Features of cervical dilatation

The purpose of the cervix - double. During pregnancy, she is responsible for ensuring that the fetus remains in the womb, does not go out ahead of time, grows and develops where it is provided by nature. It is tightly closed. But it depends on it when labor begins, because the beginning of its disclosure is the generic process.

There is nothing surprising in the fact that the speed and intensity of disclosure, as well as possible difficulties, raise many questions for women. In this article we will talk about the features of this process.

The uterus is shaped like a knotted bag, while its widest part is called the bottom, and the narrowest part is called the neck. The neck is a circular muscle, that is, it is originally incorporated the ability to both shrink, close and open.

Inside the cervix is ​​a thin cervical canal, one part of which goes into the uterus, and the other into the vagina. During pregnancy, the cervical canal is closed by a mucus plug, the task of which is to prevent bacteria, viruses and other unwanted "guests" from entering the uterine cavity along the ascending paths from the vagina.

Cervical dilatation begins under pressure from the head of the fetus after it descends into the uterine cavity below. Also in this process, special hormones and enzymes are actively involved, and the psychological attitude is of no small importance. Cases are known when, under the action of the fear of childbirth, a woman's neck does not open even after regular labor pains begin.

Disclosure is necessary so that the head of the fetus, and then he himself, can pass through the canal inside the cervix during childbirth. From tightly closed neck as the development of labor pains expands to 10-12 centimeters. This is called full disclosure.. After him, the child begins his journey into this world.

When the cervix is ​​mature, soft, parted and shortened, labor can begin at any minute. If the dates are suitable, and maturation does not occur, the doctors in inpatient setting are engaged in preparing the necks. Even before childbirth, the cervical canal should become softer and more elastic, acquire the shape of a funnel due to the opening of the internal os.

Disclosure mechanisms in women who give birth for the first time, and in women who already have generic experience, are somewhat different from each other.

In women who give birth for the first time, the inner opening of the mouth first opens, and only after that the cervical canal begins to expand. The outer shed remains closed. The wider the channel becomes, the shorter the neck becomes. When the neck is smoothed and no longer comes forward, the outer pharynx is still closed.

Its edges stretch and become thinner. When a woman gives birth, there is a divergence in different directions. Each labor pain increases disclosure.

At home, check the degree of disclosure is absolutely impossible. This is done by the gynecologist during the vaginal examination.But a woman can focus on signs and symptoms that indicate that the process has started.

First of all, this is the appearance of labor contractions - regular, rhythmic, periodic, intensifying as they develop. The mucus plug may come off. It comes out when the cervical canal is already enlarged, either wholly or in parts.. The cork looks like a clot of mucus milky, yellowish in color, may contain blood impurities and blood veinlets, has a jelly-like appearance.

The latent period of contractions, when uterine spasms recur every 30–20 minutes, can last up to 8 hours. In a maternity hospital, a woman in labor should be when the contractions are sure to return every five minutes. With this intensity of uterine contractions, most often the expansion of the external pharynx is about 3-4 centimeters, but all is individual.

In the period of active contractions primiparous giving birth should spend about five hours. The rate of disclosure of the cervix of the reproductive female organ increases, and during this time it opens up to an average of 7-8 centimeters. The final period is transitional. Usually it lasts up to one and a half hours, and the disclosure becomes maximum, complete.

The opening of the neck is controlled by doctors and obstetricians. While the woman is at home, there is no need for control. If the fetal bladder is intact, the vaginal examination will be carried out upon admission to the maternity hospital, and then during the discharge of water and, if necessary, during other periods..

In case of early discharge of water, the condition of the cervix is ​​monitored upon admission to the maternity hospital, and then, without any urgent need for research, they are not carried out with hands and tools so as not to carry an infection into the uterine cavity.

For women who give birth again, the birth canal is usually prepared in advance, the so-called "muscle memory" works. Features of the mechanism of natural expansion are that both the inner and outer necks of the cervix are revealed almost simultaneously. This means that when regular contractions begin, expansion will occur both inside and outside. This feature explains the shortening in time of all generic periods during repeated births.

