Sometimes a long-awaited pregnancy is complicated by the threat of not bringing the baby to term. Various pathologies of the cervix can cause istic-cervical insufficiency. In some cases, the expectant mother is recommended to have suturing on the cervix. We will talk about why this is done and how this manipulation takes place in this material.
What it is?
Putting sutures on the cervix is a necessary necessity, which gives a real chance to preserve and prolong pregnancy if the cervix for some reason cannot cope with its direct responsibilities. After conception has taken place, the cervix closes tightly. Cervical canal closes and fills with mucus. The task before this part of the reproductive female organ stands big and important - keep the growing fetus in the uterine cavity and prevent it from leaving it prematurely.
In addition to retention, the cervix with a mucus plug prevents pathogenic bacteria, viruses, and other unpleasant uninvited “guests” from entering the uterine cavity from the vagina, which can cause intrauterine infection of the baby. This is dangerous, because infections suffered in the embryonic and later periods usually result in developmental defects and severe congenital pathologies, and intrauterine death of the baby.
If the cervix does not provide adequate protection to the growing baby, the likelihood of miscarriage and premature birth increases. If by this time the baby is not yet able to survive on his own in this world, then such a birth will end tragically. In order to strengthen a weak neck, doctors recommend in certain situations to sutured it so that the mechanical barrier in the form of sutures prevents it from opening prematurely.
Indications
For this type of surgical intervention during pregnancy there must be strict indications and clear recommendations from the attending physician. These factors include:
- high risk of miscarriage or premature birth due to the presence of similar cases in the anamnesis;
- recurrent miscarriage in the 1st and 2nd trimesters of pregnancy;
- miscarriage in the third trimester;
- earlier shortening and opening of the cervix, expansion of the internal or external pharynx;
- dubious scars left as “memories” from previous births in which cervical ruptures occurred;
- any destructive changes in the cervix during the process of bearing a child, which are prone to further development.
Decide that there is a need for such at least, like suturing, the doctor cannot do it based on an examination alone in a gynecological chair. He needs comprehensive information about the condition of the lower segment of the uterus, which is the cervix. For this purpose it is assigned full biometric examination, which includes colposcopy and ultrasound diagnostics, as well as laboratory test smear
Only after all risk factors have been identified, the length and width of the cervix have been measured, the condition of the cervical canal inside it has been assessed, as well as the patient’s personal history, can a decision be made about suturing the cervix.
Contraindications
Suturing this organ during pregnancy is possible only if, apart from a weak cervix, no other global problems have been identified in this pregnancy. If some concomitant pathologies are detected, the operation will have to be abandoned. Contraindications include:
- diseases of the heart and blood vessels, kidneys, which have worsened in the expectant mother due to pregnancy, the risk of death of the woman in the event of mechanical prolongation of pregnancy;
- bleeding, increasing in strength and character, as well as recurrent bleeding when there is a threat;
- gross malformations of the baby;
- hypertonicity of the uterine muscles, which cannot be reduced with medical conservative treatment;
- chronic inflammation of the female reproductive organs, the presence of sexually transmitted infections, STDs;
- late detection of cervical pathologies - after 22 weeks of pregnancy ( best time The period from 14 to 21 weeks is considered for successful intervention).
How is the operation performed?
The duration of the operation is great importance. From 14 to 21 weeks, the baby is not large enough to stretch the walls of the uterus and the muscles of the cervix, more later suturing is not recommended due to the fact that highly stretched tissues may not be able to withstand and the seams will cut through with subsequent rupture.
The operation, which in medical language is called "cervical cerclage", carried out only in a hospital. It is not considered painful or excruciating because the woman is given an epidural or intravenous anesthesia.
There is no need to be afraid of it, because experienced anesthesiologists will calculate the dosage of drugs solely taking into account the gestational age, physique, weight and health status of the expectant mother herself and the developmental characteristics of her baby. The dose will be safe for mother and fetus.
The duration of the entire manipulation does not exceed a quarter of an hour. Depending on the condition of the cervix, the doctor will suture either the external or internal os of the cervix. The external one will not be touched if there is erosion, dysplasia, or pseudo-erosion on the cervix. The technique is very simple - surgeons suture the edges of the outer part of the neck together with strong surgical threads.
This method requires careful preparation. If there is an infection in the uterus, the consequences will be more than dire. Stitching will create a closed space inside the female reproductive organ in which any microbe can begin to multiply quickly. The woman is first treated with antibiotics, and the vagina is thoroughly sanitized. However, this does not always help.
