Cough

Suturing the cervix during pregnancy. Suturing the cervix - the path to a successful pregnancy Does it hurt to put stitches on the cervix?

At week 17, the cervix was sutured (there was a miscarriage in the past at this stage, dynamic shortening of the cervix and opening of the internal os). I re-read everything on the site about ICN and suturing, and about tocolytic therapy. But there remain a number of questions regarding which (due to great experiences) I would very much like to receive an additional answer. (The brains give in to panic when they are worried).

Do I understand correctly that after stitching:

1) there is no particular point in lying down, because according to research this does not affect the situation (except for multiple births)

2) there is no point in any tocolytics, because there are no effective ones anyway (or are there some that are still justified?). Do I need to take any special pills after stitching?

3) is it necessary to inject - take antibiotics immediately after stitching? How many days? (It’s not healthy for a child, so it worries me a lot, I’ve been injected for 5 days now)

4) do the seams need to be rehabilitated? If yes, how often? Only immediately after application for a couple of days or then too?

5) is it true that the tone of the uterus during sutures is not dangerous, because whether it was tone at all was unknown (it is often misdiagnosed on ultrasound) and it is not a constant phenomenon. In addition, in fear, fighting tone is a useless way, since this is what it appears from. Is this correct? If not, then what about the tone at the sutures? How should we approach this issue? Is he dangerous at all?

6) Do I understand correctly that after suturing, smears and examinations in a chair and ultrasound are recommended every 2 weeks? What exactly is being checked during these procedures? The strokes are still somewhat clear, but the rest is not so good. On smears, they look primarily at leukocytes, right?

7) and in light of the question above: what dynamics of the length of the neck and the opening of the internal pharynx should be after suturing (ultrasound)? Should everything lengthen and close? How fast? What if it shortens and opens further? Or is this an unimportant factor? Why then regular ultrasounds?

I beg your pardon for the number of questions, but I know the official answers of traditional gynecologists to them (even many options), but I don’t really trust them, because no one can really explain anything and they prescribe “because”. At the same time, sometimes even I can understand that the logic in the answers is broken and the person most likely does not understand what he is talking about. I got myself into trouble with this.

Dear girls:) For 3 years I’ve been here honestly answering questions about poop, colostrum, breastfeeding, threats, who’s age, whether the dress is good and whether the world will end. I understand that it’s more interesting to discuss mothers-in-law and fights on platforms, I’m a sinner myself, but now I kindly ask everyone who is “in the know” to respond to a question that’s very important to me important question.

During my first pregnancy I had ICI - isthmic-cervical insufficiency, which is when the cervix softens, shortens and tends to open long before the due date. They discovered it at 9 weeks, kept it until 18, and put a ring on it. This time, everything I drank and did to prevent the diagnosis, at 19 weeks my cervix was just beautiful - 37 mm, but yesterday, at 23 weeks, it was already 26. And it needs to be corrected in any case.

All four of me are in favor of a ring or a pessary, but the doctor (paid, I haven’t gone to a consultation yet and don’t want to yet) suggests stitches on the cervix. The argument is my symphysitis (symphysitis is inflammation of the symphysis pubis, separation of the pubic bones, it is painful and it threatens to rupture the symphysis during childbirth, which is what I had last time). He says that the ring will put pressure on the bones, and they will diverge even more.

So - attention - question!

Who had cervical stitches stitched - was a ring offered as an alternative? Have you asked yourself? What were the arguments for the stitches? Or simply no one mentioned rings and pessaries, and you didn’t know?

Who had the ring put on - were there any complications from the pelvis or pubic symphysis? Was it painful to put it on? On the forum I read the opinion of girls (not doctors) that it hurts especially those who have symphysitis. It hurt me the first time.

The experience of friends and relatives is also suitable if the information is reliable, and not “my mother’s friend said about the daughter-in-law of her godfather’s brother.”

Below is background information for those who are interested:

Obstetric pessary

An obstetric pessary is a small plastic or silicone medical device that is inserted into the vagina to hold the uterus in a certain position. An obstetric pessary is used in obstetrics for the prevention premature birth in pregnant women with isthmic-cervical insufficiency (ICI) and to prevent the development of this pathology. The effectiveness of this method of correcting ICI is 85%. The obstetric unloading pessary has been used in a number of countries (Germany, France) for more than 30 years, in the CIS countries (Russia, Belarus, Ukraine) for more than 18 years.