What happens in the cervix, the doctors will find out on arrival of the patient in the hospital, after a vaginal examination.

Usually, at the end of the term of carrying a baby in multiparous females, the external pharynx is slightly open and can miss the tip of the obstetrician-gynecologist. A cervical examination of the degree of maturity is carried out in the last couple of weeks before the expected date of birth.

Many women who are in an “interesting position” have heard that obstetricians evaluate the degree of neck opening in their fingers. But it is difficult for an average person to understand whose fingers are based on the measurement system and how much it is in centimeters that we are used to.

This is a conventional unit for measuring the degree of cervical dilatation, which is proudly referred to as an obstetric finger. Exists There are only two ways to measure disclosure - make a transvaginal ultrasound and examine the cervix manually. The second method is considered faster, but because it is actively used by midwives around the world.

Examination is carried out as needed in the maternity hospital or in consultation with examinations for long periods of pregnancy.The midwife gently inserts several fingers into the vagina, not counting the thumb, since it is short. The hand should be in a sterile glove, if necessary, the doctor can use medical petroleum jelly.

How many fingers the uterus "will let in", on so much and disclosure is great. The stronger the neck will expand, the more fingers will pass.

That is why, in later periods, doctors often state, in case of a mature cervix, that there is a disclosure on one finger. And in the maternity hospital, where they check the progress of the generic process, they can already inform about 2-3 fingers on admission.

And how much is it in centimeters? According to generally accepted international practice, one conventional obstetric finger is 1.5-2 centimeters.. The error in half a centimeter is due to the different size of the fingers of different health workers.

Thus, when a woman arrives at the maternity hospital with contractions that recur every five minutes, it is most often recorded 2 fingers extension, i.e. the actual extension is approximately 3-4 centimeters, which means that the woman has not yet entered into active fights. Active uterine cramps, repeated every 2-3 minutes, usually lead to an extension of 3-3.5 fingers, which corresponds to 6-7 centimeters.

Full cervical dilatation corresponds to the concept of "more than 4 fingers". There are only four free fingers that can be inserted (minus a large one, as we remember). Therefore, to accurately measure the full disclosure and state that five or seven fingers pass, there is no physical possibility.

Cervical preparation begins if, by the 39-40 week of pregnancy, doctors recognize it as immature or not mature enough. In order to make the appropriate conclusion, one finger method will not be enough.

For the correct conclusions, the Bishop rating system is applied.. It includes several important features that are taken into account during vaginal examination. For each sign is charged from 0 to 2 points. Mature is the neck at 8 points on the Bishop scale.. At the same time, the neck is soft, ready for quicker and easier expansion during labor, the neck is less than a centimeter, the outer jaw misses 1-2 fingers, the neck itself (its contraction ring) is located clearly in the middle, not deviating either to the right or left , neither back nor forward.

If the assessment of the degree of maturation of the cervix is ​​less than 8, preparatory medical events are held.. In this case, the choice of training methods depends on the duration of pregnancy and on the specific number of points.

3-4 points on the Bishop scale - insufficient maturity. If the period of pregnancy allows, a woman can be left alone, because the neck can still ripen itself. 5-8 points gets quite mature neck and her condition does not need correction if there is still a week before delivery.

In-patient training can be of two types - medical and mechanical. Mechanical methods include kelp sticks and a Foley catheter. Medications are usually hormonal drugs - tablets, suppositories, gel for applying directly to the neck. The choice of method is the task of the doctor.

At 38-39 weeks or a little earlier, women are often advised to take "No-Shpu"Since this antispasmodic drug effectively relaxes smooth and round muscles and allows you to speed up the process of smoothing and maturation.

If the cervix does not open and does not soften at 40–41 weeks, doctors take other measures to prepare it for labor.

