Deformation of the cervix - a change in the natural state of the cervix, as well as its vaginal part. Most often, the deformation of the cervix occurs after abortion, during childbirth, since during the passage of the fetus through the cervix, small cracks and tears form, after surgical interventions, as well as after gynecological operations, which lead to its changes.
Deformation of the cervix after childbirth
During labor, the cervix becomes much shorter and smoother, which allows it to open 8-10 cm and allow the baby's head to pass easily. Quite often during the passage of the fetus through birth canal rupture of the cervix occurs. The causes of these adverse events may be: previous ruptures during childbirth, the large weight of the child, gynecological operations, abortion, weak generic activity followed by rapid delivery, improperly selected obstetric forceps, untimely strong attempts. As a result, ruptures of the cervix are formed. Tears and cracks can be of different depths and even touch the vagina and the uterus itself. Therefore, at the end of childbirth, the doctor must carefully examine the cervix and the uterus itself for ruptures. If any are found, they are sutured with special threads, which will resolve themselves over time.
If not all breaks were detected and sewn up, the cervix is deformed, its shape and pharynx change. The woman in labor herself may not feel any changes. Most often, an incorrect cervix does not cause any concern in a woman and does not affect the patient's well-being in any way. But this factor can play a decisive role in planning a future pregnancy, since an abnormal cervix can lead to miscarriages, bleeding, amniotic fluid leakage and, as a result, to premature birth. Therefore, it is very important to undergo an examination of the cervix after childbirth for changes, then the doctor will be able to prescribe proper treatment and remove all the consequences of a difficult birth.
Cicatricial deformity of the cervix
As a result of surgical interventions or difficult childbirth, ruptures and cracks that are not sewn up at all or not sewn up at all are healed. After that, the woman develops cicatricial deformity of the cervix. In this case, the cervix is deformed and everted into the vaginal part. Scar deformity neck can lead to many diseases: infectious, severe inflammatory processes, which can be aggravated by purulent rashes, hardening of the endometrium, erosion of the cervix, and even the formation cancer cells. For women who are trying to conceive or carry a child, cervical scarring can be a major cause for concern.
Very often, cicatricial deformity of the cervix does not manifest itself, although clear signs this pathology can be: failures in the menstrual cycle, as well as the abundance of secretions during the cycle itself, unpleasant pain lower abdomen, painful sexual intercourse, white discharge that may have bad smell. If you find any of these symptoms in yourself, immediately go to a doctor who can confirm or refute the presumptive diagnosis. To do this, you will be examined on a chair with the help of mirrors, a colposcopy, a cytology of smears will be prescribed, and you will also need to pass some tests. If, nevertheless, you have been diagnosed with a cicatricial deformity of the cervix, do not panic, the doctor will prescribe you a course of treatment that will be aimed at restoring the natural initial state of the cervix and its integrity. In most cases, this treatment is quite successful, although it will take some time.
Cervical deformity: consequences
As mentioned above, many women may not even notice that their cervix is deformed and they do not observe any negative consequences. Although for many this can become a significant obstacle in planning and bearing a child. Very often, it is the deformation of the cervix that becomes the main cause of involuntary abortions and early births. In addition, with strong changes in the cervix, or rather, its eversion into the vaginal part, a woman can develop: keratinization of the tissues of the cervical canal, death of the epithelium, endometritis, cervicitis, erosion, inflammation and even cervical cancer. So don't delay too long timely treatment, which can prevent many health problems in the future.
Cervical deformity: treatment
When choosing a treatment for cervical deformity, many factors are taken into account: what caused the development of the disease, the degree of tissue damage, the age of the patient, concomitant infections and inflammatory processes. Most often, the deformation of the cervix is treated by surgery or destructive methods. If the changes are minor, the tissues are not deeply affected, then laser plastic surgery, cryodestruction or diathermocoagulation is prescribed. If the deformation is significant enough and there are prerequisites for the presence of neoplasms, then a reconstructive Plastic surgery or excision of the cervix.
All these methods are aimed at restoring the natural state of the cervix, vaginal microflora and restoring reproductive function. It is also recommended to prevent the development of cancer cells and neoplasms. Treatment of cervical deformity is a rather lengthy process, but, in most cases, it is very successful, and a woman will be able to become pregnant and bear an absolutely healthy baby.
Cervical deformity is not as scary as it seems at first glance, because the disease can be diagnosed and treated, after which you can plan a pregnancy and get rid of many concomitant diseases. The main thing is to seek help from a specialist in time.
Deformation of the uterus can be both congenital and acquired. With progression tumor processes the size and shape of the reproductive organ may change. Such diseases must be treated surgically.
Causes of congenital deformity of the uterus can be:
- Genetic disorders.
- Adverse effects on the fetus in the womb during the first trimester of pregnancy. It can be severe poisoning, experienced stress, an infectious or chronic disease.
Normally, the uterus is located in the pelvis, has the shape of a pear. The lower part of the organ smoothly passes into the neck, which is connected to the vagina. The growth and development of the fetus occurs precisely in the uterus, so its deformation and improper development can be quite dangerous.
Classification
The doctor conducted an examination and said that the uterine cavity is deformed - what does this mean? AT modern medicine distinguish several types of anomalous development of this reproductive organ.
- The uterus is in the form of an arc or saddle. Top part organ is concave. Such a violation is not dangerous to the health of the patient, does not prevent the conception and normal bearing of the child.
- The uterus is bicornuate. Patients with this diagnosis have an additional wall that divides the organ into two parts. With such a deformation, a woman will easily become pregnant, but there may be problems with carrying the embryo. In a bicornuate uterus, the child is cramped, and this is fraught with premature birth.
- Unicornuate reproductive organ. In this case, the uterus is connected to only one ovary. Such a violation is very rare. It is difficult for patients with such a diagnosis to become pregnant, but there are chances. high risk miscarriage or the onset of premature labor.
- Several queens in one organism. An extremely rare pathology. The organs are not related to each other in any way. With such an anomaly, women experience pain during intimacy or menstrual bleeding. The patient can become pregnant, but the risk of miscarriage and misplacement of the embryo is quite high.
Some representatives of the fair sex do not have a uterus from birth. In this case, agenesis is diagnosed. A patient with this type of anomaly cannot become pregnant and bear a child, as the reproductive system is not developed. The girl does not have menstruation, serious hormonal disorders may occur.
Diagnostics
Congenital deformity of the uterus with a standard gynecological examination almost impossible to find on the chair. As a rule, doctors suspect anomalies in the development of the reproductive organ if the patient cannot long time become pregnant, but does not suffer from any gynecological diseases. To detect deviations are used various methods diagnostics:
- Ultrasound of the pelvic organs (transabdominal or transvaginal).
- MRI. With the help of modern equipment, you can see a clear image of the uterus. This examination is not carried out during pregnancy.