There will be no closed space if the doctor decides to sew up the internal os of the cervix. In this case, specialists leave a small drainage hole. The sutures themselves are applied in different ways, each surgeon has his own favorite, and besides, a lot depends on anatomical features of this patient.
The cerclage itself can be performed laparoscopic method. It has many advantages - speed, fairly easy postoperative period, low blood loss, lower risk of complications.
Laparoscopic cerclage is indicated for women with congenital shortening of the cervix and those who have had unsuccessful vaginal suturing surgery.
Possible problems and complications
Like any surgical intervention, cerclage can also have its complications. The most dangerous are considered to be the addition of infection, development inflammatory process and increased tone of the uterine muscles. Inflammation may develop due to an internal infection that could not be “defeated” in the preoperative period. Sometimes a woman has an individual allergic reaction on the suture material used by doctors.
ABOUT possible problems can talk prolonged discharge after surgery, the appearance of a burning sensation, weak pain syndrome . Moreover, inflammation can appear not only immediately after surgery, but also several weeks after suturing. This is why it is important to visit your doctor more often and monitor any changes.
Hypertonicity is also a reaction of the uterus to surgery and suture material foreign to its structures. Some heaviness in the abdomen, slight tugging sensations may be quite normal in the first time after surgery, but subsequently they should disappear. If this does not happen, you should inform your doctor.
Not often, but it also happens that a woman’s body categorically refuses to accept foreign body, which are surgical threads, a violent immune process of rejection begins, which may be accompanied high temperature, atypical discharge, pain.
In later stages, cerclage may have one more unpleasant consequence– a sutured cervix can be seriously damaged if labor has already begun and the stitches have not yet been removed. Therefore, it is important not to ask the doctor to “stay at home for another week,” but to go to the hospital in advance.
After the intervention, the woman needs to remain under 24-hour medical supervision in the hospital for several more days. She is prescribed antispasmodic drugs to reduce the muscle tone of the uterus, as well as strict bed rest. The vagina is sanitized daily to avoid infection. After this, the pregnant woman can be sent home. Discharge after the intervention continues for approximately 3-5 days.
Stitches on the cervix will require the expectant mother to reconsider her lifestyle until the very birth. Contraindicated physical exercise, prolonged standing in an upright position, prolonged walking. Under no circumstances should you lift heavy objects. You should also refrain from sex life so as not to provoke hypertonicity of the uterus, which can lead to the cutting of sutures.
Until childbirth, a woman will have to monitor her stool - constipation is extremely undesirable, since pushing is prohibited. Therefore, you will have to go on a diet, introduce more fresh vegetables and fruits, juices into your diet, limit salt, an abundance of protein foods, as well as baked goods.
You will have to go to the doctor more often, than women in an “interesting position” usually do. The doctor will monitor the condition of the stitches, take smears vaginal microflora, as necessary, prescribe unscheduled ultrasound examinations, the purpose of which will be to measure the parameters of the cervix and evaluate its internal structures.
A woman with stitches on her uterus will have to go to the maternity hospital at 36-37 weeks. Around this time, the sutures are removed. Labor can begin at any time after this, even on the same day.
It is not painful to remove the sutures; there is no need to use anesthesia or other anesthesia methods.
Predictions and consequences
The pregnancy rate after cerclage is quite high - more than 80%. Prognosis depends on the degree of cervical insufficiency and the reasons why the woman was indicated for surgery. If after the operation she follows all the doctor’s recommendations, then the chances of carrying a baby to 36-37 weeks are significantly increased.
There are pathological abnormalities that cause the risk of uncontrolled abortion. Suturing the cervix makes it possible to combat spontaneous miscarriages during pregnancy and significantly increases the likelihood of having a normal child.
There are currently several known in various ways For this operation, the main thing is that the surgical intervention should be carried out in a specialized clinic. Suturing the cervix in artisanal conditions is a very life-threatening undertaking. Carrying out such manipulations by specialists has shown high efficiency and safety.
Reasons for surgery
During a normal pregnancy, the cervix should hold the fetus inside and gradually open only before childbirth. In some cases, pathology may be observed during pregnancy, when the process of dilation of the cervix begins at 14 weeks, when future baby not yet viable. This phenomenon causes relaxation of the uterine muscles, called isthmic-cervical insufficiency (ICI).
This disease most often explains the problem of early miscarriages.
