During pregnancy, the cervix may open before term, increasing the risk of miscarriage or premature delivery. What is it due? What are the symptoms and treatments? We take stock.
What role does the cervix play during pregnancy?
- This is the lock of the uterine cavity. In early pregnancy, the cervix is long, posterior, normally closed. It is a sort of narrow and hard parade of a length of about 3 cm. Throughout your pregnancy, the uterine volume will increase significantly, the cervix will soften gradually under the influence of hormones (estrogen, progesterone), but remain closed. In the 9th month, it softens again, is shortened, and opens naturally: it is then mature. At the time of work, under the effect of other hormones, prostaglandins that trigger contractions, the cervix fades and opens to facilitate the passage of the baby.
- The premature opening of the cervix corresponds to the inadvertent opening of the lock of the uterine chamber. She is responsible for late abortions (before the 6th month) or for premature births (after the 6th month).
What are the causes that can cause premature opening of the cervix?
- The causes may be functional (the cervix opens during pregnancy, with no apparent cause).
- They are sometimes anatomical and of congenital origin (insufficiency of the muscular fibers which hold this collar closed, often accompanied by uterine malformations: for example a small uterus). Also in the dock: obstetric trauma (history of termination of pregnancy, difficult delivery, expulsion efforts on an incomplete dilated cervix), heavy babies, late abortions that require dilation of the cervix. brutal, finally the curettage which, even if it is done gently, can traumatize the cervix.
- The premature opening of the cervix is also the consequence of the appearance of uterine contractions treated too late.
- Last but not least: living conditions, ie overwork, long journeys between the office and the home (some women add up to two to three hours of transport per day), finally the presence of toddlers at home: it can be a source of extra fatigue.
What can be done if this opening occurs during the first trimester of pregnancy?
- Strapping is the treatment of premature opening of the cervix. It is ideally practiced before the end of the 3rd month. It combines progesterone (which will relax the uterus) and rest.
- Performed under local or general anesthesia, the strapping consis-te to tighten the inner orifice of the neck with a solid wire. A short hospitalization is often necessary. No strapping is done without a prior ultrasound check, to ensure the proper evolution of the pregnancy and the absence of fetal abnormalities.
What are the symptoms that need to worry?
- The symptomatology is poor, it is essentially the appearance of uterine contractions (short but repetitive pain) which should alert you.
- However, be careful if you have a gynecological "past", that is to say if you have had a difficult birth, or a late miscarriage. Your doctor will then search by ultrasound, and apart from any clinical symptoms, a gap of the cervix. This is an indication to strapping.
Can we wait for the monthly consultation with the doctor to talk about these concerns?
- Certainly not. As soon as the first contractions appear, you must immediately consult your gynecologist. He alone will be able to advise you on the treatment to follow.
What are some ways to avoid premature labor?
- They range from strict bed rest to taking medications that will relax the uterine muscle and prevent the onset of uterine contractions, treating the cause in itself. If it is a gap of the neck, one will practice a strapping. If a urinary or vaginal infection is suspected, this problem will be addressed immediately.
Is strapping still a method advocated by doctors?
- Yes, in the case of a gap of the cervix. It is carried out at the end of the third month, in the absence of uterine contractions and provided that the pregnancy evolves well.
- In the past, doctors prescribed hormones, but today there are much more effective treatments. However, the use of progesterone is still relevant.
Is this opening of the uterus more prone to infections?
- Much more. The egg which was hitherto well protected in the closed uterine cavity is abruptly at the mercy of all the germs contained in the vagina. A simple vaginal infection can result in an infection of the egg.
The lying position is very restrictive, can we take some liberties?
- If the mother-to-be has a neck that is really open and a strapping is impossible, she is condemned to a strict rest, that is to say, not to get up from her bed at all. However, if it has been circled and no uterine contraction is present, the absolute rest is no longer indicated and it can lead a life almost normal, but greatly slowed down.
Is it true that strapping, medication and bed rest often exceed the expected term of delivery?
- No, it's inaccurate. As a precaution, medication is stopped at the beginning of the 9th month, one month before the expected date of delivery. Decercling is also done on the same date, that is to say 37 weeks of amenorrhea. In the 9th month, we are sure that the fetus is physically ready for life on earth.
- In very rare cases, strapping may result in fibrosis of the muscular fibers of the cervix. Consequence: the collar becomes hard and opens more difficult. The work can be a little longer then. In case of failure to open the cervix, we will do a caesarean section.
After a first pregnancy of this type, should we say that those who follow will also be "problem"?
- There is no indication that a subsequent pregnancy will proceed in the same way. On the other hand, if the cause of the premature opening of the cervix persists, there is a good chance that the phenomenon will happen again. For example, if a diagnosis of open bite of the cervix was worn during a first pregnancy, the young mother will be advised to be very reasonable in her activities and, if necessary, she will be prescribed an early work stoppage. and we will practice a strapping.
Can we prevent premature opening of the cervix?
- Yes. If the diagnosis of open bite of the cervix is done before the beginning of pregnancy, on the gynecological antecedents, the practice of cerclage will be a good prevention.