Mechanism of action of the obstetric pessary

The mechanism of action of the obstetric unloading pessary is based on reducing the load on the cervix due to a decrease in pressure ovum.

Indications for use of an obstetric pessary

functional and organic isthmic-cervical insufficiency;
prevention of isthmic-cervical insufficiency in pregnant women;
prevention of suture failure during surgical correction ICN.

Obstetric pessary

Meyer ring

Suturing the cervix

Indication The progression of ICI leads to surgical treatment: changes in the consistency and shortening of the cervix, a gradual increase (“gaping”) of the external pharynx and opening of the internal pharynx.

Contraindications For surgical treatment of ICI in pregnant women, the following are considered: diseases and pathological conditions that are a contraindication to continuing pregnancy (severe forms of diseases cardiovascular system, liver, kidney, infectious, mental and genetic diseases), symptoms of threat of interruption, birth defects fetal development, non-developing pregnancy, III-IV degree of purity of the vaginal flora, the presence of pathogenic microflora in the discharge of the cervical canal. B 2 recent cases preliminary sanitation of the genital tract is necessary.

At the 17th Congress of the International Federation of Obstetricians and Gynecologists (FIGO), surgical correction of ICI was recognized as the most effective for prolonging pregnancy by applying a circular suture in the area of the internal os using the Shirodkar method (the suture is almost completely immersed in the mucous membrane of the cervix). If a caesarean section is performed, the suture is usually not removed.

The second method of suturing the neck is the Mac Donald method - a simple procedure that involves less blood loss and is less traumatic for the neck compared to the Shirodkar method. A simple purse-string suture is placed on the cervix.

Suturing the cervix for ICN

Recurrent inflammatory processes, repeated births or congenital anatomical features impair the plasticity of the cervical muscles.

At the same time, the cervix does not sufficiently perform its obturator functions, which is the cause of almost 40% of cases.

Surgical intervention allows you to solve the mechanical side of the problem: sutures are placed on the cervix to prevent dilation and allow you to carry the pregnancy to term (in the absence of other serious pathological factors).

Suturing is a last resort and is carried out only if necessary. The reason for the examination will be failed previous pregnancies that ended in late miscarriage or premature birth.

The first stage of the examination will be a diagnostic obstetric examination, followed by an ultrasound examination.

Ultrasound with an external transabdominal sensor allows you to determine the position of the uterus and assess the condition of the internal pharynx.

Indications for suturing the cervix during pregnancy are:

opening of the external pharynx
progressive changes in the size and consistency of the cervix
early opening of the internal os
history of miscarriages in the 2nd-3rd trimester
scars on the cervix after ruptures in previous births

Doctors are not always in a hurry to send a woman to the operating room. In some cases, a simpler measure that does not require anesthesia or hospitalization also helps: this.

A special device made of plastic or silicone is placed on the cervix, preventing it from dilating. But with some anatomical features uterus or muscle weakness, a pessary will not help. In this case, suturing surgery is prescribed.

Technique for suturing surgery

The optimal time for surgical correction is from 15 to 21 weeks of pregnancy.

During this period, the fetus and uterus do not yet exert very strong pressure on the cervical canal, and it will be much more difficult to perform surgery later, on tense, stretched muscles.

The technique of suturing the cervix was developed by an Indian surgeon half a century ago.

The operation to suture the cervix is painless.

The point is that this procedure performed in a hospital setting using epidural or intravenous anesthesia. The anesthetic drug and its dosage are selected taking into account the period and condition of the pregnant woman and are safe for the fetus. The operation lasts only 15 minutes; a suture is placed on the cervix with dense lavsan or nylon threads.

Depending on the condition of the cervix, the doctor sutures the external or internal os.

Suturing the external pharynx.

The operation of suturing the external pharynx, called the Czendi method, consists of stitching together the anterior and posterior edges of the cervix. However, in case of cervical erosion, surgery on the external os is not indicated.

In addition, the result of suturing will be the formation of a closed space in the uterus, and this is a favorable environment for development hidden infections.

To avoid such complications, a woman is prescribed antibacterial therapy at the stage of preparation for surgery. But this measure is not always effective enough.

Suturing the internal pharynx.

Suturing the internal pharynx allows you to leave cervical canal hole for drainage, which means the risk of infections is reduced. Sutures on the cervix (on the internal os) can be applied in various ways: circular or circular purse-string suture, suture with the letter P. The choice of suture technique remains with the specialist performing the operation.

