The cervix is not just the entrance to the uterine cavity. The elastic and elastic neck (the cervical canal in it) protects the developing fetus from infections and, closing tightly, holds it until the moment of birth. Normally, the cervix is closed, but softens and opens slightly by the 37th week, when the woman’s body is preparing for childbirth.
Short cervix - diagnosis and risks at different stages of pregnancy
Unfortunately, the pregnancy period does not always go smoothly and without problems. A very common cause of miscarriage and spontaneous abortion or premature birth is a pathologically short cervix, or isthmic-cervical insufficiency.
The reasons that cause this pathology are:
- Progesterone deficiency.
- Injuries to the cervix after operations on it, conization, abortion or previous births.
- Changes in the structure of cervical tissue as a result of hormonal changes in the body.
- Psychogenic factors – fears and stress.
- Infectious and inflammatory diseases of the pelvic organs and directly of the uterus and cervix, which lead to tissue deformation and scarring.
- Changes caused by uterine bleeding.
- Individual anatomical and physiological characteristics of the expectant mother’s body.
Measuring the length of the cervix during pregnancy is very important, because this will allow timely detection of pathology and take measures to prevent miscarriage.
As a rule, ICI is accurately diagnosed in the second half of pregnancy, when the fetus is already large.
- At a gynecological examination The obstetrician-gynecologist evaluates the condition of the cervix, the size of the external os, the presence and nature of the discharge. Normally, the cervix in the first weeks of pregnancy is dense, has a posterior deviation, the external pharynx is closed and does not allow a finger to pass through.
- To diagnose a pathologically shortened cervix, it is prescribed (with a transvaginal sensor - in the early stages of pregnancy, transabdominal - in the second half of pregnancy). The study involves performing cervicometry, that is, measuring the length of the cervix. According to the data received, the issue of methods that will help maintain pregnancy is being decided - a suture on the cervix or the installation of an obstetric pessary.
Cervical length during pregnancy - table of norms by week
Norms for cervical length can be found from the table data:
An ultrasound examination also determines the degree of maturity of the cervix, and the result is assessed in points.
Table of signs of cervical maturity
| Sign | Point 0 | Point 1 | Point 2 |
| Consistency of the cervix | Dense structure | Soft, compacted in the area of the internal pharynx | Soft |
| Cervical length and smoothness | More than 20 mm | 10-20 mm | Less than 10 mm or smoothed |
| Patency of the cervical canal | The external pharynx is closed, allowing the tip of the finger to pass through | 1 finger can pass into the cervical canal, but the internal os is closed | 2 or more fingers pass into the cervical canal (with a smoothed cervix) |
| Cervical position | Posteriorly | Anterior | In the middle |
Survey results are assessed in this way (the points obtained for the characteristics are summed up):
- From 0 to 3 points– immature cervix
- From 4 to 6 points– insufficiently mature cervix, or ripening
- From 7 to 10 points– mature cervix
Until 37 weeks, the cervix is normally immature, and enters a mature state before childbirth. It should be noted that cervical immaturity in the last weeks of pregnancy - this is a pathology opposite to ICI, and it also requires observation and correction, up to the choice of the method of delivery by cesarean section.
If the length of the cervix is within the normal range , but there are signs of the onset of premature labor, it is necessary to perform another ultrasound. Which will help accurately diagnose ICN if it is present.
Shortening of the cervix before childbirth - what to do and how to treat?
Shortening of the cervix, diagnosed between 14 and 24 weeks, indicates a clear risk of premature birth and requires urgent correction.
- If during this period the length of the cervix is less than 1 cm , the baby will be born at 32 weeks of pregnancy.
- If from 1.5 to 1 cm , the baby will be born at 33 weeks of pregnancy.
- Cervical length less than 2 cm indicates that birth can occur at 34 weeks of pregnancy.
- Cervical length from 2.5 cm to 2 cm - a sign that the baby is likely to be born at 36 weeks of pregnancy.
If the expectant mother is diagnosed with a shortened cervix , then treatment will be offered, taking into account the degree of shortening and duration of pregnancy:
- Conservative therapy with tocolytic drugs, progesterone . Treatment is performed in a hospital.