- Examination of the uterine cavity using a special device - a hysteroscope.
- X-ray s contrast agent. Allows you to determine the shape and size of the genital organ, its functioning.
- Laparoscopy. During this operation, a puncture is made in abdominal cavity, and a special device with a camera is inserted through it.
1 Description
Cicatricial deformity of the cervix is a disease that is a change in the vaginal and cervical canals. ICD-10 code: N88 "Other non-inflammatory diseases of the cervix."
The cervical canal is located in the lower part of the uterus. Its walls are lined with epithelial cells that produce alkaline mucous secretions. With the development of cicatricial deformity, the mucous membrane of the cervical canal enters the vaginal canal, which has an acidic environment.
As a result of an imbalance, the protective functions of the reproductive system weaken, it begins to malfunction. Mucus secretions change their composition. This contributes to the development of infectious and inflammatory diseases.
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2 reasons
Most high degree the risk of cicatricial deformity occurs after an assisted delivery using an extractor or medical forceps. Independent childbirth can lead to the development of pathology if they were complex and accompanied by multiple internal tears.
Surgical interventions, surgical abortions, violations of the suturing technique lead to the development of deformation. The congenital type of pathology is very rare. It is associated with physiological and hormonal failures.
3 Symptoms and complications
After tissue rupture, its healing begins. The process is the replacement of organ tissue with connective tissue. In this case, the following processes are observed:
- there are disturbances in blood microcirculation;
- there is a redistribution of nerve cells;
- trophic changes in the structure of the canal develop, which contribute to its deformation and eversion of the mucosa into the vaginal canal;
- sometimes cervical-vaginal fistulas are formed.
For a long time, the pathology does not manifest itself in any way externally. As it progresses, there are:
- aching pain in the pelvis, radiating to the lower back;
- violations and failures in the duration and frequency of the menstrual cycle;
- pain during sexual intercourse;
- copious menstrual flow;
- stretching vaginal discharge white.
Complications of cicatricial deformity of the cervix include:
- cervicitis;
- endometritis;
- endocervicitis;
- erosion;
- keratinization of the tissues of the cervical canal;
- violation of the development of the epithelium;
- oncology.
4 Effects on pregnancy and childbirth
Pathology can lead to infertility or problems with bearing a fetus. This is possible for several reasons:
- an imbalance in the acidity of cervical mucus is an obstacle to the penetration of spermatozoa into the uterus and their normal functioning;
- due to violation defense mechanism increases the risk of miscarriage and the possibility of infection of the fetus through the vagina.
During pregnancy, a woman with a deformity is advised to observe sexual rest and limit physical activity. If during childbirth the cervix opens on its own, the birth process passes through the natural birth canal. In the absence of disclosure, a caesarean section is performed.
5 Diagnostics
If you change the nature of the discharge or the composition of the mucus, the appearance of pain or bleeding, you should immediately visit a gynecologist. Your doctor will examine you with a speculum or colposcope. Signs of cicatricial deformity of the cervix are:
- canal eversion;
- the presence of scars near the sutures that arose during the suturing of birth gaps.
In the process of colposcopy, the doctor examines changes in the surface of the cervical canal, complications of the pathology, and takes tissue for biopsy. If the problem is congenital, tests are prescribed to determine the level of hormones in the woman's body.
The gynecologist may prescribe additional studies:
- bacteriological tests;
- PCR diagnostics;
- smear for cytology.
Differential diagnosis is carried out to exclude functional disorders during childbirth. During the birth process itself, when the first signs of deformation usually appear, it is necessary to distinguish the pathology from the secondary weakness of labor activity. The latter is characterized by a slow opening of the cervix (insufficient for normal childbirth), but with positive dynamics. With deformation, disclosure does not occur at all; instead, the doctor may notice a curvature of the organ.
General concept
Most people know what a scar or scar is. This formation, consisting of connective tissue, appears as a result of healing deep wounds, damage or inflammatory diseases.
Scar heals not only skin covering. The mucous membranes of the stomach and intestines are scarred (after ulcers and operations), the uterus and cervical canal, gallbladder, the myocardium is scarred after ischemia. A scar can heal tissues of almost any organ.
Basically, scar tissues are represented by collagen, they are dense and can cause deformation of the organ. Due to their appearance in the surrounding tissues, the processes of blood microcirculation are disturbed, and, consequently, their trophism (nutrition) suffers. The innervation of the tissue may be disturbed.
The connective tissue of the scar is not able to perform the function of the tissues that they replaced.
Effects
Since the scar is not functional as a mucosal lining of the cervix (cervical canal), the mucosa partially loses its function. As a result, cicatricial deformity of the cervix:
- It leads to a decrease in the barrier functions of the mucous membrane of the cervical canal due to a violation of the production of cervical mucus and its qualities.
- May be accompanied by ectropion (eversion of the mucous lining of the cervical canal into the vagina).
Ectropion occurs due to rupture of the circular muscles of the cervix. The longitudinal muscle tissues located at the lips of the cervical canal remain intact. They continue active contractions without meeting the resistance of the circular muscles. The external os of the cervix undergoes deformation, turns out and sags into the vagina. Sagging tissues are exposed to the acidic vaginal environment. They erode, the glands of the mucous lining atrophy and stop producing the usual mucus.
The result of such anatomical and physiological changes is an increased predisposition of the female genital organs to inflammatory processes:
- Endocervicitis.
- Endometritis.
- Ectopia and true erosion.
- tissue atrophy.
The main feature of a healthy cervix is the presence of a mucous plug in it, which is formed and located in the canal due to its special spindle shape. And it is she (cork) that performs the barrier function of the cervix.
The appearance of scars on the mucous membrane of the cervical canal is considered one of the key points predisposing to keratinization of the mucous lining, degeneration of epithelial cells up to the development cancers cervix. The formation of scar tissue can cause a curvature of the cervix. Such changes, complementing each other, become a threat to reproductive function. female body, leading to:
- Infertility.
- miscarriages.
- Bleeding.
- Leakage of amniotic fluid during subsequent pregnancies.
- Premature birth.
- Violation of the ability to give birth independently and the need for operative delivery.
In addition, scarring and curvature of the cervix can cause discomfort and pain in a woman.
The reasons
Such changes are usually secondary. There are few reasons for the development of this pathology. The main ones are considered to be:
- Injuries and ruptures (birth, resulting from abortions, diagnostic curettage, and for other reasons).
- Surgical interventions.
- Inflammation (chronic and severe), leading to adhesive changes and scarring of tissues.
Most often there is a deformation of the cervix after childbirth. This leads to:
- Birth large fruit(more than 4.5–5 kg).
- Breech presentation.
- Insufficient elasticity of the walls of the cervical canal due to chronic inflammatory diseases of the genital organs.
- Rapid childbirth, accompanied by cracks and ruptures.
- Untimely and excessive attempts.
