ILI during pregnancy

Normally, the muscle fibers of the cervix during pregnancy are closed in a tight ring, relaxing gradually as the term of delivery approaches. In the event that this occurs prematurely, the cervix begins to shorten and unfold. In this situation, they talk about the development of ischemic-cervical insufficiency (ICI). This disorder occurs in about 1-9% of pregnant women, including 15-40% of them suffer from habitual miscarriages, i.e. 2 and more previous pregnancies ended in miscarriage.

ILI during pregnancy leads to an expansion of the uterine neck, as a result of which the fetal bladder falls, which ends with its opening. Further, labor activity develops, which leads to late miscarriage or premature birth.

Why does the ICI occur?

The main causes that lead to the development of ICI during pregnancy are:

• trauma of the cervix (tears, injuries) during previous births or with the artificial termination of pregnancy;
• abnormalities in the development of reproductive organs;
• functional changes in connective tissue dysplasia, hyperandrogenia, and deficiency of sex hormones;
• carrying out IVF;
• multiple fetus, polyhydramnios, large fetus.

What are the main signs of the NIH?

Symptoms of ICI during pregnancy are hidden in most cases, therefore it is rather difficult to determine the presence of the disease of a pregnant woman on their own. So at the initial stage of bearing a fetus (1 trimester) they are completely absent. Later, when it would seem normal for the current pregnancy, future mothers note the appearance of such signs of ICI:

• the appearance of a small amount of spotting;
• the appearance of mucous discharge with blood veins;
• pain in the lumbar region of the back and in the lower abdomen;
• the appearance of a feeling of "raspiraniya" in the vagina.

However, in most cases, as already mentioned, the disease is asymptomatic, and to diagnose the ICI during pregnancy, the doctor performs an examination of the cervix with the help of mirrors, as well as using an ultrasound machine.

Thus, with palpation of the cervical canal of the uterus, the gynecologist can detect a significant softening of the uterus, as well as a shortening of the length of the cervix, and the opening of its canal through which the fetal bladder is seen. In view of the fact that in primiparous women the external pharynx can be closed, the diagnosis is confirmed by ultrasound using a transvaginal sensor. The following criteria are taken into account:

1. The length of the cervix. At 24-28 weeks it is equal to 35-45 mm, and after 32 weeks of pregnancy - 30-35. If in 20-30 weeks its length is less than 25 mm, then they speak about the development of the ICI.
2. The presence of V-shaped opening of the internal pharynx.

How is the ICI treated?

In total, there are 2 ways of treating the ICI during pregnancy:

• surgical;
• conservative.

The first is the application of sutures to the cervical part of the uterus. At the same time, the inner throat of the uterus is mechanically narrowed and the external uterus is sewn, which significantly reduces the likelihood of premature birth. The timing of such an operation is set individually, but in order to avoid the progress of the process, doctors try to perform the operation for up to 17 weeks if the violation is detected at the beginning of pregnancy, but not later than 28 weeks.

Conservative way is to install obstetric pessary (Meyer's ring). This kind of device redistributes the weight of the fetus and helps the cervix retain it. Installation of pessaries is effective only if it is suspected of an NIH or in its early stages. With severe symptoms, this method is used, rather, as an auxiliary.