- Cervical cerclage , that is, suturing. Stitches are removed before birth.
- Placement of an obstetric pessary – a rubber uterine ring that relieves the cervix and eliminates its stretching.
- Reduce physical activity. Avoid activities that increase pressure on the abdominal area.
- Refuse sexual activity until childbirth.
- Take natural sedatives - for example, tinctures of motherwort or valerian.
- Take antispasmodic medications prescribed by your doctor – for example, no-shpa, papaverine.
The cervix is a kind of entrance to the organ cavity, which plays a fairly large role during pregnancy. It is this structure that performs a protective function during this period. The length of the organ increases during pregnancy; if this does not happen, then a threat of miscarriage is registered and the patient is left in the hospital for further therapy.
Collapse
Cervical length indicators
The length of the cervical cavity in a healthy pregnant woman becomes 3.5-4.5 cm. The pharynx is closed in nulliparous women, and in women who have already given birth the pharynx is slightly open. Since it is the cervix that holds the baby, because it is dense and long.
If during pregnancy the length of the cervix is too short - less than 1.5-2 cm, then isthmic-cervical insufficiency is diagnosed. It is important to diagnose this condition before conception, so that adequate treatment can be carried out. And there will be no problems with pregnancy.
The length of the cervix can be determined using ultrasound using both vaginal and transabdominal sensors. Additionally, with the help of such a study, it is determined how closed the cervical canal is.
1-4 week
The reproductive organ at this stage is just beginning to change. After examination, the doctor will definitely understand that there is a pregnancy by the appearance of the cervix. Its length begins to increase.
4-8 weeks
At this stage, the cervix should not be less than 2 cm. And also changes in this muscle structure are already visually visible.
8-12 weeks
At this period, the cervical canal reaches 3.0-3.5 cm. That is, it is already approaching the norm, which must be maintained throughout pregnancy for its normal course.
12-15 week
At this stage of pregnancy, the cervix continues to increase and reaches 3.6-3.8 cm.
16-20 weeks
For the normal condition of the woman and the fetus, the cervical mass should be from 4 to 4.5 cm at this stage. This is the peak of this indicator, starting from this period the length of the cervix begins to gradually decrease.
25-28 weeks
At this stage, the indicator may remain at the same level or drop to 3.5-4 cm. This is the norm. At week 30, the cervical canal should not be less than 3 cm in length.
32-36 weeks
The norm at 32 weeks does not differ from 30 weeks, and then the decrease reaches 3.3 cm.
At the end of pregnancy
The main task of the cervix during pregnancy is to keep it in the uterus. Therefore, closer to childbirth, its length decreases so that the baby passes through the birth canal unhindered and without complications. Therefore, starting from week 37, the cervix shortens to 1.5-2.5 cm. It also becomes soft.
Shortening of the cervix at 14-24 weeks
What is the normal length of the cervix during pregnancy at 14-24 weeks? This indicator should be in the range of 3.5-4.5 cm. Deviation from this norm, namely shortening, is very dangerous. Since this can provoke premature labor.
What are the risks of shortening?
It is recorded that if the cervix in this period is less than 1 cm, then labor will begin at 31-32 weeks. And accordingly, if this value reaches 1.5 cm, then birth will take place at 33 weeks.
The cervix reaching 2 cm during this period is a condition that is fraught with labor activity at 34 weeks. At 2.5 cm, the period may increase to 36 weeks.
That is, if it shortens, you must immediately take measures and consult a doctor to prescribe the correct treatment.
Treatment options
There are several effective ways to treat a shortened cervix. The doctor determines which one to choose depending on the degree of shortening of the cervix. A woman is primarily prescribed conservative therapy, which includes taking tocolytic drugs and progesterone. In this case, the woman is prescribed bed rest. Treatment is carried out only in a hospital.
Hormonal therapy is also indicated for shortening of the cervix, since quite often it is hormonal imbalance that is the cause of the pathology. In this case, the woman must adhere to the doctor’s exact recommendations.
Another treatment option for a shortened cervix is cerclage. This method involves applying a suture, which is removed before childbirth. The procedure consists of surgery with local anesthesia, but not earlier than in the second trimester. This is due to the negative impact of anesthesia on the fetus. With the help of cerclage, preterm labor and rupture of the membranes can be prevented. During the procedure, the cervical tumor is not completely sutured, since a small hole is still needed anatomically.