ICI is a shortening and softening of the cervix, an increase in the internal pharynx, leading to damage amniotic sac and spontaneous miscarriage.
The main reasons leading to pathology: excess male hormones, previous abortions, anomalies during previous births or physiological underdevelopment of the organ. As a result of the changes, the cervix loses its functional locking role, and the lower part of the amniotic sac becomes infected, and the amniotic fluid leaves prematurely.
Features of the surgical operation
Treatment of ICI at certain stages can be carried out by medication and other methods, for example, using an obstetric pessary. However, most effective way suturing the cervix is considered highly likely to provide a positive result. At its core, suturing the cervix (cervical cerclage) is a fairly simple surgical procedure if it is performed in a specialized institution.
The manipulation consists of surgeons, using a needle and thread, suturing the cervix through the vagina, using one of several known techniques, taking into account the individual characteristics of the body. Only in exceptional circumstances are sutures on the cervix made laparoscopically (through an incision in the abdominal tissue).
Any technique has general rules: the operation is based on individual indications for surgery during the period 14-20 weeks of pregnancy; in this case, the most common period is 14-17 weeks, and after 27 weeks, intervention is not performed due to the increased size of the fetus, which causes a risk of complications. Sutures are placed under general anesthesia, are removed at 37 weeks of pregnancy. The operation is usually performed after preliminary preparation, but can be performed urgently if high risk miscarriage.
Methods of performing the operation
Currently, several methods have been developed to perform a surgical operation that allows suturing pathological change. Fundamentally, there are 2 methods of influence: suturing the external pharynx and narrowing the internal pharynx. Of the first option, the Czendi method is used, which consists of connecting the anterior and posterior lips of the cervix by stitching with silk or kengut threads. This method ensures a closed space in the uterine cavity, which creates a risk of developing hidden infection.
Methods of suturing in the area of the internal pharynx include the following:
- Palmer method: tracheolystic mycoplasty - dissection of the vaginal wall, displacement Bladder, excision of an oval flap in the isthmus zone and application of chrome catgut sutures without damaging the cervical canal.
- Lasch method: excision of the area from the external pharynx to the isthmus, followed by suturing.
- Shirodkar's method: placing a circular nylon suture on the cervix in the internal os after cutting the vaginal wall and raising the bladder.
- MacDonald's method: applying a purse-string suture at the junction of the vaginal mucosa and the cervix with multiple punctures of the vaginal wall without cutting it.
- Lyubimova's method: the cervix is pulled forward with Museau forceps, a circular silk suture is applied in the area of the entrance of the uterosacral ligaments, with which a copper wire with a diameter of 0.2 mm in a polyethylene sheath is secured.
- Method of Lyubimova and Mamedalieva: U-shaped seam in the development of Lyubimova’s method.
Indications and contraindications for suturing
Surgical intervention is indicated for severe ICI, which is assessed using a scoring system using ultrasound and transvaginal sonography. The following indicators are taken into account when assessing: the length of the cervix in the vaginal area; patency of the uterine canal; location of the cervix (sacral, central, displaced forward); consistency of cervical tissue; location of the nearest fetal area. The severity of ICI is accepted when the neck is shortened to 20 mm or less; expansion of the internal pharynx (cervical canal) more than 9 mm.
The following possible conditions for cervical suturing are recognized:
- gestation period 14-25 weeks;
- integrity of the membranes;
- absence of increased smoothing of the cervix and obvious prolapse of the fetal bladder;
- exclusion of chorioamnionitis and vulvovaginitis.
The following contraindications exist for the operation:
- dangerous diseases somatic nature in which termination of pregnancy is necessary;
- the likelihood of termination of pregnancy;
- noticeable bleeding during pregnancy;
- abnormal excitability of the uterus, not eliminated by drug therapy;
- pathology of fetal development;
- the appearance of pathogenic microflora in the uterine canal.
Carrying out the operation
Before the operation of suturing the cervix, preparatory measures are carried out for 2-3 days: microbiological studies uterine canal and vagina; tocolytic therapy to reduce uterine tone; treatment of the vagina with antibacterial drugs.
The operation itself is performed quickly (15-20 minutes) using one of the described methods under general anesthesia, which is safe for the fetus and the woman in labor.
The methods of McDonald's and Lyubimova are most often used. The following are used as anesthetic and painkillers: atropine sulfate and midozolam (intramuscular); ketamine (intravenous or intramuscular); propofol (intravenously). After suturing, the body’s natural reaction is considered normal: slight nagging pain and slight bleeding, which should disappear completely on its own after 2-3 days.