There may be other provoking factors that caused a violation of the integrity of the cervix.
Such gaps can be of different depths and lengths, touch the uterus and violate the integrity of the vaginal tissues. If tears are detected early and properly sutured, they usually heal without deformities.
Suture material used for suturing internal breaks, self-absorbable. Therefore, it is not necessary to remove the stitches, the damage (if there is no secondary infection) heals well.
If not all tissue ruptures were sewn up, most likely they will grow together anyway, but with the formation of scars and deformation of the shape of the cervix.
One of the rarest cases of the development of such a pathology is primary cicatricial changes (congenital). In this case, their cause is considered to be a hormonal imbalance.
signs
Quite often cicatricial deformity of the cervix in mild degree does not show up symptomatically. And it is found only as a result of a gynecological examination. If the changes are pronounced, then unpleasant symptoms may appear:
- Pain in the pelvic region radiating to the lumbar region.
- Discomfort in the lower abdomen (heaviness and pronounced pulling discomfort).
- Discharge (white, slimy, stretchy).
- Painful intercourse.
- Abundant menstruation with severe pain syndrome.
- Shift in the menstrual cycle.
If the pathology is primary, then in addition to the described violations, there may be cycle disorders, early menarche, severe and painful bleeding.
Diagnostics
The main diagnostic method is a gynecological examination by a gynecologist. That's just mild cicatricial changes in the cervix and eversion of the mucous membrane in the vagina presents difficulties in diagnosis. A severely deformed cervical canal does not cause diagnostic difficulties.
According to literary sources, in at least 70% of cases, ectropion, combined with cicatricial changes, is diagnosed as ectopia. That is, as a physiologically variable condition that does not require treatment.
Additional diagnostic methods that the gynecologist uses are:
- Colposcopy.
- Cytological analysis of tissues.
- Examination of the vaginal secretion for the presence of pathogenic bacterial microflora.
- Blood tests ( most often PCR method is used).
If primary deformity is suspected, the patient is asked to take blood tests for hormones.
Treatment
Therapeutic tactics are developed for each patient separately. And it depends on several factors:
- The severity of the condition.
- Realization of the childbearing function (that is, whether the woman has children).
- age.
- Associated pathologies.
For the treatment of this pathology, destructive methods and surgical plastics are used. The main therapeutic task is not only the elimination of cicatricial changes in the cervix and its return to the physiological position.
Therapy solves several more important tasks:
- The return of a woman's ability to reproduce.
- Restoration of the barrier functions of the cervical mucosa.
- Normalization of the microflora of the vagina.
- Prevention of mucosal atrophy and its cancerous degeneration.
Destructive methods give a good result with a mild degree of scarring. Thanks to them, altered tissues are destroyed and the normal lining of the cervix is restored.
There are several destructive methods, the main ones are:
- diathermal coagulation.
- cryogenic destruction.
- Laser evaporation (vaporization).
Modern bloodless surgical techniques include ultrasonic, radio wave and electrical methods that allow the destruction of pathologically formed tissues.
Severe cicatricial deformity of the cervix is corrected by excision. Average postoperative period– 10 days, average recovery period– 90 days. At the same time, experts advise sexual abstinence. In addition, a sparing labor regime(you need to avoid physical exertion), you also need to strictly follow the rules of intimate hygiene.
Cicatricial deformity of the cervix, fortunately for women, is rare.
rehabilitation period
You need to visit your doctor regularly during the rehabilitation period, and conscientiously follow his recommendations. This will allow the healing process to proceed as quickly and efficiently as possible.
In some cases, in order to eliminate inflammation, patients are recommended antibiotic therapy. or application local antiseptics. It may be necessary to restore the vaginal microflora.
You can think about planning a pregnancy 4–5 months after successful tissue healing, if the process went without complications.
Characteristics of the pathology
Every woman, having heard that she has a deformity of the cervix, wants to know what it is. Most often, this is the name of the condition in which the integrity of the cervix (its visible vaginal part) is broken, and a scar has formed at the site of damage. It is he who leads to visible changes in the shape of the cervix and cervical canal. But there are other types of deformities, and for some, surgical treatment is recommended.
Deformation of the cervix leads to the fact that the blood microcirculation in its tissues is disturbed, nerve cells begin to gradually die off. This provokes the appearance of trophic changes in the tissues of the cervical canal. Sometimes even the uterus is involved in the process: its mucous part turns into the vagina, cervical-vaginal fistulas form.
Types of pathologies
Cervical deformity can be acquired or congenital. But congenital pathology is extremely rare. Hormonal disruptions in the body can lead to the appearance of pathology.
Doctors believe that congenital deformity can occur under the influence negative factors on the mother's body in the first 3 months of pregnancy. These include stress, infectious lesions, intoxication. Also, the cause of a birth defect can be genetic failures. Such a change in the shape of the cervix is accompanied by anomalies in the development of other organs (uterus, vagina).
Most often, women are diagnosed with cicatricial deformity of the cervix.
But there are other pathologies of the cervical part of the uterus:
- narrowing of the cervical canal: the diagnosis is made if its dimensions do not exceed 5 mm;
- circular channel: wrong location muscle fibers leads to the appearance of a funnel-shaped cervical canal;
- lengthening or shortening: the length is less than 35 mm or more than 45 mm.
These deformations of the cervix lead to disruption of menstrual and reproductive function. Women who are planning a pregnancy, be sure to select the optimal treatment tactics.
Reasons for the appearance
Most often, violations of the shape and integrity of the neck occur as a result of:
- injuries during childbirth, for example, due to ruptures of the cervix during the passage of the baby's head;
- damage that arose due to the incorrect location of the fetus;
- violations of the technique of surgical interventions;
- improper suturing.
These reasons lead to the fact that physiologically normal structure the cervical part of the uterus is broken. Scar tissue forms on the damaged areas, and the cervix is deformed. Timely diagnosis and treatment can help prevent problems in the future.
Why does pathology occur?
In most cases, severe childbirth provokes the onset of pathology, during which lateral tears appear on the cervix.
Also, the condition occurs during surgical interventions for obstetrics - illiterate forceps, insufficiently qualified suturing. Cause cervical changes abortion and gynecological curettage.
One of the factors that increase the risk of deformity is a hereditary pathology, in which scars in the cervical canal are formed against the background of hormonal disruptions. The human papillomavirus affects the development of deformation.
The mechanism of development of pathology
The cells of the cylindrical epithelium, which make up the lower region of the cervical canal, constantly produce a mucous secret. In the presence of provoking factors - traumatic injuries and hormonal imbalance – alkaline balance environment is disturbed, and the mucous membrane falls much less alkaline, and more acidic environment of the vagina.
A change in acidity causes inflammatory processes, the consequence of which is a violation of the trophic tissue of the cervical canal. The uterus is everted by the mucous membrane into the vaginal area and vaginal-cervical fistulas are formed.
