How to treat cicatricial deformity of the cervix. Cicatricial deformity of the cervix: causes and treatment. Cervix after childbirth. Main causes of pathology

Cicatricial deformity of the cervix is a disease that represents changes 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 deformation, the mucous membrane of the cervical canal enters the vaginal canal, which has an acidic environment.

As a result of imbalance, the protective functions of the reproductive system weaken and it begins to malfunction. Mucous secretions change their composition. This contributes to the development of infectious and inflammatory diseases.

When replacement of normal connective tissue occurs, the regeneration processes of the endocervix and exocervix are disrupted. Normally, these areas are covered by epithelial tissue, but in the area where its integrity is damaged, connective tissue cells are restored and proliferation occurs. At the initial stage, the connective tissue is quite elastic, but as a post-traumatic scar forms, the tissue thickens and becomes less extensible, and the cells lose their ability to contract.

The most important disadvantage of scarring is incomplete closure of the cervical canal. Because of this consequence, its main function is lost - protective, because a closed canal prevents infections from entering the uterine cavity. In such a situation, labor is also complicated - childbirth threatens with incomplete opening of the canal and the need for more severe intervention or emergency caesarean section.

Causes of pathology

Most often, violations of the shape and integrity of the cervix occur as a result of:

injuries during childbirth, for example, due to cervical ruptures during the passage of the baby’s head;
damage that occurred due to improper positioning of the fetus;
violations of surgical techniques;
improper suturing.

These reasons lead to the fact that the physiologically normal structure of the cervical part of the uterus is disrupted. Scar tissue forms in the damaged areas and the cervix becomes deformed. Timely diagnosis and treatment can prevent future problems.

The highest risk of scar deformation occurs after assisted delivery using an extractor or medical forceps. Independent childbirth can lead to the development of pathology if it was complex and accompanied by multiple internal ruptures.

Pathological processes accompanied by a violation of the integrity of the epithelium lead to disruption of the anatomical structure of the cervix. As a result of its damage, the body launches regeneration processes, during which damaged cells are restored by connective tissue.

Cervical deformity as a birth defect occurs extremely rarely. Usually, scars are accompanied by other deviations in the anatomical structure of the genital organs, for example, a bend of the uterus.

The most common causes of pathology:

abnormal position of the fetus;
injuries received as a result of childbirth. As the fetus passes, the cervix ruptures.
incorrect surgical technique;
presence of a cyst.
improper suturing.
abortions.

In very extreme cases, the pathology may be congenital. Also, an obvious cause may be lengthening, narrowing or shortening of the cervical canal.

All of the above reasons fully influence the normal functioning of the organ and the development of the scar.

The main cause of cicatricial deformation of the cervix is difficult childbirth, which was accompanied by large ruptures and damage to the organ tissue. Moreover, such a pathology occurs both after spontaneous childbirth and after childbirth with auxiliary manipulations, for example, in the case of the application of medical forceps or fetal extraction.

Sometimes surgical interventions in the pelvic area, incorrectly applied sutures and surgical abortions through curettage lead to the development of cicatricial deformity.

It is very rare, but congenital deformation of the cervix occurs. In this case, it is associated with physiological hormonal imbalances.

Types of pathologies

Deformation of the cervix can be acquired or congenital. But congenital pathology is extremely rare. Hormonal imbalances in the body can lead to the appearance of pathology.

Doctors believe that congenital deformity can occur under the influence of negative factors on the mother’s body in the first 3 months of pregnancy. These include stress, infectious lesions, and intoxication. Also, the cause of a birth defect can be genetic failures. This 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 also 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 canal: incorrect arrangement of muscle fibers leads to the appearance of a funnel-shaped cervical canal;
lengthening or shortening: length is less than 35 mm or more than 45 mm.

These cervical deformities lead to disruption of menstrual and reproductive function. Women who are planning a pregnancy must select the optimal treatment tactics.

Degree of development of pathology

When diagnosing a disease, it is important to indicate the degree of pathological changes. They are assessed by the size and number of scars, and the condition of the surrounding tissues. There are four degrees of severity of pathology:

in the first degree, the pharynx will allow only the tip of the doctor's finger or the entire finger to pass through. The cervical canal is conical in shape, the gaps are single and not deep, reaching a maximum of two centimeters. The lower cervical canal shows signs of ectropion;
in the second degree, the uterine os is not detected, the endocervix is turned outward, and the uterine cervix is split, there are old tears up to the fornix, hypertrophy;
in the third degree, ruptures are determined at the level of the vaults, there are dysplastic changes in the epithelium, there is inflammatory process;
in the fourth stage of the pathology, old ruptures are combined, and insufficiency of the pelvic floor muscles is diagnosed.

Depending on the degree of pathology, treatment is selected for patients.

4 Effect 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 sperm into the uterus and their normal functioning;
due to a violation of the protective mechanism, the risk of miscarriage and the possibility of infection of the fetus through the vagina increases.