Another method of surgical correction has been developed: creating muscle duplication on the walls of the cervix. This is the most physiological method, but it is more difficult to perform and will require an increase in anesthesia time, so it is not widely used.

After the operation, the woman must remain in the hospital under the supervision of doctors for several days.

Usually during this period antispasmodic drugs are prescribed to reduce the tone of the uterus. If necessary, antibacterial therapy is also prescribed. The vagina and cervix are treated with disinfectant solutions.

Postoperative period

Depending on the woman’s condition and concomitant pathologies, a pregnant woman can remain in the hospital from 3-5 days to several weeks.

You cannot sit for the first day after surgery.

In the future, there are usually no serious restrictions, but the woman must follow the regime, have enough time for sleep, limit physical activity, do not lift heavy objects, sexual rest is recommended.

All of these measures are aimed at avoiding uterine tone. Muscle tension can cause the suture thread to cut through, a serious complication.

Attention should be paid proper nutrition and regular bowel movements. Since pushing is prohibited, constipation must be avoided. A woman should use sufficient quantity fresh vegetables, limit flour products.

Dried fruits have a good effect; they can be added to compotes, desserts and even meat dishes. They not only diversify the diet and help the intestines work, but are also an excellent source of microelements necessary expectant mother and the baby.

To monitor the condition of the suture and prevent the development of infections, a woman should attend a consultation more often than provided for in the normal pregnancy calendar.

The doctor monitors the condition of the suture and the cervix, and always takes a smear for the flora. If necessary, tocolytic drugs are prescribed or their dose is adjusted.

At 35-37 weeks, the woman is admitted to the hospital. the size of the fetus and its readiness for birth will be determined. At 37 weeks, the sutures are removed and labor can begin on the same day.

Removal of sutures from the cervix occurs without anesthesia. This is a quick and uncomplicated procedure.

If, despite all measures to preserve pregnancy, labor begins suddenly and ahead of schedule, then the seams are removed in urgently. Otherwise suture material can severely damage the edge of the cervix, which will further complicate subsequent pregnancies.

Possible complications

The main complications of surgery to suture the uterus can be called inflammatory process and increased uterine tone.

Inflammatory processes can be either a consequence of a developed internal infection or the body’s reaction to the suture material (aseptic inflammation or allergic reaction). In this case, after suturing, discharge may occur different colors and consistency.

To avoid such troubles, you need to regularly visit a doctor, get tested for vaginal flora, and be more careful about intimate hygiene.

It is made of hypoallergenic plastic and has special form, thanks to which not only the edges of the cervix close, but also the load from the walls is reduced amniotic sac And internal organs. Thus, the pessary also serves as a bandage.

When installing a pessary, as well as when applying sutures, the likelihood of infection or rejection of the material increases. In addition, it is less effective than sutures for some anatomical pathologies. But at the same time, the installation of a pessary is painless and does not require anesthesia or hospitalization, which is a big advantage of this technique.

Protective measures also help to carry the pregnancy to term. In particular, bed rest, sometimes with the foot edge of the bed raised. This position allows you to reduce the load on the cervix.

Cervical pathologies are the cause of most premature births or miscarriages in the 2nd trimester. Compliance with all medical prescriptions will allow a woman to carry her pregnancy to term. Don't be afraid of surgery!

The surgical technique has been well developed, and safe doses of anesthesia for the fetus have been calculated. For many women, timely sutures placed on the uterus gave them the joy of motherhood.

During pregnancy, the cervix of the reproductive organ holds the fetus inside the mother's body and closer to the due date it gradually opens. In some cases, this process begins much earlier, when the child is not yet ready to exist outside the womb. This pathological condition of the uterus is called isthmic-cervical insufficiency (ICI) and is considered one of the main causes of miscarriages and premature labor activity. A caesarean section is performed if there are certain indications, and one of them is considered to be incompetence of the uterine muscles. Many mothers are concerned about the question of when to remove the sutures from the cervix during caesarean section, is it possible to cut them, how long does it take? recovery period after the operation and can such an operation affect life in the future?

During pregnancy, the cervix of the reproductive organ is a kind of closure, thanks to which the child is held inside the mother’s body. In some situations, there is an increased risk that it may open prematurely in a pregnant woman. In order to prevent such a pathological condition, a woman undergoes an operation - tightening the neck of the reproductive organ with sutures.