Sometimes it is necessary to install an obstetric pessary. This method does not involve surgical damage to tissue. This device is a rubber uterine ring that helps relieve the cervix and additionally prevents it from stretching.
Elongated cervix
Normally, the length of the cervix should decrease before childbirth in order for the baby to come out without obstacles, without causing complications, and, consequently, pathologies of the child and mother. The long neck is hard to the touch, which is why doctors call it “oak.”
The peculiarity of this pathological condition is that the muscle ring does not open well or does not open at all. Therefore, if such a condition is diagnosed, then the woman needs special preparation for childbirth, in the form of drug treatment.
Causes
The primary cause of a long neck is a congenital anomaly in the structure of the reproductive system. There may also be such provoking factors:
- Inflammatory pathologies localized in the genital organs - cervicitis, endometritis, adnexitis. Since after these pathologies an adhesive process occurs.
- Injuries received during previous births. If the treatment of these injuries was carried out surgically, then a change in the size of the uterus and cervix occurs due to sutures.
- Frequent abortions and childbirth.
What to do?
If a long cervix is diagnosed, then medications can be used. This method involves relaxing the muscles and smoothing out the tissue structure. But the danger of such an action lies in the risk of premature birth and early breaking of water. In later stages they can even stimulate labor. Such medications include Mirolut in the form of tablets and additionally prostaglandins in the form of suppositories.
Sometimes they resort to mechanical methods. Namely, they use a Foley catheter, or amniotomy. A common method is kelp sticks. This is seaweed that can expand 5-6 times in the vagina. They have a stimulating effect on the cervix, thereby it begins to open and smooth out.
How to determine the degree of maturity of the uterus during pregnancy?
In determining the maturity of the cervix, the length of the organ, consistency, and patency of the cervical canal play an important role. Another important criterion is the location of the cervix relative to the pelvic line. What should the cervix be like? The length of the mature neck should be 1.5-2 cm; its density is quite soft. The patency of the cervical canal should be at a sufficient level, and the finger should pass freely into the pharynx.
Each criterion has a score of 0 to 2 points. The highest score is 5-6; if there is such an indicator, it means that the uterus is mature. An indicator of 3-4 means insufficient maturity and at 0-2 an immature uterus is registered. But still, the maturity of the cervix should be determined by a qualified specialist after examining the vagina.
Already at 38 weeks, the doctor can tell by the condition of the cervix how much time is left before birth. A mature cervix will be soft, shortened and localized in the center of the pelvis.
If the doctor of a pregnant woman at 38 weeks diagnosed an immature uterus, then the woman should not panic. After all, the uterus can become mature 1-2 days before birth.
If the uterus is not mature, preparation is done artificially. There are several ways to do this, most often it is a medicinal method.
Conclusion
The length of the cervix by week of pregnancy is an important criterion. After all, the course of pregnancy and the onset of labor directly depend on the state of this structure. Throughout the entire period, the woman should be observed by a doctor to monitor the length and tone of the cervix.
The structure of the female reproductive system allows us to provide the necessary conditions for bearing a baby. The cervix plays a significant role during pregnancy - its structure and functions will be discussed below. Assessment of cervix biometry has diagnostic value for monitoring normal gestation.
Determining the length of the cervix by week of pregnancy will help to identify a number of serious pathologies within an acceptable time frame and take measures to correct them. What length of the cervix is normal and what length indicates pathology - this is discussed in detail in the article.
Structure of the cervix
The structure of the cervix is a ring of muscle tissue located in the lower part of the uterus. Its main function is to connect this organ with the vaginal canal. Menstrual fluid is also removed through the cervical canal. Through the cervix, sperm reach the egg for fertilization.
Normally, the neck length parameter should be in the range from 34 to 35 millimeters. The organ is conventionally divided into two structural units:
- The internal section located closer to the uterus (uterus).
- The external section, located closer to the vagina.
The shape of the cervix may change. Before delivery begins, it has a flat shape, resembling a cylinder in appearance. After childbirth, the organ acquires a trapezoidal shape. Also, the parameters of the cervix may change after surgical interventions affecting this anatomical area.
