The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
One of the causes of miscarriage is cervical incompetence or failure of the cervix. This pathology may be anatomical or functional origin.
An alternative to surgical treatment of cervical incompetence during gestation is the installation of obstetric pessary. This device is made of a flexible plastic or silicone, is treated with gamma rays (providing sterility) and represents a concave pyramid of several interconnected rings with smooth and semi-circular edges.
Wide basis pessary is guided in the direction of the rectum, and a narrower toward the symphysis pubis. Due to the concave shape of bases rectum and bladder are unloaded and not compressed. In the center there is a fit opening for the cervix, which is shifted to a broad base. On either side of the central opening there are holes with a smaller diameter required for outflow of vaginal secretions. Lintel disposed between the openings, support rigidity and apparatus fortress.
Photo: Y.Dranitskaya at ru.wikipedia.org
The mechanism of action pessary
Action obstetric pessary carried out due to the following points:
- reducing the load on the neck untenable due embryo pressure offset;
- pressure redistribution within the uterus;
- cervix closed walls of the central opening;
- retained mucus plug in the cervix, it reduces the risk of infection, fetal membranes and fetus.
Indications for installation
Pessary during pregnancy is established in the following cases:
- cervical incompetence (both functional and organic);
- prevention of divergence of seams on the cervix after surgical treatment failure cervix;
- multiple pregnancy (high risk of premature birth);
- high risk of cervical incompetence.
Photo: Madhero88 at ru.wikipedia.org
Contraindications
Obstetric pessary can not be installed in the following circumstances:
- sukrovichnye or bleeding from the genital tract;
- not excluded missed abortion;
- the presence of inflammation in the vagina and cervix (obesity, cervicitis);
- prolapsed bladder into the vagina;
- the presence of a woman's disease, is contraindicated for child bearing;
- gross fetal malformations.
How to establish a pessary
Set obstetric pessary after 20 weeks, but in some cases it is possible and earlier its introduction (12-17 weeks).
Before installing the device (for 30 minutes) for the prevention of uterine hypertonus doctor may advise to take antispasmodics (no-spa, papaverine).
The installation procedure for the pessary takes a few minutes, but can deliver unpleasant woman.
The device is introduced without anesthesia, on reception in the antenatal clinic (less often in the hospital) after emptying the bladder woman. The doctor examines pregnant on a gynecological chair handles pessary glycerol (to facilitate its introduction) and a device at the entrance to the vagina wide base down. First introduced bottom (wide) half-ring in the posterior vaginal fornix. Then, a little pressing on it and on the rear wall of the vagina is inputted top (wide) half-ring. Next, the whole is introduced pessary.
After administration, deploying pessary into the vagina so that it was in kosopoperechnoy plane relative to the longitudinal axis of the body of the pregnant. From the inside it looks like this: the broad base is located in the posterior vaginal fornix, and narrow is located under the symphysis pubis (which determines the picture of the "oblique" arrangement). In this case, the cervix is located in the central opening of a pessary.
After installation
After the establishment of a pessary woman delivers a regular basis (every 2-3 weeks) vaginal swabs (not to miss the development of vaginitis). And every 3-4 weeks held cervical ultrasonography and assessment of its condition. Every 14 days the vagina and pessary (without extraction) are treated with an antiseptic solution (furatsilin, chlorhexidine aqueous solution).
Deleted device on 37-38 week or emergency indications (premature rupture of waters, occurrence of bleeding, beginning on delivery).
Side effects and complications
Side effects after installing obstetric pessary may:
- occurrence of unpleasant sensations long after sitting;
- offset pessary in the vagina with the further development of vaginitis;
- strengthening the vaginal discharge.
Complications can include the development vaginitis (In case of no effect of treatment for 10 days pessary removed) and chorioamnionitis (inflammation of the membranes and the membranes of the amniotic fluid infection).
Efficiency of use
According to statistics, pessary efficiency during pregnancy (pregnancy prolongation to the expected delivery date) reaches 70-80%.
Some studies in pregnancy
- Smears in pregnancy
- Analyzes during pregnancy trimesters
- Ultrasound in pregnancy
- Urinalysis in pregnancy
- coagulation
- glucose tolerance test
- Homocysteine in pregnancy
- Anesthesia during childbirth
- Fetal CTG (cardiotocography)
- cordocentesis
- Epidurals in labor