During pregnancy, a woman with a deformity is advised to maintain sexual rest and limit physical activity. If during childbirth the cervix opens on its own, the birth process passes through the natural birth canal. If there is no dilatation, a cesarean section is performed.

Symptoms

It is almost impossible to suspect many violations on your own. Only a gynecologist can tell by visual examination that a woman has a deformed cervix. Despite the absence of symptoms, the seriousness of the pathology cannot be underestimated, because any change in the structure and shape of this organ can lead to negative consequences.

Some women who are found to have a deformity upon examination come to the examination with complaints. They talk about:

aching pain in the pelvic area;
copious whitish discharge;
menstrual irregularities;
pain (lack of sensitivity) during sexual intercourse;
scanty menstruation, as blood flow is difficult.

After a gynecological examination, the doctor sends the woman for additional diagnostics: a biopsy, colposcopy, and a smear for cytology. Bacteriological cultures and PCR tests are also carried out to identify infectious diseases.

Once the tissue is torn, healing begins. The process is the replacement of organ tissue with connective tissue. In this case, the following processes are observed:

disturbances in blood microcirculation occur;
redistribution of nerve cells occurs;
trophic changes in the structure of the canal develop, which contribute to its deformation and eversion of the mucous membrane into the vaginal canal;
sometimes cervicovaginal fistulas form.

For a long time, the pathology does not manifest itself externally. As it progresses, the following appear:

aching pain in the pelvis, radiating to the lower back;
disturbances and disruptions in the duration and frequency of the menstrual cycle;
pain during sexual intercourse;
heavy menstrual flow;
stretchy white vaginal discharge.

Complications of cicatricial deformity of the cervix include:

cervicitis;
endometritis;
endocervicitis;
erosion;
keratinization of cervical canal tissue;
disruption of epithelial development;
oncology.

At the first stage of development of the pathology, the woman practically does not feel the symptoms of the disease. The only deviation may be increased secretion of cervical mucus. The second stage of development of the disease is already more aggressive - here patients experience aching and nagging pain in the lower abdomen, in the lumbar region and sacrum.

When an infection occurs, the discharge takes on a characteristic yellowish-green tint and becomes cloudy. Usually the menstrual cycle is not disrupted, but the duration of menstruation may increase by a couple of days. About every tenth woman complains of pain during intimate contact. Also a clear indication of problems with the cervix is an unsuccessful pregnancy, the inability to fully bear the 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 and ovaries. If the environment is too acidic, erosion and dysplasia appear.

Pathology can be detected through a visual examination by a gynecologist.

General symptoms:

menstrual irregularities;
pain in the pelvic area;
pain during sexual intercourse;
constant discharge from the genitals.

Quite often, cicatricial deformation of the cervix does not manifest itself for a long time. But sometimes symptoms of the disease are present. Signs of pathology include the following manifestations and conditions:

white, stretchy vaginal discharge;
severe aching pain in the pelvis and lower back;
irregularities in the menstrual cycle;
heavier menstrual flow;
pain during sexual intercourse.

Complications of cicatricial deformity of the cervix include: endometritis, cervicitis, endocervicitis, cervical erosion, keratinization of cervical canal tissue, atrophy and abnormal development of the epithelium, and cancer. This pathology is often an obstacle to conceiving and bearing a child.

Diagnostics

If the nature of discharge or the composition of mucus changes, pain or bleeding occurs, you should immediately visit a gynecologist. The doctor will examine you using a mirror or colposcope. Signs of cicatricial deformation of the cervix are:

eversion of the canal;
the presence of scars near the sutures that arose during the suturing of birth ruptures.

During colposcopy, the doctor examines changes in the surface of the cervical canal, complications of pathology, and collects 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 tests:

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 pathology from secondary weakness of labor. The latter is characterized by slow dilatation of the cervix (insufficient for normal childbirth), but with positive dynamics. With deformation, opening does not occur at all; instead, the doctor may notice a curvature of the organ.

The diagnosis is made when gross changes in the form of scarring are detected on the cervix.

Often, this type of disease is discovered during a routine examination, since the patient does not have any specific symptoms or complaints.

Pathology can be detected by examination in the mirrors, with the condition that the patient will have a scar deformity, because with a normal one, this method will be of little information.

When doing a general clinical analysis, you will notice that urine and blood will be in normal values. The essence of this method will determine the presence of an inflammatory process.

Smears from the cervical canal will also be uninformative.

The key diagnostic method is instrumental examination. With its help, you can visually assess the condition of the organ and understand whether there is a place for this pathology.

Ultrasound examination - cervicometry - is used to make a diagnosis.

Thanks to ultrasound waves, it is possible to obtain information about the size of the cervix, to understand whether there is pathological lengthening and shortening and the presence of cicatricial deformation.

A mandatory procedure is colposcopy, a procedure using an optical system that provides a 30-fold magnification of the image of the cervix.

An additional method of research is a biopsy - it allows you to obtain a small section of the mucous membrane for a more in-depth study.