Postoperative period
The suturing operation usually does not require strict bed rest, and after signs of anesthesia have disappeared, the patient can walk. To eliminate possible consequences, the following preventive measures are taken:
- Disinfection of the surgical area with hydrogen peroxide or chlorhexidine for 4-5 days.
- Prescription of antispasmodics: drotaverine for 3 days.
- Prescription of adrenergic agonists: hexoprenaline and verapamil for 10 days.
- Antibacterial drugs as needed in case of negative microbiological studies.
- If there are no complications, the patient is discharged from the hospital 7 days after the operation.
Sutures are removed at 37 weeks of pregnancy. After surgery, patients are not recommended to have sexual intercourse, lift loads, or stay in sitting position, overworked, under stress.
The effectiveness of suturing the cervix while maintaining pregnancy is estimated to be above 90%, which gives a high chance of giving birth to a normally termed baby. To provide positive result You must follow all doctor’s instructions and be constantly examined by a gynecologist, incl. using ultrasound. It is important to correctly follow a gentle preventive regimen before childbirth.
Sutures on the cervix during pregnancy are necessary if there is a serious risk of miscarriage or premature birth. The main cause of such problems is isthmic-cervical insufficiency.
If, after a thorough examination of the expectant mother, the physician discovers a threat to the fetus, the patient is prescribed suturing of the cervix during pregnancy. This operation is forced, but it really helps to maintain the pregnancy and carry the child to term so that he is born strong and healthy.
U healthy woman After fertilization of the egg, the cervix closes tightly. The cervical canal is filled with dense mucus, which prevents the embryo from leaving the womb prematurely. Suturing the cervix during pregnancy prevents pathogens from entering the uterus from the outside.
Bacteria and viruses can infect the fetus and lead to the development of dangerous malformations, severe congenital pathologies and even the death of a baby. Suturing the cervix during pregnancy is necessary if there is a threat of premature birth, but the child is not yet developed enough to survive in the outside world. A mechanical barrier will prevent the neck from opening prematurely.
A suture on the cervix during pregnancy is placed by a surgeon only after preliminary examination the expectant mother, the availability of recommendations from a gynecologist. Indications for such surgical procedure may act:
The final decision on the need for sutures on the cervix during pregnancy is made by the gynecologist after full examination patients. A simple examination on the chair is not enough for this.
It's important to get full information about the condition of the internal genital organs. To do this, the patient needs to undergo a biometric examination, consisting of colposcopy, ultrasound, and laboratory smear examination. If the risk factors are serious, surgery is prescribed.
Contraindications
During pregnancy, the cervix is sutured only in extreme cases, if there are indications or certain pathologies of this organ. If during diagnosis a pregnant woman was found to have additional diseases fetus or organs reproductive system, such a procedure will have to be abandoned.
Suturing the cervix has contraindications. These include:
- Serious pathologies of the cardiovascular system and liver, which were greatly aggravated due to pregnancy. In the event of a forced extension of gestation, the woman may die.
- The presence of bloody secretion from the vagina, bleeding.
- Pathologies of intrauterine development of the fetus.
- The tone of the uterine muscles, which is not reduced by taking medications.
- Inflammatory pathologies of the genital organs, infectious and venereal diseases.
- Detection of cervical disease in late pregnancy (after the 22nd week).
If the patient is found to have contraindications to surgery to suture the cervix, the physician selects other methods of treatment and preservation of pregnancy. It all depends on the period, as well as the individual characteristics of the body.
Methodology
How is the cervix sutured during pregnancy? Suturing the cervix is surgery, which can be performed in a hospital setting from 14 to 21 weeks of pregnancy. It is during this period that the fetus reaches its optimal size, but is not yet so large as to greatly stretch the muscles of the uterus. If the procedure is performed later, the tissues of the reproductive organ may be greatly stretched and the sutures will rupture.
Source: novosti-mediciny.ru
The operation is called cervical cerclage. It is performed under general or epidural anesthesia, so the pregnant woman does not feel any discomfort. The dosage of the drug should be selected by an experienced anesthesiologist, taking into account the timing of pregnancy, the characteristics of fetal development and the health status of the expectant mother. If everything is done correctly, the operation will be absolutely safe and painless.
