Why do pregnant women need an obstetric pessary? Obstetric pessaries

One of the most unpleasant complications of pregnancy is isthmic-cervical insufficiency (ICI). It is she, according to various sources, that causes from 15 to 42% of spontaneous miscarriages. It is especially dangerous that in many expectant mothers, ICI does not manifest itself in any way and is not diagnosed until the onset of the second trimester of gestation. In cases where the presence of a pathology creates a risk of premature termination of pregnancy, the situation can be corrected with the help of an unloading obstetric pessary.

The principle of operation and types of device

Clinically, ICI is manifested in the fact that the cervix shortens and softens long before the term of delivery. As the fetal egg grows, the pressure on the cervix increases, it gradually opens. The result can be a discharge of amniotic fluid, which causes a halt in the development of the fetus in the second or third trimester and subsequent miscarriage. To prevent this from happening, the installation of an obstetric pessary is recommended.

The use of this device allows you to stop the process of opening the cervix, reduce the pressure on it of the fetal egg and prevent miscarriage. An obstetric pessary is a device that is inserted into the vagina and put on the cervix. The device is made of durable and plastic material. The shape of the pessary can be different: ring-shaped, funnel-shaped, oval and even cubic. The efficiency of the device is about 83%, provided that it is correctly selected and installed.

Devices are of three different types. The choice of a particular model depends mainly on the size of the woman's reproductive organs:

• Type 1 obstetric pessary is installed in cases where the length of the upper third of the vagina is 55-65 mm, and the diameter of the cervix does not exceed 30 mm;
• Device type 2 is used when the length of the upper third of the pregnant woman's vagina is 66-75 mm with a cervical diameter of 25-30 mm;
• When the length of the upper third of the vagina is more than 76 mm and the diameter of the cervix is ​​from 31 to 37 mm, a type 3 pessary is used.

Obstetric pessaries of type 1 and 2 are installed during the first or second pregnancy. If a woman has already carried two or more babies, a type 3 device is preferred. In any case, it is up to the doctor to decide which type of device will be used.

When and to whom can an unloading obstetric pessary be installed

Indications for the use of the device are:

• Diagnosed CCI or the risk of its development;
• Multiple pregnancy;
• The presence of one or more spontaneous miscarriages in history.

Insertion of a pessary is usually painless. The procedure is performed on an outpatient basis, usually at 23-24 weeks of gestation, and takes no more than 10 minutes. Unpleasant sensations during the introduction may be associated with the wrong choice of type (size) of the device. If the pessary is installed correctly, after a few days it completely ceases to be felt. After installing the device, a woman is recommended to limit physical activity as much as possible, to rest more. The use of an obstetric pessary excludes sexual intercourse. The device is removed either at a period of 38 weeks, or urgently, if the amniotic fluid begins to drain earlier.

If installed incorrectly, the pessary may move. If this happens, the inflammatory process of the vaginal mucosa often develops. Pathogens sometimes accumulate on the surface of the device, so its use requires constant monitoring. In order for the doctor to be able to take timely measures to eliminate the infection, the expectant mother needs to take a smear of cervical mucus at least once every two weeks, and regularly undergo an examination by a gynecologist.

The use of an obstetric pessary has contraindications. It cannot be installed if a woman suffers from untreated inflammatory diseases of the genital tract, as well as in cases where she has bloody vaginal discharge several times during the second and third trimesters.

So, yesterday we started a conversation, and their types and indications for their use and contraindications for use. Due to the fact that these devices have come to obstetrics relatively recently, many questions and controversial issues arise around them, although they have already proven themselves well as a remedy for the threat of abortion due to premature opening of the cervix. Today we will talk further, discussing certain issues related to the setting of these pessaries and some of the nuances of their use.

Terms of setting pessaries

Always an important issue when deciding on the treatment of isthmic-cervical insufficiency or in the presence of other indications, will be the timing of the pessary. If it was possible to suture the cervix only from about twenty weeks of pregnancy due to the need for general anesthesia, then the installation of a pessary is possible according to the indications and earlier than this period, if such an action becomes a real need. But in such cases, only the ring of the first type will be used. But these indications are extremely rare, usually obstetric pessaries are mostly installed as a means for the prevention and treatment of this pathology in terms of more than 20 weeks, and often this happens in the period from 28 to 33 weeks of pregnancy. The most basic thing for setting up an obstetric pessary is the full preparation of a woman's genital area, and more specifically, a complete sanitation of the vagina. If there are signs of any infections, including such a common pathology during pregnancy as thrush, this problem in almost one hundred percent of cases will exacerbate when wearing a pessary. Therefore, advance preparation is needed.