A medical device that is used for bladder catheterization. Some types of catheter (in particular, catheter No. 18) are used to stimulate labor.

It is a thin latex tube coated with silicone. At the distal end there is a small cartridge. The tube is inserted into the cervical canal through the vagina and the balloon is filled with 10 ml of saline or water. In addition to the uterus, a small amount of saline is injected through the catheter. The balloon, having increased in size, puts pressure on the cervix, due to which its mechanical expansion occurs.

Recently, the method is used infrequently, mainly in cases where other methods are contraindicated for a woman.

Sticks of dried seaweed-laminaria in length are about 6 cm, and their thickness is different - from 3 to 9 mm. What size to choose, the doctor determines, basing his choice on the real state of the neck at the time of the start of preparation.

Sticks injected into the cervical canal. Laminaria tends to expand and increase in volume when in contact with liquid media. The stick in the canal begins to swell, the cervix, as a result, expands mechanically. In addition, algae stimulate the production of prostaglandin F2A. This substance at the biochemical level contributes to a more rapid shortening and smoothing of the neck.

Set sticks on the day. After this time, they can be retrieved. Whether it is necessary to establish new, broader, the doctor decides.

This method is the most popular and frequently used in modern obstetrics. In addition to "No-Shpy," the antispasmodic action of which was described above, can appoint candles "Buscopan" or "Papaverin".

Among the hormonal drugs that are used in the hospital under the supervision of a physician, drugs that belong to estrogens and prostaglandins prevail.

The exact names of drugs, as well as the dosage and frequency of use are selected for each woman individually. The method is considered quite effective.

Problems may occur with the cervix during pregnancy as well as during delivery. It is necessary to tell about possible consequences in more detail that the woman could be guided in a range of different situations.

If shortening and smoothing of the cervix occurs too early, for example, in the second trimester, it is said that there is a functional failure of the cervix - isthmic-cervical insufficiency (ICN).

With these devices, a woman has every chance of bringing the pregnancy to a normal period, while observing all the recommendations of the doctor.

With the onset of labor, the cervix may behave differently, and it is far from always the process takes place exactly as described in courses for expectant mothers or in books for women in childbirth.

Disclosure may be too fast. This creates the prerequisites for rapid delivery. They represent a real danger for the child and mother, because they often end in serious birth injuries. Most often this occurs in women with weakened cervical muscle - giving birth many times, pregnant twins or triplets, with ICN, which was mentioned above.

Preterm labor is often accompanied by an overly rapid opening of the external pharynx. Also, such an anomaly may be a consequence of the stimulation of labor as such.

Another common complication is the primary weakness of the labor forces. When it happens reverse processes - contractions are coordinated, weak or absent, or are present, but the cervix opens very slowly, at an insufficient pace. In this case apply amniotomy - puncture of the fetal bladder, and if this does not help, carry out injections of oxytocin and antispasmodics according to a certain pattern. If this also fails, can hold a manual cervical dilatationbut it is a very painful and traumatic procedure. It is conducted mainly in the event that a woman in this situation flatly refuses the operation of emergency cesarean section.

Problems with disclosure are often experienced by women who give birth at too young ages (under 18), as well as after 37 years, especially if a woman has had a long time after the first birth. The cause of weakness can be a strong fear and muscle clamps arising from it at the psychosomatic level. Primary weakness in those who give birth recurs less frequently than primipara. Also, the problem may lie in the complicated obstetric history, for example, previously made abortions. Often the reason for the lack of proper disclosure lies in hormonal disorders.

A woman who is preparing to become a mother should not miss a routine in the antenatal clinic because it is also important for the timely diagnosis of problems with the cervix. Well in advance you should enroll in courses for expectant mothers and learn the technique of proper breathing in labor and posture to help uncover. This knowledge is very useful in the period of labor.

Not forbidden to have sex, the neck begins to mature faster due to the prostaglandins contained in the sperm. But you should check with the doctor if there are any contraindications to sex.

More on cervical dilatation in labor - in the next video.