There are other painful conditions:
- endometritis;
- cervicitis;
- endocervicitis.
This leads to the appearance of erosion, atrophy of the epithelium, keratinization of the cells lining the cervical canal, and can become an insidious impetus to the onset of cancerous cell transformations.
Also, the scar neck significantly reduces the quality of sexual life and reduces the possibility of conception, and if it occurs, it prevents the pregnancy from being carried out for the prescribed period.
Symptoms and diagnosis of the disease
In some cases, the patient may complain of aching pain in the lower abdomen - mainly during the menstrual cycle - and the appearance of profuse leucorrhoea.
Changes in the menstrual cycle may also occur - the cycle is broken, the amount of discharge increases, etc.
But in most cases, the disease develops asymptomatically and is detected during a gynecological examination.
Usually, diagnosis is not a problem - in the gynecological mirror, the eversion of the cervical canal and visual cicatricial changes at the places of suturing or at breaks are immediately visible. If confirmation of the diagnosis is required, then a colposcopy is prescribed.
Laboratory studies to determine the severity of the pathology:
- smears for bacterial flora and cytology;
- PCR - diagnostics.
During colposcopy, changes in the folds of the cervical canal are assessed and a tissue sample is taken for a biopsy - a histological examination.
If the patient has congenital eversion, it is necessary to take a course of tests to determine the level of sex hormones.
Influence of a scar cervix on pregnancy and childbirth
Scars localized in the area of the cervical canal may not affect conception - if the disease proceeded without severe symptoms, - but the condition negatively affects the course of pregnancy. This increases the risk of miscarriage, increases the possibility of infection of the fetus with an infection in ascending ways - through the vagina.
A pregnant woman needs to be attentive to herself, observe sexual rest, and, if possible, reduce activity. The decision on additional therapeutic intervention at this stage is made by the gynecologist observing the pregnancy.
With scarring of the cervix, childbirth can occur naturally - if the cervix has opened itself - but a caesarean section may be necessary.
As already mentioned, most cases of deformation of the cervical canal occur just after childbirth, if deep tears have not been repaired or sutured not thoroughly enough.
Deformation of the cervix after childbirth
During labor, the cervix becomes much shorter and smoother, which allows it to open 8-10 cm and allow the baby's head to pass easily. Quite often, during the passage of the fetus through the birth canal, ruptures of the cervix occur. The reasons for these adverse events may be: previous ruptures during childbirth, the large weight of the child, gynecological operations, abortions, weak labor activity followed by rapid labor, improperly selected obstetric forceps, untimely strong attempts. As a result, ruptures of the cervix are formed. Tears and cracks can be of different depths and even touch the vagina and the uterus itself. Therefore, at the end of childbirth, the doctor must carefully examine the cervix and the uterus itself for ruptures. If any are found, they are sutured with special threads, which will resolve themselves over time.
If not all breaks were detected and sewn up, the cervix is deformed, its shape and pharynx change. The woman in labor herself may not feel any changes. Most often, an incorrect cervix does not cause any concern in a woman and does not affect the patient's well-being in any way. But this factor can play a decisive role in planning a future pregnancy, since an incorrect cervix can lead to miscarriages, bleeding, amniotic fluid leakage and, as a result, to premature birth. Therefore, it is very important to undergo an examination of the cervix after childbirth for changes, then the doctor will be able to prescribe the correct treatment and remove all the consequences of a difficult birth.
Cicatricial deformity of the cervix
As a result of surgical interventions or difficult childbirth, ruptures and cracks that are not sewn up at all or not sewn up at all are healed. After that, the woman develops cicatricial deformity of the cervix. In this case, the cervix is deformed and everted into the vaginal part. Cicatricial deformity of the cervix can lead to many diseases: infectious, severe inflammatory processes, which can be aggravated by purulent rashes, roughening of the endometrium, erosion of the cervix, and even the formation of cancer cells. For women who are trying to conceive or carry a child, cervical scarring can be a major cause for concern.
Very often, cicatricial deformity of the cervix does not manifest itself in any way, although obvious signs of this pathology can be: disruptions in the menstrual cycle, as well as abundant discharge during the cycle itself, unpleasant pain in the lower abdomen, painful sexual contacts, white discharge, which may have an unpleasant odor. If you find any of these symptoms in yourself, immediately go to a doctor who can confirm or refute the presumptive diagnosis. To do this, you will be examined on a chair with the help of mirrors, a colposcopy, a cytology of smears will be prescribed, and you will also need to pass some tests. If, nevertheless, you have been diagnosed with a cicatricial deformity of the cervix, do not panic, the doctor will prescribe you a course of treatment that will be aimed at restoring the natural initial state of the cervix and its integrity. In most cases, this treatment is quite successful, although it will take some time.
Cervical deformity: consequences
As mentioned above, many women may not even notice that their cervix is deformed and they do not observe any negative consequences. Although for many this can become a significant obstacle in planning and bearing a child. Very often, it is the deformation of the cervix that becomes the main cause of involuntary abortions and early births. In addition, with strong changes in the cervix, or rather, its eversion into the vaginal part, a woman can develop: keratinization of the tissues of the cervical canal, death of the epithelium, endometritis, cervicitis, erosion, inflammation and even cervical cancer. Therefore, you should not delay timely treatment for a long time, which can prevent many health problems in the future.
Sources
- https://uterus2.ru/disease/deformatsiya-matki.html
- http://noprost.ru/gynecology/erosion/rubcovaya-deformaciya-shejki-matki.html
- https://flovit.ru/medicina/ginekologiya/rubcovaya-deformaciya-shejki-matki.html
- http://ginekola.ru/ginekologiya/shejka-matki/lechenie-deformatsii-shejki-matki.html
- https://mjusli.ru/zhenskoe_zdorove/ginekologicheskie_zabolevanija/rubcovaya-deformaciya-shejki-matki
- http://www.probirka.org/zhenskoe-besplodie/8988-deformatsiya-sheyki-matki.html
During a gynecological examination, problems with organs are detected in 5% of cases. Cicatricial deformity of the cervix after childbirth is considered dangerous pathology covering the cervical and vaginal canals. Due to changes in the structure and length of the neck, the genital organs are displaced. The problem cannot be ignored, since the lack of treatment leads to the development of a malignant disease.
Large babies over 3.5 kg pass through the birth canal when they are born. If the muscles are weak, the woman has injuries and tears. The neck is not fully restored, scars appear. The fabric becomes rough, inelastic. The opening of the cervix after childbirth does not always indicate pathology. In women who give birth not for the first time, a small pharynx remains.
How does the cervix change after childbirth:
- a red organ in the form of a ball 135 mm long;
- oval, yellow discharge, length 110 mm;
- pear-shaped normal color with a usual size of 9 mm.