Applying sutures to the cervix takes no more than 15 minutes. Depending on the indications, the surgeon sutures the external or internal pharynx. Strong surgical threads are used for this. .
For the operation to be successful, you need to carefully prepare for it, make sure that there are no dangerous infection. When the pharynx closes, conditions will be created in the uterus for the rapid proliferation of microorganisms. It is because of this that doctors recommend that the patient first take a course of antibiotics and perform extensive sanitation of the vagina.
In modern clinics, laparoscopy is often used for suturing the cervix during pregnancy. This operation is quick and painless. After it, there is almost no bleeding or complications, and the patient recovers quite quickly.
Complications
Any surgery during pregnancy may have serious complications. The following are considered especially dangerous:
- infection of the patient;
- development of severe inflammation;
- hypertonicity of the uterine muscles.
If during the preparation for surgery it was not possible to destroy harmful microorganisms in the organs of the reproductive system, severe inflammation may occur after suturing. Before the procedure, the physician must make sure that the pregnant woman is not allergic to the suture material used.
If you notice that after surgery there is discharge from the vagina, you feel a burning sensation and discomfort, be sure to consult a doctor. The inflammatory process may not occur immediately, but after several weeks, so it is very important to carefully monitor your well-being.
During surgical intervention, hypertonicity of the uterine muscles often occurs. With this diagnosis, the pregnant woman experiences a heaviness in the lower abdomen that does not go away for a long time. If you do not want the cervix to be severely damaged during childbirth, go to the hospital several weeks before the expected birth.
Recovery
After surgery future mom remains in the hospital for several days. Doctors are closely monitoring the patient’s condition at this time. If the tone of the uterus is increased, antispasmodics and bed rest are prescribed. The doctor sanitizes the vagina every day to destroy any harmful microorganisms in the genitals. If everything went well, the woman is discharged 4-5 days after the operation.
During the recovery period and up to childbirth, the following are prohibited:
- Any physical activity;
- Long walking, running and even standing in an upright position;
- Lifting weights;
- Active intimate life.
- Push when constipated.
A gynecologist should monitor the condition of the sutures on the cervix, so be prepared to visit him often. Sutures are removed at 36-37 weeks. During this period, the pregnant woman should already be in the hospital and prepare for childbirth.
Pregnancy is an important and responsible period in the life of every woman. Unfortunately, health problems are not uncommon at this time. And in some cases, the doctor recommends a special procedure to the patient, during which a suture is placed. Sutures are needed on the cervix during pregnancy to prevent miscarriage or premature birth.
On the other hand, surgery during pregnancy frightens women. So in what cases is such a procedure prescribed? What risks does it involve? What is the surgical procedure and how is the rehabilitation period? The answers to these questions are of interest to many patients.
Suturing the cervix during pregnancy: why is it necessary?
Uterus - important organ reproductive system. This is where the fertilized egg is implanted and further development embryo. Normally, the cervix begins to dilate slowly starting at the 36th week. But in some patients the discovery occurs in the early stages.
This is fraught with extremely dangerous consequences for the child, because the growing organism may not yet be viable. Miscarriage or premature birth are consequences that may be encountered expectant mother. It is in such situations that doctors prescribe suturing the cervix during pregnancy - such a procedure can save the child’s life.
Main indications for the procedure
Of course, there are situations when cervical stitches are simply necessary. Indications for the procedure are as follows:
- Isthmic-cervical insufficiency is a pathology that is accompanied by dilation or shortening. A similar phenomenon develops with anatomical defects of the cervix, which in turn may be associated with mechanical damage, previously transferred inflammatory diseases, cancer, etc.
- Hormonal imbalances, because it is hormones that control the condition of the walls of the reproductive organ. A change in the amount of certain hormones in the blood can cause relaxation or contraction of the muscles of the uterus, and early opening of the cervix.
- If the patient's history includes information about previous miscarriages or premature birth, then the doctor will probably closely monitor the patient’s health condition and, if necessary, prescribe surgical intervention.
A suture on the cervix during pregnancy can ensure the normal development of the child. However, only an experienced obstetrician-gynecologist is able to decide on the procedure.
What preparation does suturing require?
Applying a suture to the cervix during pregnancy is not a very complicated procedure. However, the doctor can decide to perform surgery only after passing all the necessary tests and tests.