Bacteriological tests - to determine the microorganisms of the virus and infection. The most common infection is human papillomavirus.

Primary diagnosis is carried out by a gynecologist when examining the patient on a chair using special mirrors. To clarify the diagnosis, the doctor takes smears for cytology, prescribes PCR diagnostics and bacteriological tests. An informative method for confirming or rejecting the diagnosis is colposcopy. During the procedure, the specialist examines changes in the surface and appearance of the folds of the part of the cervical canal that is inverted into the vagina. Also, the gynecologist determines complications of the deformity and performs a biopsy of pathological tissues for further histological examination.

In case of congenital deformation, the patient is prescribed a series of hormonal blood tests.

Treatment

After completing the diagnosis, the doctor selects the most appropriate therapy, focusing on the patient’s general condition, her age and identified concomitant diseases.

Treatment is required in cases where the pathology is found only in women of reproductive age. During the period after menopause, you should not try to change the condition of the cervix, because the deformation itself is not dangerous.

The remaining patients can be prescribed surgical or conservative treatment. Surgical methods are used for significant deformities. Most often, doctors recommend using minimally invasive treatment methods. For example, if the canal is narrowed or obstructed, bougienage is prescribed. Patency is restored using a special medical instrument - a bougie.

If the deformation of the cervix is serious, then plastic surgery is performed. The deformed part is excised, and the remaining tissue is sutured. Laser and radio wave treatment methods are popular; many clinics use cryodestruction or diathermocoagulation of problem areas.

Conservative treatment of cervical deformities includes:

massage designed to improve the outflow of lymph and blood;
performing physical exercises to strengthen the muscles of the perineum;
medicinal methods.

Drug treatment of deformity refers to methods of symptomatic therapy. Most often they are used to stimulate labor. In maternity hospitals, the opening of the cervix is stimulated with the help of kelp. This is seaweed in the form of sticks that is inserted into the vagina. They increase several times and provoke the opening and smoothing of the cervix.

For the symptomatic treatment of deformity during childbirth, the use of prostaglandins, E2-misoprostol, is popular. They stimulate the onset of labor.

If a deformity is detected during a routine gynecological examination, you should not wait for pregnancy. The doctor will prescribe one of the surgical treatment methods. This minimizes the likelihood of problems occurring during pregnancy and childbirth.

The method of treating the pathology is selected depending on the individual characteristics, age of the patient, general clinical picture, and the presence of complications. The main treatment method is surgery. It can be destructive or surgical:

During surgery, excision or conization of the cervix may be performed. If the pathology is severe, plastic surgery to reconstruct the organ is additionally prescribed. The operation is performed not only with a scalpel, but also with ultrasound, laser, radio wave and electrical methods. The excised tissue can be sent for research.
Destructive methods are used if the deformation is minor. In this case, the doctor is faced with the task of destroying pathological tissues. Most often, one of three methods is used: laser vaporization, diathermocoagulation, cryodestruction.

The purpose of surgery is to excise the area of scar tissue and restore the normal anatomical position of the cervix.

If the disease is diagnosed at an early stage, intervention will be the least difficult. Timely detection of pathology is facilitated by periodic gynecological examinations after a difficult birth or surgical abortion.

For cervical scarring, conservative treatment is ineffective. Doctors prefer to treat scarring surgically, and the choice of a specific technique is determined depending on the condition of the cervix and the results of a diagnostic study.

Ablative techniques are used through laser therapy, argon plasma therapy or radio wave treatment. It is possible to use 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, tracheloplasty surgery will be more effective. When performing an intervention using this method, scars are removed, tissues are exfoliated, and while maintaining the function of the muscle layer, the mucous membrane of the canal is restored and its shape is improved.

Conization and trachelectomy are also possible, in which the affected areas are amputated, but such operations are performed on those women who have entered menopause and can no longer give birth.

The method of treating cervical deformity is selected depending on the general clinical picture, the patient’s age, and the presence of complications. Its goal is to excise the pathological area, restore the anatomically correct position of the cervix and normal microflora of the vaginal canal, as well as restore reproductive function.

The main method of treating cervical deformity is surgery. It comes in two types: surgical and using destructive methods.

Surgery can be performed using excision or conization of the cervix. If the pathology is quite severe, the patient is prescribed reconstructive plastic surgery. Modern surgical methods include laser, ultrasound, electrical and radio wave operating methods.

Destructive methods are used for mild cases of the disease. They are aimed at destroying pathologically affected tissues. The most well-known destructive methods of treating deformity are cryodestruction, laser vaporization and diathermocoagulation.

Cervical deformity is a rather dangerous disease. Therefore, at the first discomfort, a woman should consult a doctor. Also, do not neglect regular preventive examinations with a gynecologist, which will allow you to diagnose the pathology in a timely manner.

Therapy

Before treatment, screening for sexually transmitted infections is mandatory.

If an infection is detected, appropriate treatment is prescribed.

