Suture placement on the cervix for isthmic-cervical insufficiency. If there are sutures on the cervix Short cervix suturing

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. 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 the sutures are removed from the cervix during a caesarean section, whether it is possible to cut them, how long it lasts 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 some cases, to confirm the ICN, it is necessary special examinations which must be completed from 12 to 25 weeks. How a woman with such a pathology will 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:

1. 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;

1. Presence in the woman’s history of premature labor and spontaneous miscarriages at a long term;
2. 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: If the cervix begins to open prematurely ahead of schedule, the membranes containing the baby may rupture. With a short period of up to 22 weeks, the pregnancy is terminated, and after 28 weeks a child is born ahead of schedule.

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 planned operation, blood testing 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 suturing, pregnancy ends successfully, but cases of its termination due to weakness of the uterine pharynx still occur.

Video: Suture after caesarean section

Video: Scar and suture after cesarean section

The successful course of pregnancy largely depends on the condition of the cervix, which actually holds the baby in the mother’s womb. During the period of intrauterine life of the baby, she fences him off from the outside world and begins to gradually open up only on the eve of childbirth. If pregnancy proceeds without complications, this occurs after 36 weeks. Unfortunately, there are many factors that cause the natural “shutter” to open earlier. In this case, the problem is solved by suturing the cervix during pregnancy.

Premature opening of the uterine pharynx can be triggered by the repeated development of a local inflammatory reaction, repeated births, or a congenital anatomical feature of the organ. All these factors make the muscles that make up the cervix less elastic. Because of this, the pharynx cannot to the fullest realize their obturator function, and this in 40% of cases is a sad prerequisite for premature birth.

The mechanical aspect of the problem is today eliminated surgically: the surgeon “tightens” the woman’s pharynx with special sutures, which prevent opening and give the expectant mother hope for successful outcome carrying a baby.

Suturing the cervix during pregnancy: when medical help is needed

The surgical procedure of suturing is not carried out in all cases, but only when the baby’s life is at stake. The likelihood of such a turn in the development of events increases if in the past a woman has had cases of failed pregnancies, which resulted in premature birth or long-term miscarriages.

The operations are preceded by the following diagnostic measures, like an examination on a gynecological chair and an ultrasound. During the examination using an external transabdominal apparatus, the doctor will be able to determine how the uterus is located, determine the size of its cervix and assess the condition of the internal os.

Stitches on the cervix during pregnancy appear for the following reasons:

1. Opening of the outer side of the cervix.
2. Changes in parameters and density of the cervix.
3. Early divergence of the internal os of the cervix.
4. Information in the medical history about spontaneous termination of pregnancy at a later stage.
5. The presence of scars on the cervix after damage to its tissues during childbirth in the past.

Doctors are in no hurry to take emergency measures in the form of fastening the external pharynx with sutures right away. In some cases, the dangerous position of a pregnant woman can be corrected by applying a pessary. To perform this simple procedure, the patient does not need anesthesia or hospitalization. A pessary is a special plastic or silicone device that is placed on the external pharynx to fix it. However, some anatomical features of the uterus or insufficient muscle tone make the use of a pessary impossible. Then the only solution to the problem is surgery by placing sutures on the cervix.

Features of surgical intervention

The most suitable period of pregnancy for surgery is considered to be from 13 to 22 weeks. Sometimes, due to certain circumstances, the timing shifts slightly, but after the 25th week of the fetus’s intrauterine life, the procedure is no longer relevant. Before the onset of 21 weeks, the uterus and the baby growing in it are not yet strongly compressed cervical canal, and later, when the muscles are very tense and stretched, it is very difficult to carry out the operation.

The procedure for suturing the cervix during pregnancy is preceded by a preparatory period, which takes 2 to 3 days. At this time, the expectant mother is in the hospital, where she is undergoing necessary tests and undergoes examination for ultrasound machine. Overlay Process suture material does not cause any pain to the patient, since the operation is performed under epidural or intravenous anesthesia. The drug with which a woman is put into a state of anesthesia is completely safe for her baby.

The operation takes no more than a quarter of an hour. Surgery occurs through the vagina. Suture material (lavsan or nylon thread high degree strength) are applied using a special needle. How many stitches there will be depends on how much the cervix has dilated. If the tissue attachment turns out to be unreliable, the doctor changes the plan of action and performs laparoscopic surgery. Access to the desired area of ​​the cervix is ​​gained through the abdomen: several small holes are made in it and the tissue that has separated is tightened in the area as close as possible to the pharynx.