The cervix in a month and a half will not be conical, as before pregnancy, but cylindrical. It does not affect health. The form is determined by the gynecologist during the examination. Happens almost full recovery if there are no health problems. Organ weight is about 50 gr. The fundus of the uterus after childbirth is 12-15 cm above the womb.
Can the cervix close after dilation? Yes. When the firstborn has appeared, the closure will be complete if the ruptures are properly sutured. With a repeated process, the passage of one finger is allowed during examination by a gynecologist.
A woman will not be able to independently determine whether the cervix has deformed after childbirth or not. Pathology affects subsequent pregnancy. Miscarriages occur more often, bleeding opens, amniotic fluid leaks before the process begins.
Among the factors contributing to ruptures, there are changes of an inflammatory and dystrophic nature. The type of disease is determined taking into account the outer diameter of the open pharynx, how many scars there are, whether their size has increased. What happens to the surrounding tissues, the state of the exocervix.
During childbirth, the cervix becomes smooth, the edges thin and stretched. From the outer part to the inner fabric are torn. They are limited to the area of the vagina, do not reach the vaults. Sometimes they capture the peritoneum. Cicatricial deformity of the cervix is manifested as a result of improperly sewn or untreated breaks. The organ turns into the side of the vagina. Leads to inflammatory processes, hardening of the endometrium, erosion.
There are four levels of change:
- I degree. The gynecologist inserts the tip or the entire finger through a cone-shaped hole. The depth of the gaps is not more than 2 cm. Signs of ectropion of the cervix are revealed after childbirth in the lower part of the cervical canal;
- II degree. The open part is not identified. The front and back are important. Old breaks extend to the vaults. Endocervix completely everted;
- III degree. The uterus is stretched after childbirth, the cracks extend to the vagina. It is impossible to determine the external pharynx. Hypertrophy of one lip of the neck is revealed. Diagnose the inflammatory process and epithelial dysplasia;
- IV degree. There are old tears and fissures that reach the fornix of the vagina. Eversion of the uterus after childbirth is associated with insufficiency of the pelvic muscles.
Ectopia occurs as a result of tissue incision during childbirth. The mucous membrane of the cervical canal extends to the lower part of the organ. Ectropion is a more complex form of the disease, in which the mucous membrane unfolds towards the vagina. It is difficult to diagnose due to the late detection of extraneous tissue from the outside. Deformation of scars occurs during suturing after childbirth. The cervix is unnatural to the touch, with a changed structure, necrosis of parts of the tissue.
Symptoms and Diagnosis
In the first degree of the disease, the amount of cervical discharge increases. If the cicatricial deformity is more pronounced, aching and drawing pains in the lower back and lower abdomen. The color of whiter changes: they become cloudy, white or yellow. The cycle is not broken, but increases by 1-2 days. Sometimes there are discomfort during intercourse.
A gynecologist can determine changes in the cervix after childbirth. The woman is sent to additional diagnostics. Perform a biopsy, colposcopy, take a smear for cytology. PCR tests are needed to detect infectious diseases. Primary deformation is difficult to detect. If in doubt, take blood tests for hormones.
A loose cervix is a condition in which the density and elasticity of tissues decreases. Due to the decrease in tone, the pharynx opens. Occurs with muscle weakness, weakening of the immune system, cervical insufficiency. Pathology provokes miscarriages and premature births.
Due to injury, the muscles are stretched, do not always return to their original position. Under load, they relax so much that after childbirth, the intestine sticks out of the uterus. On the initial stage prolapse clean up physical activity, medical gymnastics.
Tests in a month will help to identify the disease on early stage. Colposcopy allows you to determine changes in the cervical epithelium. If a pathology is suspected, a biopsy is performed, smears are taken using special solutions.
The reasons
The deformity develops after childbirth and may be a congenital pathology. More common in women reproductive age due to scars adhesive processes. The reason is the use of obstetric forceps during operative childbirth, manual assistance in breech presentation of the fetus.
An everted cervix is detected after a difficult birth, if the circumference of the baby's head is larger with occiput presentation. Pathology occurs during a rapid process, when the uterus does not have time to expand sufficiently, with prolonged labor, premature rupture of amniotic fluid.
Deformation is observed with injuries and ruptures, surgery, chronic inflammation of the cervix, which lead to tissue scarring and deformation. A self-absorbable material is used to suture internal tears. In the absence of a secondary infection, they heal quickly.
When a problem is identified, the funnel-shaped shape of the circular canal of the cervix is \u200b\u200bdetermined. The anatomical arrangement of muscle fibers is disturbed, the organ cannot contract. Narrowing is noted if the size of the neck is less than 5 mm. A woman has oligomenorrhea in the form of menstrual irregularities. The extreme degree is its obstruction with a mechanical barrier that affects further deformation.
Elongation of the neck means that the dimensions of the organ are greater than 45 mm. It accompanies a change in the thickness of the walls of the uterus and pharynx. Shortening - the value does not exceed 25 mm. Occurs due to the passage of a large baby through the birth canal and improperly applied sutures. Violated normal physiological structure neck, tissue regeneration, scarring develops, which contributes to further deformation.
Consequences and complications
The cervical canal partially loses its function, as the scar becomes part of the tissues. The protection of the shell is reduced, as the quality of the mucus is impaired. There are negative consequences of cervical deformation after childbirth in the form of eversion of the canal into the vagina.
Ectropion occurs due to rupture of the muscles of the cervix. When visiting a gynecologist, cervicitis after childbirth, endometritis, ectopia, and tissue atrophy are detected. Longitudinal, which are located near the lips, remain intact. They are actively shrinking. The external pharynx is deformed, everted and sags into the vagina.
The tissues are exposed to the environment, erosion develops, atrophy of the glands occurs, and mucus is not produced in the usual way. Note the anatomical and physiological changes, a woman is more prone to the development of inflammatory processes.
An inflamed cervix after childbirth can be caused by trauma to the genital organs, if more than 6 hours pass between opening and the appearance of the baby. After the process is completed, placental tissues remain on the walls of the uterus. If they are not detected in time, inflammation begins.
When a woman's neck crawls out after childbirth, the tone of the muscles of the perineum decreases, they feel foreign body, discomfort when moving. Bowel prolapse occurs and Bladder. Are squeezed blood vessels tissue nutrition is disrupted.
Impact on pregnancy and childbirth. A healthy cervix is evidenced by a mucous plug located in a spindle-shaped canal. It is a protective barrier in the cervix. The appearance of scars indicates keratinization of the tissue, the degeneration of epithelial cells. The risk of developing cancerous growths increases, there is a curvature of the cervix.
All changes pose a threat to the reproductive function of the body. A woman cannot give birth on her own; operative delivery is used. With localization in the cervical canal, conception occurs if there were no symptoms. The effect is on the course of pregnancy. The risk of miscarriage, infection of the fetus through the vagina increases. A woman needs to lead less active life, observe sexual rest. With scarring, independent childbirth is possible if the harness opens on its own.