In order to carry out the setting of an obstetric pessary, you must first take a course with special sanitizing vaginal suppositories to prevent infection or to eliminate it, and only after the full course has been completed, the vaginal ring will be set. By itself, the procedure for its setting does not have any physiological difficulties, it does not require much time and effort, for several minutes the vaginal ring can be quite easily installed inside the woman's body. Previously, the woman will be asked to completely empty the bladder, and then lie down in the gynecological chair, while the doctor, bending the pessary itself in a special way, will gently insert the ring through the vagina and install it in the right place. To facilitate insertion, the pessary is pre-lubricated with a moisturizing agent, for example, a solution of glycerin, in order to reduce the uncomfortable and unpleasant moments of its introduction into the body.

Is the placement of an obstetric pessary unpleasant?

Naturally, the setting of an obstetric pessary is not the most pleasant procedure, given the psychological state and different pain thresholds for different groups of women. Therefore, some of the expectant mothers, when placing a pessary, talk about feelings of pain, sometimes even very strong, in the process of putting it in place. But it is quite possible to endure these unpleasant sensations, they will not be long at all, although there is very little pleasant in the procedure. However, according to doctors, these sensations will be akin to severe discomfort due to tissue stretching, rather than real pain during the procedure. To withstand such sensations is quite possible, but it can be unpleasant. However, here it is worth making a reservation that if the uterus is especially sensitive or is in good shape, then about half an hour before the procedure it is recommended to take an antispasmodic on the advice of a doctor so that the procedure can be transferred much easier. Painkillers and anesthesia are not used when placing pessaries. After the pessary is installed, detailed instructions for intimate hygiene will be developed for the woman, what should be avoided when wearing a pessary and what will need to be done. The main recommendations will be the following:
- a ban on intimate life when setting a pessary;
- observance of physical rest;
- as prescribed by the doctor, special vaginal suppositories will be used to prevent the formation of genital infections;
- regular examinations with swabs for flora every 2-3 weeks;
- conducting a gynecological examination to determine whether the pessary is correctly located on the cervix and in the vagina, whether there are any complications as a result of wearing it.

If you think that something is wrong with the pessary, you should not try to correct or remove it yourself, immediately consult a doctor for advice and checking the correct installation.

Can there be problems with wearing a pessary?

In cases of correct setting of the pessary, the ring will be almost imperceptible, and will not cause any severe discomfort to its owner in wearing. A woman usually quickly gets used to its presence inside the body, which does not give any unpleasant and uncomfortable sensations. However, almost every one of them will worry about whether the pessary will somehow fall out of the vagina as the pregnancy progresses. This is not completely excluded, but such a phenomenon is extremely rare. The main reason for this may be an incorrectly selected type and size of a pessary or its inept establishment by a doctor. When the pessary is displaced from its proper place, the woman will immediately feel it, since the pessary will press on her in the wrong places. First of all, it will be uncomfortable to sit, or the presence of a pessary will be felt when changing the position of the body. However, if the pessary is chosen according to all sizes, and the woman follows all the instructions of the doctor and she is careful in wearing it, then you should not worry about the possible loss of the pessary, it will simply be impossible. Also, it sometimes seems to women that the pessary is placed too low, and it can even be felt when washing. It is important to remember that if there is no discomfort and pain, it is better not to touch the pessary and not to put your hands and fingers into the vagina and not to touch the pessary. Do not forget to visit a doctor, he will check the correct setting of the pessary.