There are several ways to apply sutures. Which option the surgeon will use depends on the degree of dilation and the patient’s medical history:

1. Applying sutures to the external os. The procedure is aimed at connecting the anterior and posterior edges of the cervix to each other. Contraindications for this type surgical intervention considered cervical ectopia. Moreover, after such an operation, there is also some risk to the health of the pregnant woman: the uterus actually turns into a closed space, where with a high degree of probability it can develop infectious process. To prevent this from happening, the expectant mother is prescribed a comprehensive course of antibiotic treatment in the preparatory period before surgery.
2. Applying sutures to the internal os. This method is safer when we're talking about about the risk of infection in a pregnant woman. By suturing the internal pharynx, the doctor leaves a small drainage hole in the cervical canal, which reduces the likelihood of developing negative consequences in the postoperative period.

How is the postoperative period going?

After the operation, the expectant mother remains under the supervision of doctors for some time (from 3 to 7 days). At this time, she is prescribed antibacterial and antispasmodic drugs, and the sutures are lubricated with a special disinfectant. In general, all women tolerate cervical suturing surgery well during pregnancy. For several days after the intervention, the pregnant woman does not feel too much severe pain in the lower abdomen. After suturing the cervix during pregnancy, discharge in the form of ichor is considered normal. This goes away within a few days after surgery without any special treatment.

The next day after suturing, the patient is given bed rest - she cannot sit. After some time, the expectant mother can calmly return to her usual way of life, making sure to pay attention to the daily routine and sufficient rest (at night and short-term during the day). Pregnancy with stitches on the cervix obliges the expectant mother to treat herself very carefully:

1. All physical activity at this time are maximally limited, and intimate relationships With a loved one, it is better to postpone it until the birth of the child.
2. Of no small importance for the successful course of pregnancy in such conditions is the correct and healthy eating, which promotes regular bowel cleansing and is effective prevention constipation To feel good, the expectant mother should give preference to fresh fruits and vegetables, limit the consumption of flour, fatty and sweet foods.
3. Regular consumption of dried fruits will not only make the intestines work like clockwork, but will also saturate the pregnant woman’s body with valuable microelements. You can prepare compotes, desserts and meat dishes using dried fruits.

In order to monitor the condition of the cervix and prudently suppress the possible development of infectious inflammation, a woman who has undergone surgery to suture the pharynx should visit the doctor more often than the usual pregnancy management program. Each time, the gynecologist not only examines the suture, but also takes a smear from the vagina to analyze the condition of the flora. If necessary, the expectant mother will be prescribed medications whose tocolytic effect prevents the premature onset of labor.

Removing stitches from the cervix during pregnancy

When the pregnancy reaches 36–37 weeks, the expectant mother with stitches on the cervix should be under medical supervision in a hospital setting. An ultrasound control procedure will help determine the degree of development of the fetus and understand how ready it is to be born. The stitches are removed at 37 weeks, and it is not uncommon for the baby to be born on the same day. The threads are removed without an anesthetic injection, since the procedure does not require much time and does not cause pain to the woman.

If measures to prolong pregnancy still turn out to be insufficiently effective, and premature labor activity begins to develop rapidly, the suture material from the cervix is ​​removed in urgently. If this is not done on time, strong threads will damage the edges of the pharynx, which will significantly complicate the course of labor and have a very negative impact on future pregnancies.

Complications after suturing the cervix during pregnancy

The main risks after surgery are: possible development inflammation and the appearance of increased muscle tone of the uterus.

Inflammation can have different origins. In some cases, it is caused by an internal infection, and sometimes the body reacts in a similar way to the material of the thread that held the tissue of the cervix together. In this case, due to aseptic inflammation or allergies, a pregnant woman may observe discharge of different shades and consistency. A pregnant woman can avoid such troubles if she regularly visits her doctor, takes tests to monitor vaginal flora and carefully follows the rules of intimate hygiene.

Development of uterine hypertonicity female body may react to contact between suture material and living tissue. In this case, it often occurs mechanical irritation the area of ​​the cervix on which the operation was performed. This is what is associated with post-operative nagging pain in the lower abdomen, which soon disappears on its own. If discomfort persist for a long time, a pregnant woman should definitely inform her gynecologist about this. Most often, the problem of increased uterine tension is solved by taking gentle sedatives, good rest and a balanced diet.

During treatment expectant mother Doctors must determine the cause of premature cervical divergence. If the pathology is caused by hormonal factors or the influence of certain chronic diseases, the woman is referred for examination to specialized doctors.