Treatment
The tactics of treating cervical inversion involves a complete examination and determination of the severity of the disease. The gynecologist notes the cause of the development of the disease, how much the tissues are affected. The age of the patient, the presence of inflammation and infectious diseases matters. Therapy includes medicines and carrying out the operation.
With minor changes, if the tissue damage is shallow, laser plasty, cryodestruction or diathermocoagulation are chosen. With a strong deformation and suspicion of a neoplasm, an excision of the neck is performed.
Treatment of divergence of uterine elevators in a therapeutic way is effective only in the initial stage. The neglected state is restored surgically. Advanced techniques allow for treatment and reduce the likelihood of relapse. Due to the gentle mode of conduct shown to elderly patients. All manipulations are carried out through the vagina.
Perineolevathoroplasty. A high-quality operation if the disease is detected at an early stage. Muscles can still contract on their own. The method is aimed at the treatment of rectocele, cystocele, deformity.
Colporrhaphy. Performed to stitch the walls of the vagina. Strengthen, eliminate rough, painful scars.
Operation Lefort-Neigebauer. It is carried out only in the absence of intimate relationships.
All methods are designed to restore the natural state of the cervix, vaginal microflora. Treatment is long, but in 90% of cases it completely eliminates problems. A woman can become pregnant and bear a child. The deformity is treatable. are recovering barrier functions cervical mucosa, neoplasms are being prevented.
Alternative treatment of a loose uterus brings results if you use herbal tinctures and decoctions regularly. Plantain syrup is prepared, honey and fragrant celery seeds are added. Make a tincture with dill seeds. They drink for three weeks, rest for two. Course 3 months. Infusion with lemon balm is brewed in a thermos and taken 50 g an hour before meals.
Forecast and prevention
A gynecologist is visited regularly once every six months. Following the recommendations will allow healing to take place quickly and efficiently. Planning to get pregnant in 4-5 months successful treatment. No one can guarantee that damage to the uterus can be avoided. Much depends on the obstetricians who will be next to the woman in labor during the appearance of the baby.
Reconstructive plastic surgery restores the shape and function of the cervix in 95% of cases of deformation. When applying purse-string sutures, positive dynamics is noted in 80% of the procedures performed. AT preventive purposes prescribe invasive treatment. If there are traumatic ruptures, suturing is carried out with constant monitoring by a gynecologist.
When choosing a conservative treatment, do not refuse massage. It affects blood flow. Perform physical exercises to strengthen the muscles of the perineum. Preventive measures include adequate sexual activity. Apply modern ways contraception to avoid abortion. Minimize the risk of STDs by choosing a permanent partner, refuse casual relationships.
Timely register for pregnancy, prepare in advance for childbirth and competently conduct the process. Attend courses where they talk about correct breathing, body position. Control endocrine and hormonal disorders.
You can avoid cervical deformation if you take care of your health in advance. Issues are resolved at a gynecologist's appointment. If incomprehensible symptoms are detected, tests are taken to confirm or exclude the development of the disease.
This pathology of the cervix occurs after its rupture during childbirth, less often after surgery. The main complaints of the patient are pain, sometimes contact bloody issues, pain in the event of an ascending infection. In such patients, miscarriage due to isthmic-cervical insufficiency or infertility is often observed.
The diagnosis is based on the history, a thorough examination with the help of mirrors and bullet forceps.
Treatment of cicatricial deformity of the cervix is only surgical and is carried out after preliminary colposcopy, cytology, targeted biopsy. The purpose of surgical interventions (Emmett's operation, patchwork method) is to restore not only the ectocervix, but also the correct fusiform shape of the cervical canal, which has great importance to restore its normal content and reproductive function. Less commonly used amputation of the cervix according to Sturmdorf, high amputation of the cervix. But the operation of choice for cicatricial deformity of the cervix is the operation of cervical plasty by the method of dissection according to V.I. Eltsov-Strelkov, which restores not only the shape, but also the anatomy of the cervix.
Genital fistulas (urogenital and enterogenital)
Genital fistulas are among the most serious diseases of women, leading to multiple organ disorders, long-term and permanent disability, as well as causing deep moral and physical suffering, menstrual and reproductive dysfunction.
To date, the true frequency of genital fistulas is unknown. This is due to the fact that the treatment of such patients is carried out in urological, general surgical, proctological and only a small part - in gynecological hospitals. The frequency of urogenital fistulas of obstetric and gynecological etiology reaches 0.5-6%, and these figures do not reflect the true state of affairs, since some patients are treated by gynecologists. According to various authors, the proportion of patients with rectovaginal fistulas among patients hospitalized in general surgical clinics is 2.7%, in gynecological clinics - 5.5%, in proctological - 15-30%. Over the past 25 years, the structure of genital fistulas has changed. According to V.I. Krasnopolsky and S.N. Buyanova (1994), enterogenital fistulas account for 49.3%, vesicogenital fistulas - 17.3%, genital fistulas proper - 15.1%, abdominal wall fistulas - 11.2% . The most rare are ureterovaginal and urethrovaginal fistulas - 3.85 and 1.6%, respectively.
The structure of the reasons for the formation of genital fistulas also changed. In the first place are traumatic fistulas, and obstetric injuries predominate. After spontaneous childbirth, fistulas are observed 2 times less often than after surgical ones. It was found that the frequency of fistulas formed after childbirth is 2.5 times higher than fistulas resulting from gynecological diseases. Among other reasons, many authors indicate radiological in 8.1%, domestic injury in 4.1%. Of the non-traumatic factors, inflammatory diseases prevail - from 1.7 to 45%, malformations - 1.2%.
According to the etiological basis, three groups of genital fistulas are distinguished:
Traumatic, resulting from:
a) obstetric or gynecological operations;
b) spontaneous childbirth;
c) violent trauma not related to childbirth and operations
Inflammatory:
a) as a result of spontaneous perforation of pelvic abscesses into a hollow organ;
b) as a complication of colpotomy and multiple punctures.
Oncological:
a) as a result of the collapse of the tumor;
b) radiation fistulas.
The main etiological factors for the occurrence of fistulas are:
Pathological childbirth (especially their unskilled management).
Surgical interventions.
Malignant tumors of the genital organs.
Radiation therapy.
Infectious diseases (tuberculosis).
Purulent formations of the small pelvis with perforation.
Colpotomy.
The problem of classification of genital fistulas has not yet been solved and the existing classifications are based on topographic-anatomical and etiological principles. D.V. Kahn (1986) proposed to systematize genitourinary fistulas as follows:
cystic (vesico-vaginal, vesico-uterine, vesico-adnexal);
ureteral (ureteral, uretero-vaginal, uretero-uterine);
urethrovaginal and urethrovesical-vaginal;
combined;
complex urogenital fistulas.