After you finish taking the medications and the infection is cured, you can begin therapy.

Treatment has different types:

operational, chemical - use of various solutions;
hardware - laser method, cryodestruction, radio wave method.

Surgical intervention is prescribed for significant deformation, since minimally invasive is considered optimal. For example, in case of poor patency of the cervical canal, it is prescribed.

A bougie is a long rod designed for diagnosing and treating hollow organs.

Damaged tissue is removed through surgical manipulation.

Prescribed for both treatment and diagnosis. The procedure is painless, safe and highly effective.

Conservative therapy consists of:

medicinal – prescribing medications, most often for symptomatic treatment;
massage - to stimulate the inflow and outflow of lymph and blood;
physical exercise.

Thanks to all these methods, complete recovery for the patient is guaranteed.

The healing process is not the fastest, but in most cases it has a successful ending.

Symptoms and complications

Do not forget that if treatment measures are not taken in time, there is a risk of complications.

The duration of the disease can lead to cancer.

Today, cervical cancer ranks second among cancer diseases.

Other complications include: abortion and failure to carry the child to term.

Be sure to discuss with your doctor the advantages and disadvantages of each examination method, choose the most optimal one and maintain your health. Timely diagnosis, treatment and prevention are the key to a healthy woman.

This pathology of the cervix occurs after its rupture during childbirth, less often after surgery. The patient's main complaints are pain, sometimes contact bleeding, pain when an ascending infection occurs. Such patients often experience miscarriage due to isthmic-cervical insufficiency or infertility.

The diagnosis is made based on medical history, careful examination using mirrors and bullet forceps.

Treatment of cicatricial deformity of the cervix is only surgical and is carried out after preliminary colposcopy, cytology, and targeted biopsy. The purpose of surgical interventions (Emmett's operation, flap method) is to restore not only the ectocervix, but also the correct fusiform shape of the cervical canal, which is of great importance for restoring its normal contents and reproductive function. Less commonly used are Sturmdorff cervical amputations and high cervical amputations. But the operation of choice for cicatricial deformation of the cervix is the operation of cervical plastic surgery using the dissection method according to V.I. Eltsov-Strelkov, which restores not only the shape, but also the anatomy of the cervix.

Genital fistulas (genitourinary and entero-genital)

Genital fistulas are among the most serious diseases of women, leading to multiple organ disorders, long-term and permanent loss of ability to work, as well as causing deep moral and physical suffering, disruption of menstrual and reproductive functions.

To date, the true incidence of genital fistulas is unknown. This is due to the fact that such patients are treated in urological, general surgical, proctological hospitals, and only a small part - in gynecological hospitals. The frequency of genitourinary fistulas of obstetric-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 clinics - 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 - 15.1%, abdominal wall fistulas - 11.2% . The most rare cases 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, with obstetric injuries predominating. After spontaneous childbirth, fistulas are observed 2 times less often than after surgical ones. It was revealed 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 trauma in 4.1%. Of the non-traumatic factors, inflammatory diseases prevail - from 1.7 to 45%, and developmental defects - 1.2%.

Based on etiology, there are three groups of genital fistulas:

Traumatic, resulting from:

a) obstetric or gynecological operations;

b) spontaneous birth;

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 tumor disintegration;

b) radiation fistulas.

The main etiological factors for the occurrence of fistulas are:

Pathological childbirth (especially 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 classifying genital fistulas has not yet been resolved and existing classifications are based on topographic-anatomical and etiological principles. D.V. Kahn (1986) proposed to systematize genitourinary fistulas as follows:

vesical (vesico-vaginal, vesico-uterine, vesico-adnexal);

ureteral (ureteral, uretero-vaginal, uretero-uterine);

urethrovaginal and urethrovesical-vaginal;

combined;

complex genitourinary fistulas.

Fistulas can vary in their shape: cylindrical and funnel-shaped, as well as in the direction of the fistula tract: direct and indirect. In addition, genital fistulas are divided depending on topographic-segmental features into low, medium, and high. In addition, it is advisable to distinguish vesicogenital fistulas according to clinical and functional criteria: with and without renal dysfunction. This division allows you to outline a plan for examination and preoperative preparation, determine the timing of surgical intervention, access and method of operation.

Clinical manifestations genital fistulas are sufficiently characteristic. The most characteristic symptoms are involuntary discharge of urine from the vagina, release of gases, pus, and sometimes feces. The long-term existence of a fistula is complicated by the development of cystitis, colpitis, dermatitis on the anterior and inner surface of the thighs, and menstrual dysfunction (even amenorrhea). The mental state of patients changes sharply: they are depressed due to dysfunction of urination and the pungent smell of decomposed urine, sometimes gases and feces emanating from them. All this deprives them of their ability to work, often leading to depression.