Suturing the cervix during pregnancy: contraindications

A surgical solution to the problem of cervical divergence is impossible if the pregnant woman has other complications that not only put her at risk of miscarriage, but also pose a danger to her own life.

Among absolute contraindications To suturing the cervix during pregnancy, we note:

1. Severe leaks chronic diseases that have worsened due to pregnancy (for example, heart or liver disease).
2. Intrauterine death of a child or frozen pregnancy.
3. Bleeding prone to recurrence.
4. Confirmed diagnostic methods anomalies intrauterine development child.
5. High excitability of the uterus, which cannot be suppressed with medication.
6. Sluggish inflammation of the genital organs.

If suturing is contraindicated for a pregnant woman or the problem of a prematurely opening cervix was diagnosed too late (after the 25th week of pregnancy), the situation is corrected with the help of an obstetric pessary. The material for the manufacture of this specific device is hypoallergenic plastic. The device has a shape that not only compresses the edges of the cervix, but also, like a bandage, partially relieves the load from amniotic sac and internal organs.

Underlying the vast majority of cases premature birth And spontaneous interruption Pregnancies are associated with pathologies of cervical development. The technique of suturing this organ allows the woman to continue the pregnancy and wait for its successful resolution.

How to behave if there is a threat of miscarriage. Video

Content

The success of pregnancy largely depends on the condition of the cervix - this organ holds the fetus in the womb and protects the child from negative influences external factors. If the pharynx begins to open ahead of schedule, the doctor will advise stitches - this manipulation is safe for mother and baby.

In what cases is it carried out?

Premature opening of the internal os of the uterus (isthmic-cervical insufficiency) occurs due to an imbalance in the cervix of such components as muscular and connective tissue. As a result, the cervix cannot fully perform its mechanical supporting functions. As a rule, such an organ structure is due to heredity or is the result of pathological processes.

Most often, the pathology develops when repeated births, after surgical interventions, scar deformation, if present inflammatory processes. The problem is eliminated by applying sutures, which allows the fetus to bear normally.

Isthmic-cervical insufficiency can develop against the background of hyperandrogenism; in such cases, the uterus of a pregnant woman is in hypertonicity, which leads to gradual opening. Treatment of hyperandrogenism and ICI during pregnancy is accompanied not only by suturing, but also hormonal therapy, aimed at reducing the production of male sex hormones.

Suturing the cervix - the main indications for ICN:

• threat to the life of the child, especially if the woman has a history of miscarriages and premature births;
• the length of the cervix for up to 20 weeks is 2.5 cm;
• opening of the internal pharynx;
• scars on the neck.

ICNs can accompany constant pain pulling character V lower area belly, lumbar region, presence of discharge mixed with blood and mucus.

Suturing is a last resort; first, doctors recommend installing a pessary, with which the position of the cervix is ​​fixed. But if such manipulations do not bring the desired therapeutic effect, surgical intervention in the form of suturing is required.

What types are used

If no complications arise, the procedure for suturing the cervix takes approximately 15–20 minutes, the operation is performed under general anesthesia, through the vagina, high-strength threads made of nylon or lavsan are used to fasten the pharynx.

Basic techniques:

• method B. Scendi - the external pharynx is completely sutured;
• circular seam;
• Mac Donald method - suturing is carried out on the internal pharynx, which is narrowed. The method of A. I Lyubimova, N. M. Mamedalieva are also types of narrowing of the internal pharynx. During the operation, the internal os is corrected by placing a U-shaped suture on the cervix; this technique is considered the most gentle and effective.

During suturing of the cervix There is no discomfort for a pregnant woman - epidural or intravenous anesthesia is given before the operation.

Contraindications and possible complications

Before the operation, the woman must undergo full examination– examination by a gynecologist, microbiological examination of vaginal and cervical discharge, ultrasound of the cervix, general analysis urine and blood biochemistry. Based on the results obtained, the doctor makes a conclusion about the possibility of suturing.

In what cases is suturing contraindicated:

• infectious pathologies, acute inflammatory processes in the cervical canal, vagina;
• recurrent bleeding;
• serious cardiac, renal, liver pathologies;
• increased uterine tone, which cannot be eliminated with medications;
• pronounced opening of the internal os, into which the amniotic sac prolapses;
• cervical length less than 20 mm;
• developmental anomalies or intrauterine fetal death;
• violation of the integrity of the fetal bladder.