Discharge while wearing a pessary

When wearing a pessary, you need to be careful about vaginal discharge. It is important to consult a doctor earlier than the time scheduled by the plan in cases where the nature of the discharge has changed dramatically, there are discharges that disturb you, which were not detected earlier in the process of wearing the pessary. These include the presence of bloody or brown discharge, ichor immediately after the pessary is placed, but they should be completely sparse and disappear quickly. If they continue, you should immediately inform the doctor about it. Also alert should be the presence of yellow or green discharge, which are signs of bacterial infections, such conditions will require immediate treatment and it may be necessary to remove the pessary for some time if there are no positive results when the doctor prescribes therapy. Liquid and copious discharge, similar to water, practically odorless and colorless, should be no less alert, they indicate leakage of amniotic fluid and require immediate admission to the hospital.

However, it is also worth remembering that when wearing a pessary, the amount of vaginal discharge will physiologically increase - this is a completely natural phenomenon. Many of the women will complain about the fact that some time after the pessary was placed, the amount of clear vaginal discharge increased. Thus, the body resists the presence of a foreign body in it and possible infection from it. This is no cause for concern. If in doubt, you should once again visit a doctor or test for amniotic fluid leakage with a special gasket from a pharmacy. After removing the pessary, the accumulated cervical mucus may also stand out somewhat more abundantly for some time. One of the drawbacks in wearing a pessary is the possibility of developing colpitis, an inflammatory process in the vagina, when it is displaced. In this case, the main suspicions for it will be discharge with unpleasant sensations of itching and irritation in the vagina.

The pessary is removed during a successful pregnancy at 38 weeks, childbirth can be expected after its removal in the next few days. Removing the pessary is as simple as putting it on before. After its removal, the birth canal is sanitized and the woman is prepared for childbirth. Sometimes the pessary needs to be removed ahead of time - at the onset of labor or outflow of amniotic fluid, in the presence of an infection of the fetal bladder, in infectious processes of the genital tract and the need for urgent delivery.

More articles on the topic "Treatment of pregnant women":

Not always the female body is able to bear a healthy baby without any problems. So that a woman can reach her full term and not face premature birth, she is given a pessary during pregnancy. This device has replaced the previously familiar stitching. The invention really made life easier for specialists, and reduced the risk to the mother and fetus.

The main purpose

The purpose of this device is to keep the uterus closed. In addition, it effectively reduces the load on the uterus, which avoids premature disclosure of the organ. It is designed to reduce the load exerted by the growing fetus on the cervix and evenly distribute it along the walls of the organ.

Indications for installation may be:

• anatomical features of the female genital organs;
• the threat of premature termination of pregnancy;
• Isthmic-cervical insufficiency and its prevention.

Especially often it is required to install a pessary for women who bear 2 or more fetuses.

The period for which the installation of a pessary most often occurs is 18-20 weeks. Although in some cases it is necessary to resort to his help already at the 13th week of pregnancy.

Design features

Externally, the pessary is a flat device, which in most cases has an annular shape. The complete absence of sharp corners, notches and other dangerous protrusions eliminates the possibility of injury to internal organs and mucous membranes.

It is made of special plastic and silicone. An important value in the selection of materials for the ring is their hypoallergenicity. In this case, the pessary may vary in size. Correctly select the necessary parameters under the force of only a specialist.

After all, for this you need to take into account the following factors:

• vagina size;
• circumference of the cervix;
• what kind of childbirth on the account.

Depending on this, 3 types of pessary are distinguished:

1. It is established if the woman had no more than 2 pregnancies and childbirth. At the same time, the diameter of the cervix is ​​up to 30 mm and the vagina is not more than 65 mm.
2. Also shown to women with 2 previous pregnancies, but they must be diagnosed with the anatomical features of the genital organs. The vagina can be up to 75 mm.
3. In the anamnesis of such women has 2 or more pregnancies, the cervix has a diameter of about 37 mm, and the vagina reaches 85 mm.

To install the pessary, anesthesia is not required, which greatly facilitates its use.

An obstetric pessary during pregnancy can have various forms, for example:

• donut-shaped;
• round;
• oval;
• cup;
• mushroom;
• stripes;
• cubic.

How to install an obstetric pessary

A competent professional does not consider the installation of this device a serious intervention. Depending on the situation, it can be installed both in a hospital and on an outpatient basis.

The installation procedure itself does not take more than 2 minutes.

The pain of the procedure depends entirely on the individual sensitivity threshold of the woman. In most cases, the installation does not cause any discomfort. But if a woman has a rather high pain threshold, then the doctor may recommend taking 1 antispasmodic No-Shpy tablet 30 minutes before the installation.