During pregnancy, the cervical canal should be closed. During the studies, not only the total size is determined, but also the length of the closed part of the cervix - this is required when identifying the risk of premature birth.
Functions of the cervix important when carrying a child
- The cervix during pregnancy has defining functions, which include:
- Protective. It consists in preventing the penetration of pathogens - causative agents of infectious diseases. The mechanism for implementing this function is the production of special mucus, from which a plug is formed.
- Holding the baby inside the uterus. To implement this function, the length of the cervical canal is extremely important. A deviation of the parameter from the norm to a lesser extent impairs the ability of the cervix to hold the child.
So what should be the length of the cervix during pregnancy? Before answering this question, you should study ways to study the parameter.
Methods for determining the length of the cervical canal
Transvaginal ultrasound is the best method for diagnosing the length of the cervix How is the size parameters of the cervix studied? Cervical length during pregnancy is determined in two main ways, namely:
- during a medical examination by a gynecologist, while the doctor examines not only the length, but also the density of the cervix, its localization and expansion;
- , allowing you to assess the extent and maturity of the cervix.
The reasons that provoke the progression of isthmic-cervical insufficiency include:
- Underdevelopment of the uterus.
- Endocrine pathologies.
- Congenital pathologies of the anatomy of the cervix, manifested by an insufficient number of connective tissue fibers and a relative increase in the percentage of smooth muscle fibers.
- Congenital hypoplasia of the cervix.
- Injury to the cervix during abortion, during the birth of a large child and in other situations.
Shortening of the cervix allows us to make the following predictions depending on specific length values:
- less than one centimeter: delivery will occur at 32 weeks or earlier - from 30.
- from 1 cm to 1.5 cm: delivery will occur at 33 weeks.
- from 1.5 cm to 2 cm – at 34 weeks;
- from 2 cm to 2.5 cm - at 36 weeks of pregnancy.
The cervix size of 28 mm is also pathological and requires observation. A small value causes untimely early opening of the cervical canal and, accordingly, premature onset of delivery.
It is worth noting that even with successful correction of the condition and full pregnancy in patients with ICI, there is a risk of rapid or rapid labor. In primiparas, the duration of rapid delivery can take about 4 hours, rapid delivery - about 6, and in multiparas - about 2 and 4, respectively.
Thus, a smaller deviation from the norm in the length of the cervix during pregnancy allows us to assess the risk of premature, rapid and rapid labor and take timely measures to correct the situation.
Is lengthening of the cervical canal during pregnancy a pathology?
However, not only shortening of the cervix can lead to problems during pregnancy. The cervical canal may lengthen, and the reasons for this may include:
- congenital anatomical features of the cervix;
- frequent inflammation of the reproductive system;
- injury to the cervix;
- surgical interventions.
An elongated cervix can provoke disturbances in the processes of fertilization, bearing a baby, and labor.
The structure of the uterine os is disrupted, and the placenta may not attach correctly. There are often cases when a woman carries her pregnancy to term because the reproductive system is not ready for childbirth.
A long cervix is often characterized by a hard structure and is poorly extensible, which is why it does not mature by the expected date of birth.
How to use indomethacin suppositories during pregnancy
In addition, in this case, the duration of the period with contractions is prolonged, which weakens the female body and leads to a deterioration in labor. Most often in such situations, labor stimulation is required.
What causes parameter deviations from acceptable values
If you analyze the information presented above, you can understand that the length of the cervix by week of pregnancy may deviate from acceptable values in the following cases:
- Hormonal imbalance. Hormones control the normal course of pregnancy and the preparation of the woman’s reproductive system for childbirth, so any fluctuations in the endocrine balance can provoke disturbances in the anatomy and functionality of the cervix.
- Previous injury to the cervix - during abortion, surgical interventions, during previous births. Injuries to the cervical canal can cause both its shortening and lengthening.
- Infectious diseases of the reproductive system. Frequent infectious and inflammatory pathologies cause significant harm to a woman’s reproductive health.
- Features of anatomy in a specific clinical case.