The main complications after suturing are the development of inflammatory processes, increased muscle tone of the uterus, rupture of the walls of the amniotic sac, suture dehiscence, discomfort in the pelvis and lower back.

Most suitable period for fastening the walls of the throat– 13–22 weeks, the dates may be slightly shifted, but after 25 weeks surgery inappropriate.

How is the recovery period going?

To reduce the risk of complications after surgery, a woman should stay in the hospital for 5–7 days, she is prescribed antibiotics, antispasmodics, and the vagina is treated antiseptic solutions. For several days, a pregnant woman may be bothered by pain in the lower abdomen and the discharge of ichor - such phenomena are not considered pathological and most often go away on their own.

On the first day after surgery, strict bed rest is indicated; in the future, the woman will have to pay increased attention to nutrition and daily routine in order to avoid complications. The stitches are removed at 37 weeks.

What you can and cannot do after suturing:

• Do not lift heavy objects;
• Doctors recommend abstaining from sexual intercourse until childbirth;
• proper nutrition should be aimed at preventing constipation - the diet should contain more vegetables and fruits, the amount of sweets, fatty foods, baking should be limited;
• Eating dried fruits regularly will help normalize stools and saturate the body with all the necessary microelements.

After surgery, a woman needs to promptly treat all emerging diseases, avoid stress, and follow hygiene rules.

Stitching on uterine cervix– safe and effective way maintaining pregnancy with premature opening of the pharynx. Most women tolerate the operation well, complications rarely occur, you just need to strictly follow all the doctor’s instructions.

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1. Place the woman on the gynecological chair.

2. Do a bimanual examination.

3. Treat the external genitalia and vagina with an antiseptic solution.

4. Pain relief is individual, depending on the psycho-emotional state of the woman.

5. Expose the cervix in the speculum.

6. Fix each lip with bullet forceps and pull it anteriorly and downward (do not remove the mirror and lift!).

7. At the border of the transition of the mucous membrane of the anterior fornix of the vagina and the cervix, 0.5 cm from the midline to the right, the cervix is ​​pierced with a needle with a Mylar thread through the entire thickness with a puncture in the posterior fornix, then the end of the thread is transferred to the lateral fornix on the left, pierced with a needle mucous membrane and part of the thickness of the cervix with a puncture in the anterior fornix on the left at the level of the first puncture (do not cross the cervical canal!). The ends of the thread are held on a clamp.

8. The second lavsan thread is also passed through the entire thickness of the cervix, departing 0.5 cm from the midline to the left and 0.5 cm above the previous injection, the end of the second lavsan thread is transferred to the lateral fornix on the right, the mucous membrane and part of the thickness of the cervix are pierced with a puncture in the anterior arch.

9. The ends of the threads are tightened and tied with three knots in the anterior arch.

10. Insert a dry tampon into the vagina for 4-6 hours.

11. Remove tools.

12. Transport to a bed in a supine position.

Management in the postoperative period

1. Bed rest for 2 weeks.

2. Uterine tocolysis (Table 1).

Table 1

Uterine tocolysis

Preparation	Dose, method and regimen. Reagents	Start of treatment (weeks)	Duration of treatment I
Ethanol Alupent Bricanil Bricanil Partusisten Partusisten Magnesia sulfate Magnesia sulfate	10% sterile solution in isotonic sodium chloride solution or pyrogen-free water - 8-10 drops. In 1 min. within 4-6 hours in a quantity of 150-250 ml intravenously 1 ml in 250 ml of physiological sodium chloride solution or 5% glucose solution - 8-10 drops/min. over 4-6 hours intravenously 0.05 in 250 ml of physiological sodium chloride solution intravenously 8-10 drops/min. within 4-12 hours. Then 0.5 mg intramuscularly after 6 hours After eliminating the threat of interruption, according to clinical data, 5 mg in the table. After 6 hours with a gradual dose reduction (withdrawal syndrome!) 0.5 mg in 250 ml of 5% glucose intravenously 8-10 drops. per minute within 4-6 hours 1 table (5 mg) - 4-8 tablets per day, gradually reducing to 3-4 tablets per day 10 ml of 25% solution intramuscularly + 2-6 ml of 0.5% solution of novocaine x 2 times a day Electrophoresis according to Stepanyants	from 14 From 14-16 From 14-16 From 23-24 From 23-24	until pain and contractions stop 1 time 4-6 days 10-14 days Until the pain and contractions stop Up to 10 days 7-10 days 7-10 sessions