Fistulas can differ in their shape: cylindrical and funnel-shaped, as well as in the direction of the fistula: straight and indirect. In addition, genital fistulas are subdivided depending on topographic segmental features into low, medium, high. In addition, it is advisable to distinguish vesicogenital fistulas according to clinical and functional characteristics: with and without impaired renal function. Such a division allows you to outline a plan for examination and preoperative preparation, determine the timing of the surgical intervention, access and method of surgery.
Clinical manifestations genital fistulas are sufficient characteristic. The most characteristic symptoms are involuntary leakage of urine from the vagina, gas, pus, and sometimes feces. The long-term existence of the fistula is complicated by the development of cystitis, colpitis, dermatitis on the anterior and inner thighs, menstrual dysfunction (up to amenorrhea). Dramatically changing mental condition patients: they are oppressed due to dysfunction of urination and the pungent smell of decomposed urine emanating from them, sometimes gases and feces. All this deprives them of their ability to work, often leading to depressive states.
Diagnosis genital fistulas are established on the basis of anamnesis data: complaints of the patient, external examination, vaginal and recto-vaginal examination, examination with the help of vaginal mirrors, as well as probing the fistulous tract and fistulography. A dye solution (methylene blue) introduced through a catheter into the bladder or directly into the fistulous tract helps to establish the presence of a fistula. The localization of the fistula can also be clarified with the help of sigmoidoscopy, fibrocolonoscopy, chromosectoromanoscopy, vaginography, hysteroscopy, cystoscopy, ultrasound of the kidneys. If changes are detected during ultrasound or cystoscopy, emergency urography, radioisotope renography, and cystography in three projections are indicated. In some cases, a bacteriological examination of discharge from the fistula, urine, and blood is carried out.
Treatment patients with genital fistulas surgical. The technique of operations is described in detail in the specialized literature (Y.V. Kukolev, 1961; D.N. Atabekov, 1963; A.M. Mazhbits, 1964; V.I. Eltsov-Strelkov, 1972; D.V. Kan, 1986; V. I. Krasnopolsky and S. N. Buyanova, 1994, etc.). Surgical correction with genital fistulas requires high professional skills, clinical approaches, financial support and is the lot of a relatively small number of clinics not only in our country but also abroad. Surgical treatment of fistula should be carried out not earlier than 3-6 months. after it occurs, as small fistulas can heal spontaneously. It is also necessary for complete scarring of the wound and the disappearance of inflammatory changes in the tissues. But this does not apply to traumatic injuries of the bladder, intestines or ureter inflicted during surgery. These damages must be repaired immediately upon discovery.
Preoperative preparation is essential for the success of the operation. Its nature and duration are determined individually, taking into account the bacterial flora, the state of the fistulous tract and tissues around it, the age of the patient and extragenital pathology. Preoperative preparation includes local and general influences. The first ones are aimed at sanitation of the operation area, improvement of tissue trophism and conditions for their regeneration and are carried out for at least 5-7 days under the control of bacteriological tests. Sanitation of the vagina and fistulous tract with an aqueous solution of chlorhexidine, treatment of the vagina with metronidazole preparations (Klion-D, Flagyl, Metagyl) with simultaneous oral administration of Trichopolum are prescribed; in the presence of yeast-like fungi in smears, it is advisable to treat with a solution of coli-bacterin or bifidum-bacterin with the introduction of vaginal suppositories with clotrimazole. General effects include the use of sedatives and antihistamines (tavegil, suprastin, meprobamate), immunostimulants, vitamins B and C. General preparation includes the prevention of thromboembolic complications: escusan, troxevasin are prescribed. If fistulas are accompanied by concomitant general intoxication of the body, it is necessary to prescribe broad-spectrum antibiotics, intravenously metragil, detoxification drugs. In these cases, preoperative preparation is increased to 14-20 days. With urogenital fistulas, it is necessary to determine microorganisms in the urine and their sensitivity to antibiotics, eliminate encrustations, eliminate inflammatory processes in the vagina and vulva, rejection of necrotic masses in the fistula area. The operation should be carried out in the first phase of the menstrual cycle, which allows you to create Better conditions for tissue regeneration under the influence of estrogens, as well as to ensure the formation of a scar before menstruation and thereby minimize the risk of infectious and purulent complications.
Treatment of patients with rectovaginal fistulas is associated with significant difficulties. To date, more than 100 methods of operations have been developed, but the results of treatment of this pathology cannot be considered satisfactory: relapses occur in 4.3-40% of patients. There are rectal and perineal-rectal access, but currently the most widely used vaginal access, which allows you to eliminate the rectovaginal fistula by splitting the tissues of the rectovaginal septum.
As a ligature material, it is best to use a long-term absorbable synthetic material - vicryl, supramid, especially in patients with recurrent fistulas.
The success of the operation depends on the correct assessment of the anatomical and functional features of the area where the operation is performed, the degree of its infection, the quality of preoperative preparation, the correct choice and method of qualified operation, and the rational management of the postoperative period. In addition, the correct assessment of the condition of patients, including their immunological status, is of great importance.
The main goal of treating patients with vesicovaginal fistulas, which are most common, is to restore the integrity of the urinary organs and create conditions for the normal separate functioning of the urinary and reproductive systems. Extensive defects of the urogenital diaphragm are closed with some tissue on which salts are not deposited, with a muscle-fat flap of the labia majora; use the plastic properties of the greater omentum and peritoneum. Spread small intestine, lyophilized dura mater, preserved pericardium, gold foil, synthetic materials, etc. have proven themselves well. Vaginal, transvesical, transvaginal, abdominal and combined accesses are used. The location of the fistula, its size and relation to the orifices of the ureter are of decisive importance in the choice of surgical access.
Prevention genital fistulas is a system of consistently performed medical and social measures: prevention of obstetric injuries, prediction of the outcome of childbirth, qualified and careful performance of all obstetric and gynecological operations and manipulations, increased surgical training of obstetrician-gynecologists, timely and correct surgical correction of acute complications, as well as full medical examination, early detection and timely treatment of inflammatory diseases of the internal genital organs, improvement of contraceptive methods, sanitary and educational work among the female population about the dangers of abortion, the fight against criminal abortions, medical examination of women within 1 year after childbirth, timely correction of identified violations and etc.
Pregnancy after surgical correction of intestinal-genital fistulas can be resolved no earlier than in 1-2 years due to the need to restore the function of the rectum, its sphincter and muscles pelvic floor. During this period, it is recommended to use oral contraceptives. The course of pregnancy in such women has no specific features. The method of resolution is a planned caesarean section. Spontaneous childbirth through the natural birth canal is contraindicated, as the risk of developing severe injuries soft birth canal, rectum, recurrence of fistulas.
Test questions:
List the causes of genital trauma.
The most common localization of injuries of the genital organs.