- Stressful situations. It is not for nothing that they say that peace is extremely important for a pregnant woman. A stable state of the nervous system allows maintaining an acceptable neurohumoral balance. Frequent stress provokes various pathologies during pregnancy.
Constant monitoring of the parameter value is necessary not only in the above cases. Pregnancy management must take into account the size of the cervical canal
Correction methods
To determine measures to correct the condition, the degree of shortening and the period of gestation of the child should be taken into account. A specific set of measures is prescribed by the gynecologist who is managing the pregnancy.
There are the following ways to correct the condition:
- administration of tocolytics and progesterone;
- placing a suture on the cervix (it is removed before childbirth);
- installation of a special rubber ring – which helps reduce the load on the cervical canal.
Minimum stress and proper preparation for childbirth should come first
In addition, you need to protect the cervix during pregnancy in this way:
- minimize any physical activity;
- refuse sexual intercourse before delivery;
- in consultation with your doctor, take herbal sedatives and antispasmodics.
The above measures will allow a woman to carry a child even with pregnancy, reducing the risk of premature birth.
There are no ways to increase the size of the cervix or lengthen the cervix - there are only correction methods and lifestyle recommendations presented above.
In any case, it is important to take utmost care of your health and follow all the doctor’s recommendations and prescriptions. The specialist knows what the size of the cervix should be at different times, and how to correct the condition in case of deviations from the norm.
When registering for pregnancy, a woman must undergo a series of diagnostic procedures to determine her health status and ability to bear and give birth to a baby. The greatest importance is attached to the examination of the internal genital organs, especially the condition of the cervix.
What it is?
The cervix is the most important part of the female organ, associated with the process of childbirth, affecting both the course of pregnancy and the birth process. It is a small tube, approximately 4 cm by 2.5 cm, connecting the uterus and vagina. The cervix is divided into the upper - supravaginal part, located above the vagina, and the lower - vaginal part, which protrudes into the vaginal cavity.
Additionally In the center of the lower part, the cervical canal opens in the form of an internal pharynx (entrance to the uterine cavity). The surface of a healthy cervix is pale pink, shiny, smooth and elastic, and from the inside of the cervical canal the color becomes more intense, and the surface is loose and velvety.
What should the cervix be like during pregnancy?
With the onset of pregnancy, like the entire female body, the cervix undergoes significant changes. Due to a sharp change in hormonal levels and increased blood supply, within a few days after fertilization it becomes cyanotic, and the glands that are abundant in its thickness significantly expand and grow. The muscle fibers lining the cervix are replaced by connective tissue during pregnancy.
Information The newly formed collagen structure, highly extensible and elastic, promotes, in its excessive formation, stretching of the uterus and, accordingly, leads to shortening of the cervix during pregnancy and the creation of conditions for the opening of the internal pharynx.
This type of organ persists throughout pregnancy, and by the end of pregnancy, the doctor notes softening of the tissues, which indicates the maturation of the cervix and readiness for the birth process. Just before childbirth, the cervix tends to sharply shorten to 1-2 cm, fixing strictly in the center of the small pelvis. Further, periodic examination is required so as not to miss the onset of labor, which is signaled by the expansion of the internal os and the first contractions.
Cervical length during pregnancy by week
The cervix gradually becomes shorter according to the duration of pregnancy, reaching its shortest length in the longitudinal dimension towards the end of pregnancy. This dependence is presented in the table:
Inspection
The pregnancy period requires a woman to visit a doctor for a general examination and, in particular, to examine the condition of the cervix, quite often - at least once a month. This regularity is indicated for completely healthy women who do not have serious health problems. If the pregnancy is aggravated by serious diagnoses, or there is a high risk of miscarriage, the doctor establishes a more frequent schedule of visits to the gynecological office.
Regular examinations of the cervix during pregnancy are of paramount importance to identify pathologies of both mother and child, allowing the necessary treatment to be prescribed in a timely manner. At each visit, the doctor takes material to identify a possible inflammatory process, various infections, and exclude cancer in its incipient stage.
Information During appointments, the doctor pays special attention to the condition of the cervix, monitoring its size, shape, location, and consistency. Careful routine examinations are usually carried out in the first weeks of pregnancy, at 20, 28, 32 and 36 weeks. In case of deviations from the norm, inspection is carried out as necessary. Especially the condition of the cervix at the beginning of pregnancy, when its shortening indicates the onset of pregnancy.