Diagnosis genital fistulas are established on the basis of medical history: patient complaints, external examination, vaginal and recto-vaginal examination, examination using vaginal speculum, as well as probing of the fistulous tract and fistulography. A dye solution (methylene blue) injected through a catheter into the bladder or directly into the fistula tract helps determine the presence of a fistula. The localization of the fistula can also be clarified using sigmoidoscopy, fibrocolonoscopy, chromorectoromanoscopy, vaginography, hysteroscopy, cystoscopy, and ultrasound of the kidneys. If changes are detected by 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 tract, urine, and blood is carried out.

Treatment surgical treatment for patients with genital fistulas. The surgical technique is described in detail in the specialized literature (Ya.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 for genital fistulas requires high professional skills, clinical approaches, material support and is the province of a relatively small number of clinics not only in our country, but also abroad. It is advisable to perform surgical treatment of a fistula no earlier than 3-6 months. after its occurrence, since small fistulas can heal spontaneously. This 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 to the bladder, bowel or ureter caused during surgery. These damages must be immediately repaired as soon as they are discovered.

Preoperative preparation is important for the success of the operation. Its nature and duration are determined individually, taking into account the bacterial flora, the condition of the fistula tract and the tissues around it, the patient’s age and extragenital pathology. Preoperative preparation includes local and general effects. The first ones are aimed at sanitizing the operation area, improving tissue trophism and the 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 is prescribed with an aqueous solution of chlorhexidine, treatment of the vagina with metronidazole preparations (Klion-D, Flagyl, Metragil) with simultaneous oral administration of Trichopolum; if there are yeast-like fungi in the smears, it is advisable to carry out treatment 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), immunostimulating agents, vitamins B and C. General preparation includes the prevention of thromboembolic complications: aescusan and troxevasin are prescribed. If fistulas are accompanied by concomitant general intoxication of the body, it is necessary to prescribe broad-spectrum antibiotics, intravenous metragil, and detoxification drugs. In these cases, preoperative preparation increases to 14-20 days. For genitourinary 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, and reject necrotic masses in the fistula area. The operation should be performed in the first phase of the menstrual cycle, which allows creating better conditions for tissue regeneration under the influence of estrogens, as well as ensuring the formation of a scar before menstruation and thereby minimizing the risk of infectious and purulent complications.

Treatment of patients with rectovaginal fistulas is associated with significant difficulties. To date, more than 100 surgical methods 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 approaches, but currently the most widely used is the vaginal access, which makes it possible to eliminate the rectovaginal fistula by splitting the tissue of the rectovaginal septum.

As a ligature material, it is best to use long-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 characteristics of the area where the operation is performed, the degree of infection, the quality of preoperative preparation, the correct choice and method of qualified operation, and rational management of the postoperative period. In addition, a 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 occur most often, 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 genitourinary diaphragm are covered with some tissue on which salts are not deposited, a muscle-fat flap of the labia majora; use the plastic properties of the greater omentum and peritoneum. Spread out small intestine, lyophilized dura mater, preserved pericardium, gold foil, synthetic materials, etc. have proven themselves well. Vaginal, transvesical, transvaginal, abdominal and combined approaches are used. The location of the fistula, its size and relationship to the orifices of the ureter are of decisive importance in the choice of surgical approach.

Prevention genital fistulas is a system of sequentially performed medical and social measures: prevention of obstetric injuries, predicting the outcome of childbirth, qualified and careful performance of all obstetric and gynecological operations and manipulations, increasing the surgical training of obstetricians and gynecologists, timely and correct surgical correction of acutely developed complications, as well as comprehensive medical examination, early detection and timely treatment of inflammatory diseases of the internal genital organs, improvement of contraceptive methods, health education 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 1-2 years due to the need to restore the function of the rectum, its sphincter and pelvic floor muscles. During this period, it is recommended to use oral contraceptives. The course of pregnancy in such women does not have any specific features. The method of resolution is a planned caesarean section. Spontaneous birth through the birth canal is contraindicated, since there is a high risk of developing severe injuries to the soft birth canal, rectum, and recurrence of fistulas.

Control questions:

Name the causes of genital injuries.

The most common location of genital injuries.

Symptoms of genital injuries.

Features of examination of girls with genital injuries.

Principles of treatment of genital injuries.

Doctor's tactics for stable genital hematoma.

Doctor's tactics for 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.

Treatment methods for old cervical ruptures.

Task No. 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?

Problem No. 2

A 32-year-old woman was transported by ambulance on a stretcher with complaints of sharp bursting pain in the area of the right labia and difficulty urinating. From the anamnesis it is known that about an hour ago she fell (sat on the splits) while getting off the trolleybus. On examination: moderate condition, pale skin, pulse 104 beats. in 1 min., blood pressure 100/60 mm Hg. Gynecological status: the right labia is sharply increased in size, bluish-purple in color, sharply painful on palpation, tense, with a tight-elastic consistency. Catheterization of the bladder is difficult. Diagnosis? What to do?