Installation of a pessary begins with preparatory steps:

1. Treatment of existing genital infections.
2. Bladder release.

After that, the doctor will treat the device with a special ointment, such as Clotrimazole, and install a pessary. With the right size and the selected shape of the device, its installation will not cause much discomfort and in the future the ring will not make itself felt.

How to behave after installing a pessary

After the introduction of the pessary, specialists will closely monitor the condition of the woman. To do this, she will be assigned:

1. Checking swabs for bacteria. Frequency once every 2-3 weeks.
2. Ultrasonography. Once a month to check the condition of the cervix and the effectiveness of the pessary.

In addition to medical supervision, a woman herself must adhere to the following rules:

• complete rejection of vaginal intercourse;
• reduction of physical activity;
• maintenance of normal microflora of the vagina.

Self-extraction of the pessary is strictly prohibited.

In some cases, to avoid inflammation, the doctor may prescribe a prophylactic administration of antibacterial vaginal suppositories.

Does a pessary interfere with a woman

Many are concerned about the question of what feelings a woman has after the introduction of the device. To understand that everything is normal or, conversely, the participation of specialists is required, vaginal discharge will help.

There may be several options:

• bloody or brown. The most common type immediately after installation. They are associated with a mechanical effect on the tissue and pass quickly. In most cases, this is a harmless symptom, but you should definitely notify the doctor about it;
• transparent. If the discharge has become more liquid, completely transparent and does not have any smell, water may have begun to leak. In this case, the appeal to specialists cannot be postponed;
• yellow or green impurities will inform a woman about the development of genital infections, which are very dangerous for her baby. Be sure to identify their cause and undergo treatment.

Perhaps, after installation, mechanical colpitis is activated, which is easy to get rid of.

In any case, if a woman feels discomfort after inserting a pessary, she will need to discuss this issue with her doctor.

How long will it take to walk with him?

Given the purpose of the pessary, the logical answer to the question of when the device is removed would be the full maturation of the fetus. So, in most cases, the ring is removed upon reaching 38 weeks of pregnancy. This is the optimal time

By the 38th week, the fetus is already formed, the organs and systems are fully mature. This means that the baby is already able to live outside the mother's body.

Removing the pessary is similar and installing it does not cause discomfort and takes no more than 2 minutes.

But at the same time, there are a number of situations in which the removal of the device requires the condition of a pregnant woman. So, the pessary will have to be removed ahead of schedule if:

• labor activity has begun;
• the general health of the mother has worsened, so an emergency delivery is required;
• the waters began to break;
• the results of smears on the microflora revealed the development of infection in the genital tract.

In this case, the doctor decides on the early removal of the pessary and selects further tactics for managing the pregnancy.

Does it suit everyone?

Despite the simplicity of the device, not all women in need can resort to its help. The device has a number of contraindications.

So, the doctor does not have the right to install if:

1. Inflammatory processes were found in the genital organs.
2. There was bloody discharge from the vagina.
3. The lower part of the fetal bladder has shifted into the vagina.
4. There are suspicions of cessation of fetal development.

Thus, the invention and introduction of the pessary into medical practice significantly increased the chances of a positive pregnancy outcome in those women who often experienced miscarriage. In addition, its ease of use has made it a safe method of maintaining a pregnancy.

Even 50-40 years ago, pregnant women could lose a healthy fetus at the end of the first trimester of pregnancy or at the beginning of the second due to premature opening of the cervix. The fact is that in those days the only way to deal with such a phenomenon was to sew up the cervical canal, and since such an operation can only be performed under anesthesia, it had to be postponed to a later date. Fortunately, today such situations are extremely rare, as doctors use special devices - obstetric pessaries. They are not sold in pharmacies and it is not recommended to try to install them yourself.

Pessary: ​​what is it

To refer to the problems associated with premature opening of the cervix, the term “isthmic-cervical insufficiency” is used in medicine. To prevent its negative consequences, such as miscarriage, doctors often recommend the installation of an unloading pessary. The classic version of such a device, created taking into account the anatomical features of the structure of the woman's body, is several plastic or silicone rings connected to each other.

