you lift weights. You should also refrain from sexual life so as not to provoke hypertonicity of the uterus, which can lead to eruption of the sutures.
Until childbirth, a woman will have to watch her stool - constipation is highly undesirable, since it is forbidden to push. Therefore, you will have to go on a diet, introduce more fresh vegetables and fruits, juices into the diet, limit salt, an abundance of protein foods, as well as pastries and muffins.
More frequent visits to the doctor than women usually do in interesting position". The doctor will monitor the condition of the sutures, take swabs for the vaginal microflora, and, if necessary, prescribe unscheduled ultrasound examinations, the purpose of which will be to measure the parameters of the neck and evaluate its internal structures.
In the hospital, a woman with stitches on the uterus will have to lie down at 36-37 weeks. Around this time, the stitches are removed. Labor can begin after this at any time, even on the same day.
It is not painful to remove the stitches themselves; there is no need to use anesthesia or other methods of anesthesia.
Predictions and consequences
The percentage of gestation after cerclage is quite high - more than 80%. The prognosis depends on the degree of cervical insufficiency and the reasons why the woman was shown surgery. If after the operation she will follow all the recommendations of the doctor, then the chances of carrying a baby to 36-37 weeks increase significantly.