Cervical deformation is a change in the natural state of the cervix, as well as its vaginal part. Most often, deformation of the cervix occurs after abortion, during childbirth, since small cracks and tears form during the passage of the fetus through the cervix, 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 smoothes, allowing it to open 8-10 cm and allow the baby's head to pass through easily. Quite often, cervical ruptures occur during the passage of the fetus through the birth canal. The causes of these undesirable phenomena may be: previous ruptures during childbirth, high weight of the child, gynecological operations, abortions, weak labor followed by rapid labor, incorrectly selected obstetric forceps, untimely strong attempts. As a result, cervical ruptures form. Tears and cracks can be of different depths and even touch the vagina and the uterus itself. Therefore, at the end of labor, the doctor is obliged to carefully examine the cervix and the uterus itself for ruptures. If any are detected, they are sutured with special threads, which will resolve themselves over time.

If not all ruptures were detected and sutured, the cervix becomes deformed, its shape and pharynx change. The woman in labor herself may not feel any changes. Most often, an irregular cervix does not cause any concern to the woman and does not in any way affect the patient’s well-being. But this factor can play a decisive role in planning a future pregnancy, since an abnormal cervix can lead to involuntary miscarriages, bleeding, leakage of amniotic fluid and, as a result, premature birth. Therefore, it is very important after childbirth to undergo an examination of the cervix 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 incorrectly sutured or not sutured at all become healed. After which the woman develops cicatricial deformity of the cervix. In this case, the cervix becomes deformed and turns into the vaginal part. Cicatricial deformation of the cervix can lead to many diseases: infectious, severe inflammatory processes, which can be aggravated by purulent rashes, hardening of the endometrium, cervical erosion and even the formation of cancer cells. For women who are trying to get pregnant or carry a child to term, cervical scarring can be a significant cause for concern.

Very often, cicatricial deformation of the cervix does not manifest itself in any way, although obvious signs of this pathology may be: disruptions in the menstrual cycle, as well as profuse discharge during the cycle itself, unpleasant pain in the lower abdomen, painful sexual intercourse, white discharge that 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 using mirrors, a colposcopy, cytology of smears will be prescribed, and you will also need to take some tests. If, nevertheless, you have been diagnosed with 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, original 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 experience 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 severe changes in the cervix, or rather, its inversion into the vaginal part, a woman can develop: keratinization of the tissues of the cervical canal, death of the epithelium, endometritis, cervicitis, erosion, inflammatory processes and even cervical cancer. Therefore, you should not delay timely treatment for long, which can prevent many health problems in the future.

Cervical deformity: treatment

When choosing treatment for cervical deformity, many factors are taken into account: what caused the development of the disease, the degree of tissue damage, the patient’s age, concomitant infections and inflammatory processes. Most often, cervical deformity is treated through surgery or destructive methods. If the changes are minor, the tissues are not deeply affected, then laser plastic surgery, cryodestruction or diathermocoagulation are prescribed. If the deformation is significant enough and there are prerequisites for the presence of neoplasms, then reconstructive plastic surgery or excision of the cervix is performed.

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 the woman will be able to become pregnant and bear an absolutely healthy baby.

Deformation of the cervix is not as scary as it seems at first glance, because the disease can be diagnosed and treated, after which you will be able to plan a pregnancy and get rid of many associated diseases. The main thing is to seek help from a specialist in time.

Among the background diseases of the cervix, cicatricial deformity (CSD) occupies an important place mainly due to the consequences. And they are very serious: from impaired reproductive functions of the female body to cervical cancer.

Women of childbearing age most often encounter such deformities. Therefore, any woman should know about the pathology itself and its consequences, as well as what to do if it has been diagnosed.

General concept

Most people know what a scar or scar is. This is a formation consisting of connective tissue that appears as a result of the healing of deep wounds, injuries or inflammatory diseases.

It's not just the skin that heals with a scar. The mucous membranes of the stomach and intestines (after ulcers and operations), the uterus and cervical canal, and the gallbladder scar, and the myocardium scars after ischemia. The tissue of almost any organ can heal with a scar.

Scar tissue is mainly represented by collagen, they are dense and can cause deformation of the organ. Due to their appearance in the surrounding tissues, blood microcirculation processes are disrupted, and consequently, their trophism (nutrition) suffers. The innervation of the tissue may be disrupted.

The connective tissue of the scar is not able to perform the function of the tissues that it replaced.

Consequences

Since the scar is not functional as the mucous lining of the cervix (cervical canal), the mucosa partially loses its function. As a result, cicatricial deformation of the cervix:

Leads to a decrease in the barrier functions of the mucous membrane of the cervical canal due to disruption 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 maintain their integrity. They continue active contractions without encountering resistance from the circular muscles. The external os of the cervix undergoes deformation, turns out and sags in 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 reproductive organs to inflammatory processes:

Endocervicitis.
Endometritis.
Ectopia and true erosion.
Tissue atrophy.