Symptoms of genital trauma.
Features of the examination of girls with injuries of the genital organs.
Principles of treatment of genital injuries.
Tactics of a doctor with a stable hematoma of the genital organs.
Tactics of a doctor with growing hematoma of the genital organs.
Principles of formation of genital fistulas.
What genital fistulas do you know?
Clinic of vesicovaginal fistula.
Clinic of rectovaginal fistula.
Diagnosis of vaginal fistulas.
When should a patient with a genital fistula be operated on?
Treatment methods for old perineal tears.
Methods of treatment of old ruptures of the cervix.
Task #1
A 12-year-old girl was admitted with complaints of pain and bleeding in the genital area. From the anamnesis it is known that an hour ago she fell while roller skating. On examination, there is a rupture of the mucous membranes of the labia and clitoris, swelling and cyanosis of the labia. During catheterization of the bladder, there is an admixture of blood in the urine. Diagnosis? Lead tactics?
Task #2
An ambulance delivered a 32-year-old woman on a stretcher with complaints of sharp arching pains in the area of the right labia, difficulty urinating. From the anamnesis it is known that about an hour ago she fell (sat down on the splits) while getting off the trolleybus. On examination: a state of moderate severity, the skin is pale, the pulse is 104 beats. in 1 min., BP 100/60 mm Hg. Gynecological status: the right labia is sharply enlarged, bluish-purple in color, sharply painful on palpation, tense, tight-elastic consistency. Bladder catheterization is difficult. Diagnosis? What to do?
In the presence of congenital pathologies or with trauma external influence scars may remain on the cervix. In addition to the fact that scars violate the anatomical structure of the organ, they also provoke improper functioning of the cervical canal. Usually, the deformation of the cervix is mild, so many female representatives are unaware that they have such a deviation.
Cicatricial deformities are detected in almost every second woman, and 70 percent of such pathologies are diagnosed in reproductive age. Usually, the disease is detected in primiparous patients who gave birth to a child over the age of thirty. If patients develop cervicitis, then the occurrence of cicatricial pathologies occurs much more often.
Since cicatricial deformity of the cervix is a rather difficult process and calls into question the normal bearing of the fetus and delivery, the relevance of the prevention of cervical cancer among women of reproductive age is increasing. Also, cervical deformities contribute to inflammatory processes in the genital organs and can provoke oncological pathologies.
Causes of the appearance of pathology
Violation of the anatomical structure of the cervix lead pathological processes accompanied by a violation of the integrity of the epithelium. Due to its damage, the body starts regenerative processes, during which damaged cells restored by connective tissue.
The most common reasons are as follows:
- the birth process that occurs with pathologies - these can be ruptures that occur during rapid labor with an incomplete cervical canal, the use of Lazarevich obstetric forceps, the patient's age is over thirty years;
- manipulations on the genitals, carried out in an invasive way - this includes all diagnostic and healing procedures that require the introduction of gynecological instruments through the cervical canal. Usually, during such procedures, a violation of the surface layer always occurs, and injuries occur;
- inaccurate suturing or errors in suturing wounds also cause scarring. In most cases, tissues are sutured during childbirth, as well as during surgical interventions leaving behind a scar on the surface of the neck.
Cervical deformity as a congenital defect is extremely rare. Usually scars accompany other deviations in anatomical structure organs of the genital area, for example, the bend of the uterus.
Why do cicatricial changes occur and how do they affect women's health?
When there is a replacement of normal connective tissue, the processes of regeneration of the endocervix and exocervix are disturbed. Normally, these areas are covered by epithelial tissue, however, in the zone of damage to its integrity, connective tissue cells are restored - occurs. At the initial stage connective tissue quite elastic, but as the post-traumatic is formed, the tissue thickens and becomes less extensible, the cells lose their ability to contract.
The main disadvantage of scarring is the incomplete closure of the cervical canal. Because of this, its main function is lost - protective, because the closed channel prevents infections from penetrating into the uterine cavity. In such a situation, labor activity is also complicated - childbirth threatens with incomplete opening of the channel and the need for more rough intervention or emergency. If the gaps were deep and the scars formed incorrectly, then the edges of the canal can be deformed and completely take the form of shreds. With the failure to perform its function, an ectropion may develop.
The degree of development of pathology
When diagnosing a disease, it is important to indicate the degree pathological changes. They are evaluated by the size and number of scars, the condition of the surrounding tissues. There are four degrees of severity of pathology:
- in the first degree will only pass the doctor's fingertip or. The cervical canal is conical in shape, the ruptures are single and not deep, reaching a maximum of up to two centimeters. The lower cervical canal has signs of ectropion;
- in the second degree, the uterine os is not detected, the endocervix turns outward, and the uterine neck is split, there are old gaps up to the arch, hypertrophy;
- at the third degree, ruptures are determined at the level of the arches, there are dysplastic changes in the epithelium, present;
- in the fourth stage of the pathology, old ruptures are combined, insufficiency of the pelvic floor muscles is diagnosed.
Depending on the definition of the degree of pathology, the treatment is selected for patients.
Symptoms
At the first degree of development of pathology, a woman practically does not feel the symptoms of the disease. The only deviation may be an increased secretion of cervical mucus. The second degree of development of the disease is already more aggressive - here the patients experience aching and pulling pains in the lower abdomen, in the lumbar region and sacrum.
When an infection is attached, the discharge takes on a characteristic yellowish-green tint, becomes cloudy. Usually menstrual cycle is not disturbed, but the duration of menstruation may increase by a couple of days. Approximately every tenth woman complains of pain during intimate contact. Also, a clear indication of problems with the cervix is an unsuccessful pregnancy, the impossibility of fully bearing a baby.
A significant complication of the pathology is infection, leading to the development of cervicitis. With functional insufficiency of the cervical canal, the infection can penetrate not only into the uterine cavity, but also into the fallopian tubes, into the ovaries. When too acidic environment appears , .
Diagnostics
To diagnose pathology, the doctor uses standard methods patient examinations:
The diagnosis is made upon detection of gross changes in the form of scarring on the cervix.
Treatment of pathology
With scarring of the cervix conservative treatment inefficient. Doctors prefer to treat scarring surgically, and the choice of a specific technique is determined depending on the condition of the cervix, the results diagnostic study.
Ablative techniques are applied through laser therapy, argon plasma therapy or radio wave treatment. Perhaps the use of cryotherapy or diathermocoagulation. These techniques will be effective at the first stage of pathology development, when the result of therapy is positive.
With the second or third degree of development of the pathology, the operation of tracheloplasty will be more effective. During the intervention by this method, the scars are removed, the tissues are stratified, and while maintaining the function of the muscle layer, the mucosa of the canal is restored, its shape improves.
Trachelectomy is also possible, in which the affected areas are amputated, but such operations are performed in those women who have entered the menopause and can no longer give birth.
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