Due to the presence of vaginal discharge, which may also indicate the beginning of the process of interruption, the question arises of excluding this option or taking immediate action.
The cervix feels to the touch during early pregnancy
At the very beginning of pregnancy, when there are no pathologies, the cervix, upon examination, feels quite dense upon palpation and is slightly tilted back in location, which is considered normal. The absence of a threat of spontaneous miscarriage is also indicated by obstruction of the cervical canal (external pharynx) for the finger.
And, on the contrary, if such a threat exists, the doctor will notice this by the softened structure, shortened size and loosely closed cervical canal.
Loose cervix during pregnancy
As pregnancy progresses, the tissue of the cervix, like its entire body, undergoes dramatic changes in structure.
Distinguished by its smoothness at the beginning of pregnancy, due to hormonal and physiological reasons, it becomes more and more loose towards childbirth. The loose nature of the surface of the cervix is considered normal near the cervical canal. However, large, loose areas may indicate an infection causing inflammation.
Sources of trouble can be:
- gonococcus;
- and other serious infections requiring urgent treatment.
In addition to increased looseness, ulcerations, nagging pain in the lower abdomen, and discharge may be observed.
Soft
In a normal pregnancy, the cervix should be a dense area with a closed external os, protecting the inside of the uterus from infections. Only after this period does it begin to soften unevenly, that is, become “ripening” - capable of opening during the birth process, but only along the periphery, and the area of the cervical canal remains closed, as evidenced by ultrasound data.
Cervicometry
Cervicometry is a method that determines the length of the cervix during pregnancy.
The study is carried out both using the usual ultrasound procedure and using a vaginal sensor. Preparation for pregnant women does not include filling the bladder, as in the case of a general examination. The examination procedure itself does not differ from the examination of the uterus, familiar to all women, only the device’s sensor will move across the lower abdomen. The doctor preliminarily lubricates the skin with gel for better operation of the ultrasound equipment.
Information When examining with a transvaginal probe, it is wrapped in a condom, following hygienic considerations, the gel is also applied and the cervix is examined accordingly. Sometimes an examination with a vaginal probe complements a conventional examination through the abdomen.
Stitching the cervix during pregnancy
The cervix serves as a “gate” that holds the fetus inside the uterus. But if it is weak, it may not be able to withstand the increasing mass of the fetus and open ahead of schedule. In such cases, they resort to applying special sutures in the form of a ring. This method is indicated for a period of 13-24 weeks; after this period, this method is not used, but bed rest is recommended for future mothers.
This is a simple operation that involves suturing the neck with lavsan thread, which does not dissolve. It is performed under anesthesia that is safe for the baby, allowing the woman to fall asleep for a short time. After this, a short course of antibacterial and uterine relaxing drugs is given. After the operation, you may experience some bleeding and nagging pain for some time, which is normal.
Stitches are removed after 37 weeks without pain relief. Even if childbirth occurs immediately after this, major problems can no longer occur, since the child reaches functional maturity by this time. In most cases, after removal of the sutures (cerclage), childbirth occurs in a timely manner.
Cervix during second pregnancy
During a second pregnancy, the cervix looks looser at the beginning of the pregnancy compared to the previous state. If the “nulliparous” cervix has the appearance of a cylindrical tube, then the “gave birth” cervix takes on the appearance of a cone or trapezoid. In addition, its surface is no longer completely smooth, but has scars left by previous births and medical manipulations, which impairs its extensibility and leads to shortening.
There is a risk of shortening the cervix with each subsequent pregnancy, so the doctor should constantly monitor its length, especially if the pregnancy was preceded by any complications in the past. There is a widespread belief that in women who have already given birth, some opening of the external pharynx is allowed, which is gross ignorance. In any pregnancy, cervical closure must be absolute; other options are deviations.
Information The cervix is a unique formation of the female body, which plays a vital role in the desire to become a mother. And those women who responsibly eliminate the problems that have arisen with the help of a doctor have every chance of making themselves happy with motherhood more than once.