There are several reasons that can provoke dilatation of the cervix, and if identified, the doctor will decide to apply sutures. In some patients, the tissues of the cervix of the reproductive organ are too weak and this is due to their genetic feature body. As the unborn child grows, the load on the tissues and certain moment they may simply not be able to cope with it.

The risk of cervical dilatation also increases in those women who have an irregularly shaped organ, so during pregnancy they are warned about their condition. The cause of ICI is often damage to the reproductive organ, its changes hormonal levels female body. Those expectant mothers who have already encountered problems during a previous pregnancy should be attentive to their health. Put correct diagnosis and it is possible to identify such a pathology after a vaginal examination by a gynecologist and an ultrasound scan. IN in some cases To confirm ICI, special examinations are required, which must be completed from 12 to 25 weeks. How will a woman with such a pathology give birth? naturally or by caesarean section is determined only by the doctor.

Surgical treatment of ICI in expectant mothers is usually used in following cases:

Detection in the patient after gynecological examination and ultrasound of the following pathological conditions body:

incompetent cervix of the reproductive organ;
softening and shortening of the uterine pharynx;
opening of the cervical canal or internal pharynx by 20-30 mm;

Presence in the woman’s history of premature labor and spontaneous miscarriages at a long term;
The patient is pregnant with twins.

In some cases, suturing the cervix will have to be abandoned, since there are some contraindications to such an operation:

detection of developmental defects in fetuses;
pregnancy, which is complicated by bleeding;
suspicion of frozen pregnancy;
increased excitability reproductive organ, which cannot be eliminated with the help of medications;
complicated somatic pathologies in which further continuation of pregnancy is simply impossible;
genitals;
pathogenic microflora in the cervical canal.

Important: In the event that the cervix begins to open prematurely due date, then the membranes in which the child is located may rupture. With a short period of up to 22 weeks, the pregnancy is terminated, and after 28 weeks the baby is born prematurely.

The procedure for suturing the neck is carried out in inpatient conditions. After a woman's admission to medical institution Over the course of several days, specialists carry out some preparatory procedures before surgery:

relieving tension in the reproductive organ using tocolytic treatment;
vaginal sanitation using antibiotics.

Immediately before the elective surgery blood work is prescribed. In addition, it is shown general research urine and a smear to determine the sensitivity of microflora to antibiotics, and if indicated, an ultrasound is performed.

The operation of suturing the cervix of the genital organ can be carried out in the following ways:

Suturing the external pharynx. IN medical practice A widely used method involves joining the posterior and anterior lips of the uterine pharynx using silk or kengut threads. However, suturing the reproductive organ in this way can negatively affect the course of pregnancy. The fact is that during the operation a closed space is formed, which can provoke an exacerbation of hidden infections. In addition, such suturing is considered ineffective if the expectant mother has a pathology such as.
Mechanical narrowing of the internal os of the reproductive organ. This method of suturing is most often used in medical practice, since it is considered the most favorable. The peculiarity of this operation lies in the fact that after it is performed, a hole for drainage is left in the cervical canal. Suturing of the cervix of the reproductive organ can be carried out according to MacDonald, that is, the woman is given a circular purse-string suture. Besides this surgical treatment often performed according to the method of Lyubimova and Mamedalieva.

The suturing procedure lasts about 10-15 minutes, and during the procedure the patient is under anesthesia, so she is not in pain at all. After the operation, the patient may complain that the lower abdomen is severe, and small spotting, which usually disappear after a few days without special treatment.

Indications for suture removal

Prevention of ICN

If ICI is detected while expecting a child, then when planning your next pregnancy, you must definitely seek advice from a gynecologist. He examines the woman and, based on the results obtained, prescribes the patient necessary treatment.

When a woman is diagnosed with ICI, there is no need to be upset, since today such a pathology can be successfully treated. To do this, it is necessary to comply with the treatment regimen and maintain psychological attitude, which will allow you to carry your baby to term and have a successful birth. Caesarean birth is used for certain indications and is considered quite complex operation. For quick recovery You must follow all doctor’s recommendations and take care of yourself.

Many women claim that they were able to successfully carry their child to term while following all the doctor’s recommendations. Usually, with timely sutures, pregnancy ends successfully, but cases of its termination due to weakness of the uterine pharynx still occur.