Starting from the 12th week of pregnancy, women are referred to ultrasonography, during which a specialist can determine early dilatation of the uterus. An ultrasound may be repeated to confirm the diagnosis. Naturally, as before any other operation, it is necessary to take blood and urine tests, check the level of hormones in the blood of a pregnant woman and conduct other tests. Immediately the day before the operation, the vagina is sanitized.
Features of surgery
Naturally, patients are interested in questions about how exactly the surgical intervention occurs. In fact, this is not such a complicated procedure, and it lasts no more than 15-20 minutes. Suturing is carried out under general anesthesia. To strengthen the uterus, strong nylon threads are usually used.
The doctor may place a suture on the outer or inner edges of the pharynx. Access to tissue is usually through the vagina, but in some cases a laparoscopic procedure (through small punctures in the abdominal wall). The number of stitches depends on how far the cervix has dilated.
When are stitches removed?
Already placed sutures on the cervix during pregnancy help preserve the fetus inside the womb. As a rule, they are removed at 37 weeks. Naturally, before this, the woman undergoes an examination and an ultrasound examination, during which it is possible to find out whether the child is developed enough to be born.
Removal of suture material is carried out without anesthesia - this procedure may not be very pleasant, but it is painless and quick. In most cases, birth occurs on the same day. But even if there are no contractions, the woman should be in a hospital setting.
It is worth saying that in some (rare) cases, a suture on the cervix during pregnancy, unfortunately, cannot prevent early labor. Then the stitches are removed as an emergency. If the procedure is not carried out on time, the suture threads can severely damage the pharynx, complicate childbirth and create problems in the future (if the woman wants another child).
Postoperative period: rules and precautions
Sutures on the cervix during pregnancy provide the baby with normal intrauterine development. However, the success of the procedure largely depends on how the rehabilitation period goes. The woman spends the first 3-7 days after surgery in a hospital setting, under the constant supervision of doctors. She is prescribed strict intake of antibacterial agents (to prevent inflammation) and antispasmodics (to prevent contraction of the uterine walls). In addition, the seams are regularly washed with antiseptic solutions.
In the first few days, patients feel mild pain in the lower abdomen. Vaginal discharge may appear in the form of ichor, mixed with blood. Such phenomena are considered normal and go away on their own. Gradually the woman returns to her usual way of life.
There are some requirements that should be followed until the end of pregnancy. In particular, the expectant mother should not lift weights, engage in physical labor, or overexert herself (physically or emotionally). Contraindicated and sex life. Rest and healthy sleep are important for women and children. Will have a positive effect on health proper nutrition(will help prevent constipation) and walks in the fresh air.
Suture on the cervix during pregnancy: complications
Like any surgical procedure, suturing involves some risks. The procedure may cause some complications, in particular inflammation. Such a pathology can have different causes - sometimes pathogenic microorganisms penetrate into tissues during the procedure, sometimes already during rehabilitation. In addition, it is possible to develop an allergic inflammatory reaction when tissue comes into contact with suture material. These complications are usually accompanied by the appearance of uncharacteristic vaginal discharge, pain in the lower abdomen, increased body temperature.
The cervix may become hyperactive after suturing during pregnancy. Due to hypertension, women feel a tugging in the lower abdomen. As a rule, the patient’s condition can be returned to normal with the help of special medications and bed rest.
We should not forget that premature dilatation of the uterus is a consequence, and not an independent problem. It is necessary to conduct a thorough diagnosis, find out what exactly caused the pathology, and eliminate the primary cause. For example, in case of hormonal disorders, the patient is prescribed special hormonal drugs. Chronic inflammation also requires specific therapy.
Contraindications to the procedure
It is worth noting that this procedure cannot be carried out in every case. A suture on the cervix during pregnancy is contraindicated in the following cases:
- The presence of a sluggish inflammatory process in the organs of the reproductive system.
- Increased excitability of the uterus (this refers to cases when it cannot be eliminated with medication).
- Bleeding.
- Blood clotting disorders, as massive blood loss is possible.
- Severe chronic diseases, including damage to the kidneys, heart or liver.
- Frozen pregnancy, death of a child in the womb.
- The presence of certain anomalies in the process of child development (if confirmed using diagnostic procedures and analyses).
- Suturing has a time limit - the intervention is not performed after the 25th week of pregnancy.
It is worth saying that if for some reason the surgical procedure is impossible (for example, if the problem was diagnosed too late), then a special pessary made of durable plastic is placed on the uterus. It not only keeps the cervix closed, but also partially relieves the load on the uterine walls. In addition, the patient is recommended to undergo strict bed rest.
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