Kinds

Reviews about which are presented at the end of the article are of several types. In particular, the pharmaceutical industry produces such devices in three sizes:

• First. Such pessaries are suitable for women who have given birth less than 2 times, as well as for pregnant women with a length of the upper third of the vagina from 55 to 65 mm or with a cervical diameter of 25 to 30 mm.
• Second. Devices of this size are used for pregnant women who meet the criteria of the first paragraph, but whose upper third of the vagina is between 66 mm and 75 mm long.
• Third size. These are the largest pessaries that obstetricians install for mothers who have given birth many times, as well as for women whose upper third of the vagina is longer than 76 mm or whose cervical diameter ranges from 30-37 mm.

Surely, many people think about a pessary that it is one or more interconnected rings. However, there are many types of such a device of a completely different form. For example, a cup-shaped pessary is sometimes inserted into pregnant women, designed to support the cervix, reduce pressure on the fetal head and prevent the opening of the cervix. In addition, with isthmic-cervical insufficiency, a device in the form of a donut (thick ring) made of polyvinyl chloride can be installed. This material has the property of thermoplasticity and, being inside the body of a woman, becomes soft, taking the shape of the organ in which it was placed. Also, for the manufacture of a pessary, silicone is often used, which does not cause allergic reactions. Such devices are pre-sterilized using gamma radiation.

In what cases is it set

An obstetric pessary during pregnancy is installed in order to keep the uterus and neighboring internal organs in the correct position. And very often it is prescribed in case of multiple pregnancy. In addition, various types of pessaries are also used to solve health problems of non-pregnant women. In particular, they are effective in the case when it is necessary to prevent prolapse of internal organs (uterus) or to alleviate the condition of a patient who is experiencing incontinence.

Contraindications and possible negative consequences

Although obstetricians usually answer all the concerns of pregnant women about the pessary, that it is completely safe, there are cases when it is forbidden to put it. In particular, this cannot be done if:

• there is a suspicion of a frozen pregnancy;
• the lower part of the fetal bladder is already in the vagina;
• bloody discharge and / or ichor is observed;
• revealed inflammatory processes of the genital organs.

If such a device is chosen or installed incorrectly, or has shifted for some reason, then the pregnant woman may develop inflammation (colpitis), which can be eliminated by correcting the position of the pessary and applying medication.

How to put a pessary

Before such a procedure, it is necessary to undergo an examination and, if any infections of the genitourinary organs are detected, they should be treated. In addition, if a pregnant woman has an increase, then 30-60 minutes before installing the ring, she is given an antispasmodic that relieves contractions, and medical glycerin is used to reduce friction. Only then can a pessary be placed. That this is quite unpleasant, any woman will confirm. However, sometimes this procedure is the only way to save the pregnancy, especially in the early stages, when it is impossible to perform a surgical operation to sew up the cervix.

When can you bet

Most often, a pessary, reviews of which are mostly positive, are placed after the 20th week of pregnancy. However, as already mentioned, sometimes, due to the threat of miscarriage, you have to do this already at 12-14 weeks. In this case, regardless of how many times the pregnant woman has already given birth, the ring of the first size is always used.

Do's and don'ts after inserting a pessary

After such an auxiliary device has been placed on the cervix of the pregnant woman, the woman does not need to do anything special. The only thing that doctors recommend after installing a pessary is to take a smear from time to time (1 time in 14-21 days) to study the bacteriological flora, and to prevent infection, treat the vagina every 2-3 weeks, and, of course, refrain from sexual life. Moreover, the woman would have to follow the last advice, even if she had not been given a ring. After all, when it comes to the expediency of such a procedure, this fact itself indicates the presence of a threat of premature termination of pregnancy.

childbirth

Usually, the device we are considering is left until the 36-38th week of pregnancy. Then the gynecologist on an outpatient basis or in a hospital removes the pessary. This procedure is done without anesthesia, but lasts only a few seconds, so pain, if any, is extremely short. Sometimes it is done in a hospital, in the pathology department, and sometimes on an outpatient basis. The removal of the pessary leads to the fact that the cervix relaxes, and under the pressure of the fetus, it very soon softens, followed by shortening and opening. After that, somewhere within a week (sometimes this period can be a little longer), the woman begins childbirth. However, there are situations when this device has to be removed ahead of schedule. For example, this must be done if there is an outflow of amniotic fluid, the fetal bladder is infected, or an emergency delivery is necessary.