The main feature of a healthy cervix is the presence of a mucus plug, which is formed and located in the canal due to its special spindle-shaped shape. And it is she (the plug) 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 of cervical cancer. The formation of scar tissue can cause a deviated cervix. Such changes, complementing each other, become a threat to the reproductive function of the female body, leading to:

Infertility.
Miscarriages.
Bleeding.
Leakage of amniotic fluid during subsequent pregnancies.
Premature birth.
Impaired ability to give birth independently and the need for operative delivery.

In addition, the formation of scars and curvature of the cervix can cause discomfort and pain in a woman.

Causes

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 injuries, resulting from abortions, diagnostic curettages and other reasons).
Surgical interventions.
Inflammation (chronic and severe), leading to adhesive changes and tissue scarring.

Most often, cervical deformation appears after childbirth. This leads to:

Birth of a large fetus (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 tears.
Untimely and excessive attempts.

There may be other provoking factors that cause a violation of the integrity of the cervix.

Such tears can be of different depths and lengths, touch the uterus and disrupt the integrity of the vaginal tissue. If ruptures are detected promptly and properly sutured, they usually heal without deformation.

The suture material used to close internal tears is self-absorbing. Therefore, there is no need to remove sutures; the damage (if there is no secondary infection) heals well.

If not all tissue tears were stitched up, most likely they will still heal, 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, mild cicatricial deformity of the cervix does not manifest itself symptomatically. And it is discovered only as a result of a gynecological examination. If the changes are pronounced, unpleasant symptoms may appear:

Pain in the pelvic area radiating to the lumbar area.
Discomfort in the lower abdomen (heaviness and pronounced nagging discomfort).
Discharge (white, mucous, stretchy).
Painful intercourse.
Heavy periods with severe pain.
Shift in the menstrual cycle.

If the pathology is primary, then in addition to the described disorders there may be cycle disorders, early menarche, severe and painful bleeding.

Diagnostics

The main diagnostic method is a gynecological examination by a gynecologist. It’s just that mild scarring of the cervix and eversion of the mucous membrane into the vagina present 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 techniques used by the gynecologist are:

Colposcopy.
Cytological analysis of tissues.
Examination of vaginal secretions for the presence of pathogenic bacterial microflora.
Blood tests (the PCR method is most often used).

If primary deformation is suspected, the patient is asked to undergo blood tests for hormones.

Treatment

Therapeutic tactics are developed for each patient separately. And it depends on several factors:

Severity of the condition.
Realization of childbearing function (that is, whether the woman has children).
Age.
Associated pathologies.

Destructive methods and surgical plastic surgery are used to treat this pathology. The main therapeutic task is not only the elimination of scar changes in the cervix and returning it to its physiological position.

Therapy solves several other important problems:

Returning a woman's ability to reproduce.
Restoring the barrier functions of the cervical mucosa.
Normalization of vaginal microflora.
Prevention of mucosal atrophy and its cancerous degeneration.

Destructive methods give good results with mild scarring. Thanks to them, the altered tissues are destroyed and the normal lining of the cervix is restored.

There are several destructive techniques, the main ones are:

Diathermal coagulation.
Cryogenic destruction.
Laser evaporation (vaporization).

Modern bloodless surgical techniques include ultrasound, radio waves and electrical methods that allow the destruction of pathologically formed tissues.

Severe cicatricial deformity of the cervix is corrected by excision. The average postoperative period is 10 days, the average recovery period is 90 days. At the same time, experts advise sexual abstinence. In addition, the woman is recommended to have a gentle work regime (physical exertion should be avoided), and the rules of intimate hygiene must also be strictly followed.

Cicatricial deformation 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, antibacterial therapy is recommended for patients to eliminate inflammation. Or the use of 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 proceeded without complications.

Prevention

There are no ways to guarantee the avoidance of damage to the cervix and the formation of scars on its mucous membrane. Much depends on the specialists that a woman will have to contact during pregnancy and childbirth.

The girl must understand that she is required to follow certain rules:

The use of modern contraceptive methods to avoid unwanted pregnancy and abortion.
The choice of a sexual partner and the absence of casual relationships to minimize the risk of contracting STDs.
Timely consultation with a doctor for the treatment of inflammatory diseases of the female genital organs.

Paying close attention to your own body will reduce the risk of developing pathology and its consequences.

Cicatricial deformation of the cervix is a dangerous pathology. In modern medical practice, such a disease is diagnosed relatively rarely. The deformation covers the cervical and vaginal canals: the structure changes and, as a result, the organs of the reproductive system are displaced. Against the background of pathology, the risk of developing malignant diseases increases, so in no case should you ignore the problem.

How does cicatricial deformity of the cervix develop?

The so-called cervical canal passes through the cervix. Its walls are covered with columnar epithelium. It is here that specific mucous secretions are produced and a plug is formed that protects the uterine cavity from the penetration of pathogenic microorganisms.