Obstetric pessary: ​​reviews

Today, the installation of such devices is a fairly common occurrence. Therefore, many comments can be heard regarding their effectiveness and the problems associated with the use of pessaries. In particular, women complain about the discomfort they experience when they have to make long trips by car or just sit for a long time. In addition, deterioration is also observed, the cause of which is the pessary. The reviews also show that the procedures for installing and removing it can give women quite a noticeable pain. But the most unpleasant thing, according to pregnant women who have such a protective obstetric device, is a sharp increase in the amount of discharge 3-4 weeks after the insertion of the pessary, which is associated with the body's desire to get rid of the foreign body. Some patients even say that there can be so many of them that there are suspicions of amniotic fluid discharge and you have to constantly wear pads.

Now you know what an obstetric pessary is, reviews of which you may have heard from friends and acquaintances. In any case, we can say with confidence that at the moment there are no cases recorded when the use of the mentioned medical device would cause serious health problems - neither before childbirth nor after. However, doctors warn that even with a pessary installed, sometimes (though very rarely) a miscarriage can still occur. At the same time, statistics show that after the installation of such devices in early stages of isthmic-cervical insufficiency, the number of positive pregnancy outcomes has increased significantly.

Today, many women are faced with the problem of miscarriage. One of the main or miscarriage is isthmic-cervical insufficiency.

Many women perceive the doctor's words about the need to establish with horror. Of course, this is not pleasant. However, the obstetric subject does more good than harm, so all the negative reviews about it are unfair. After all, it is thanks to this gynecological device that a woman manages to safely bear the baby and give birth to him on time.

The medical device began to be used relatively recently to prevent miscarriage or premature birth. In 90% of cases, its installation and wearing allowed women in the position to maintain and prolong pregnancy to the due date.

What is an obstetric pessary?

Because the obstetric item has a rounded shape, it is often referred to simply as a ring. Nowadays, there are various types of pessaries by type, shape and purpose: oval, cup, round, etc. Gynecological devices are made from hypoallergenic materials (silicone, plastic).

The main function of a gynecological agent is to reduce excessive pressure on the pelvic organs: uterus, rectum, bladder. Its establishment and wearing reduces the risk of premature opening of the cervix.

When is the pessary removed during pregnancy?

In the normal course of pregnancy and the absence of pathological disorders, the gynecological device is removed at 37-38 weeks of gestation. Before extraction, the doctor must ensure that the cervix is ​​in the correct position and that there are no abnormalities. If there are signs of edema, then the gynecologist should warn the pregnant woman that the extraction may be accompanied by pain.

There are several reasons why an obstetric pessary should be removed and reinserted. If while wearing it, the pregnant woman has discomfort or spotting is observed, then a gynecological examination and a smear analysis are necessary to exclude either breaks. If necessary, the item is removed, washed and re-inserted. But this is possible in the absence of any pathological disorders.

The obstetric device is subject to mandatory removal when labor is activated. Strong contractions should be a signal that the device must be removed immediately to prevent undue pressure on the uterus. If the pessary is not removed in time, then uterine damage is possible, as well as venous congestion. In addition, the object must be removed after a cesarean section.

In the case when a prenatal rupture of the membranes has occurred, diagnosed by special examinations (ultrasound, biochemical analysis), the gynecological object may not be removed, but only in the absence of infection of the membranes (chorioamnionitis) and uterine contractions. In this case, the fluid will leave the woman's body through the opening of the gynecological device. However, if there is a possibility of infection, then the pessary is removed.

Extraction of a medical object, as well as its installation, are carried out in the office of a gynecologist. In no case should you remove or adjust the pessary yourself. After its removal, it is necessary to carry out mandatory sanitation of the birth canal.

So, summing up, we can distinguish the following factors for the early removal of an obstetric pessary:

• premature rupture of amniotic fluid;
• birth activation;
• chorioamnionitis;
• infectious diseases of the genital organs;
• emergency delivery.

In other cases, the gynecological device is removed immediately before childbirth. However, a woman needs to control the color, smell and structure of vaginal discharge while wearing the item. If any uncharacteristic signs appear, the pregnant woman should definitely inform the doctor about it.