Sometimes, as a result of injuries and inflammatory processes, damage to the tissues of the genital organs occurs, followed by scarring. The structure and length of the cervix changes, and the cervical canal everts and moves into the vaginal cavity. As you know, the environment here is acidic, and an alkaline reaction is necessary for the normal functioning of the endocervix.

Changes in the acidity of the environment provoke the development of inflammatory processes, as a result of which the nutrition of the epithelial cells of the cervical canal is disrupted. The chemical composition of the mucus produced is disrupted, which makes the tissue more susceptible to infection.

Main causes of pathology

If large children are born, then this is very good. At least, this is the opinion among the people. But doctors do not agree with this. The birth of a child whose weight exceeds 3.5 kg is already considered potentially dangerous, because in such cases there is a high probability of injury. Tears and other damage to the tissues of the internal genital organs require sutures.

Quite often, the cervix does not fully recover after childbirth, and scars form on it. Scar tissue is different from healthy structures—it is rough and inelastic. A large number of scar formations deform the cervix, which is fraught with dangerous consequences.

Risk factors include not only difficult childbirth. Scar formation is possible after abortions and diagnostic procedures if cervical tissue was damaged during the process. In some cases, deformities are congenital. The list of reasons includes serious hormonal imbalances.

What symptoms should you pay attention to?

Cicatricial deformation of the cervix often occurs without any symptoms. In most cases, pathology is accidentally discovered during a routine gynecological examination. However, some violations are still possible. Their signs include:

Disruptions of the menstrual cycle.
An increase in the volume of menstrual flow, sometimes even to the point of bleeding.
The appearance of thick, stretchy white vaginal discharge.
Aching pain in the lower back and pelvic area (sometimes they become quite intense).
Some patients report pain during intercourse.

These symptoms cannot be called specific, because the same clinical picture can be observed in various diseases of the pelvic organs. However, if there are any violations, you should consult a doctor.

Possible complications

Changes in the acidity of the environment increase the susceptibility of the tissues of the internal genital organs to infections. Cicatricial deformation of the cervix increases the likelihood of developing endometritis, cervicitis and endocervicitis.

In turn, these inflammatory diseases can lead to keratinization and atrophy of the epithelial tissues of the endocervix. Against the background of such a pathology, the presence of deformities often develops and negatively affects the reproductive functions of the body. Violation of tissue trophism leads to improper cell development - there is a possibility of malignant degeneration and the development of cancer.

Effective diagnostic methods

Diagnosis of such a pathology is rarely difficult. Cicatricial deformity of the cervix is detected during examination with the help of a doctor may notice displacement of the cervical canal, eversion of the mucous membranes, and the presence of scar formations.

Additionally, colposcopy is prescribed. During the procedure, the gynecologist can assess the degree of change in the folds of the cervical canal. As a rule, a biopsy is performed - tissue samples are taken for further laboratory analysis. The study makes it possible to detect cancer cells. Additionally, smears are taken to determine the composition of the bacterial microflora.

In some cases, an ultrasound examination of the pelvic organs is performed. For congenital deformities, patients undergo tests to determine hormone levels.

Treatment of cicatricial deformity of the cervix

The treatment regimen is drawn up individually, because it is necessary to take into account the patient’s age, her hormonal status, the amount of scar tissue, and the presence of concomitant diseases. The goal of treatment is to restore the structure of the uterus, normalize the reproductive and protective functions of the reproductive system.

Drug therapy is advisable only if the disease is associated with hormonal imbalances or inflammatory processes.

Next, the doctor decides on the tissue method. If the affected areas are small, then gentle destructive methods are used. Scars are removed by cryodestruction (freezing with liquid nitrogen) and diathermocoagulation (the affected tissue is exposed to high-frequency currents). The beam is also considered effective.

Surgical intervention: features of the procedure

In some cases, complete surgical intervention is necessary. If the patient is a woman past reproductive age, the doctor may recommend trachelectomy. During the procedure, the cervix is completely excised, and the uterus itself is sutured - this helps prevent it from descending into the vagina.

Young patients are prescribed surgery during which only scar tissue is removed. Excision using a laser beam is considered safer, since the risk of complications (infection, the appearance of new scars) in this case is much lower.

When removing a large amount of affected tissue, patients need another operation - cervical plastic surgery. The procedure is aimed at restoring the normal shape of organs.

Scar deformity and pregnancy

What to do if the cervix was deformed after childbirth? The presence of changes in the structure of the genital organs does not mean that a woman cannot conceive. But cicatricial deformation of the cervix has a negative effect on subsequent pregnancies, as the likelihood of spontaneous abortion increases. In addition, there is a risk of infection of the fetus, since pathogenic microorganisms against the background of this pathology easily penetrate from the vagina into the uterine cavity.

However, pregnancy is possible. The decision about the need for treatment in this case is made by the doctor. Expectant mothers are advised to carefully monitor their health, eat right, avoid physical activity, adhere to personal hygiene rules and refuse sexual intercourse.

Often, women with scar deformities even give birth naturally, although they sometimes cannot do without a cesarean section.