What to do to make the cervix dilate. What happens to the cervix before childbirth. The question of artificial stimulation

The uterus is the most important body V female body, which is responsible for bearing and giving birth to a child. In essence it is muscular organ, a receptacle for the fetus. It is represented by three parts - bottom, body, neck. The cervix is ​​the part of the uterus that is responsible for both the onset of labor and its prevention. First, it helps to retain the fetus, prevents descent and early birth due date. Then the cervix dilates before labor, which facilitates movement through the birth canal. This determines whether childbirth will proceed normally or pathologically. The uterus must be mature.

It is important for every woman to know and understand the causes, signs and mechanism of uterine dilatation, which will make it possible to distinguish pathological process from natural. With at least minimal knowledge, a woman can take timely measures. A lot also depends on a woman’s actions - if you inform your doctor about suspicions in a timely manner, point out pathological signs, measures can be taken to prevent many pathologies. For more later You can take an active part in the preparatory process.

Causes

Traditionally, there is a separation of all possible reasons into natural and pathological. Normal course pregnancy is accompanied by a closed state of the uterus, which promotes reliable retention of the fetus, ensures full development, and protection of the effects. Later, the canal is completely freed and allows the fetus to emerge. The reason for this is changes in the neck, leading to partial replacement muscle tissue to the connecting one. Collagen fibers are also actively formed, due to which the passage becomes softer and more elastic, as a result of which the tissues acquire greater stretchability.

The reason for the opening is a decrease in the length and other parameters of the neck, as a result of which the structure becomes loose and a gap is formed. Preparation is an advance process that begins at week 33. The uterus becomes looser and softer, and the position of the fetus decreases. WITH inside There is constant pressure on the uterus, it begins to gradually open.

But there are many reasons that contribute to the pathological process. If dilation occurs ahead of schedule, there is a risk of premature birth, in which the baby is completely immature.

How to prepare the cervix for dilatation?

In everyday practice, specialists are increasingly faced with uterine immaturity. Therefore, preparatory measures are needed. This issue becomes especially important at 40 weeks, when labor should begin and the placenta gradually dies. The risk of hypoxia increases sharply. With this turn of events, they resort to artificial stimulation.

In many ways, the success of preparation for disclosure depends on the woman herself. She must maintain a high level of activity and be sure to exercise. The load must be dosed. There are many programs for pregnant women that promote both physical and psychological preparation for childbirth. Physical exercises, specially designed complexes, stimulate the activity of the uterine muscles and receptors.

The effectiveness of physical activity is explained by the fact that the uterus is a muscular organ, which also requires training. Need to practice breathing exercises, belly breathing, practice relaxation and meditative techniques that make it possible to relax and concentrate. With the help of exercises, you can learn to control the relaxation of some muscles and the relaxation of others. Also used special means that promote opening, for example suppositories, tablets. Their action is aimed at softening tissues and forming connective tissue layers.

You can also prepare the uterus for childbirth using medicinal or non-medicinal methods. In the first case, the administration of drugs is ensured different ways. Most often used local remedies, the action of which is based on irritation and stimulation of receptors. For example, they use special medications, resort to the use of a stimulating catheter, and kelp sticks.

Symptoms

Once the process of disclosure has begun, it can proceed completely unnoticed. Often, women end up in the maternity hospital already having a dilation of 1-2 cm. It happens so unnoticed that the woman does not even suspect it. This is a sign physiological maturity. Stretching, tingling, and a feeling of heaviness are rarely observed.

The sign that most accurately and reliably indicates the presence of an opening is the release of a mucus plug.

A dangerous symptom may be the discharge of amniotic fluid, which indicates the need urgent hospitalization, delivery to the maternity hospital. If labor does not begin within 6-8 hours, dilatation must be stimulated because long stay A fetus without amniotic fluid is fraught with serious consequences for both the baby and the mother. Possible infection, hypoxia, and death.

If the dilatation is pathological and occurs long before birth, symptoms may also not be noticed. Therefore, it is important to consult a doctor in a timely manner so that he can identify possible pathology and prevent it.

The initial stages are completely invisible. Only if the mucus plug has come away is this considered an indicator that most accurately indicates dilation.

How long does it take for the cervix to dilate?

It is determined by whether a woman is giving birth for the first time or repeatedly. In primigravidas, dilation can be achieved after 8-10 hours. For repeat mothers, this process is reduced to 6-7 hours.

Periods and phases of cervical dilatation

Three periods are known. First stage is latent. Contractions begin. They are usually irregular and not strong. Contractions are not painful, and no significant sensations occur. Often women who are not in the maternity hospital endure this period on their feet, going about their usual activities and not noticing contractions. The latent period can last from several hours to several days.

At this time, you cannot listen to your feelings. It is also not recommended to wait for contractions. You should try not to notice them, but it’s better to be under supervision medical personnel. During this time, you should try to relax as much as possible. You can meditate, do breathing exercises, listen to soothing music, or just sleep. There is no need to waste energy in vain, you need to try to preserve and increase it, since a lot of it will still be needed. There is no need for medication yet. But your doctor can take action if there is a risk of complications. Most often they resort to artificial stimulation of labor.

The second period is called the phase of active disclosure, accompanied by the rapidity of the process. Characterized by an increase in the intensity of contractions and a reduction in the interval between them. It is at this stage that the amniotic fluid should pour out and the bladder should burst. The dilatation is 4-8 cm.

Gradually, and sometimes rapidly and quickly, the third stage begins, and the uterus opens to its fullest extent. There should be a doctor nearby who will supervise.

Sensations when the cervix dilates

Changes begin around 38-40 weeks. Aging of the placenta is observed, accompanied by the release of hormones, which stimulate the cervix to open. Significant transformations occur in the body, but no new sensations are experienced. Sometimes there may be pain, a feeling of pressure indicating descent. Sometimes women feel hormonal disbalance, which appears as sharp changes mood, irritability, anxiety, or vice versa, euphoria. But these sensations pass very quickly.

Later, after the fetus has descended sufficiently, there may be painful sensations in the lower abdomen, false contractions, which represent prenatal hypertonicity of the uterus. During this period, the uterus begins to contract intensively and gradually opens. First - latent period disclosure usually occurs without pain. In the second, active period, pain occurs.

Pain

Opening is divided into 2 phases: latent and active. Usually the latent phase occurs painlessly, while the second, active phase, already passes with a feeling of pain. In fact, this pain is natural, but nowadays not every woman can endure it, so doctors are forced to resort to pain relief. Typically, intense pain occurs when dilation exceeds 5 cm.

Discharge

First the plug comes off. Yellow mucous discharge is also possible. At the end of the active phase, amniotic fluid is released. If the cervix is ​​dilated by about 8-10 cm, this is a timely effusion. If the dilation is approximately 7 cm, the effusion is early. If the cervix is ​​opened by 10 cm or more and there is no rupture of water, it is necessary to perform an amniotomy, at the entrance of which the wall of the bladder is pierced.

Nausea

Nausea is rare: as a reaction to hormonal shifts. Nausea rarely occurs when the cervix is ​​dilated. May sometimes occur as a reaction to pain, or as a side effect on the effects of drugs.

Blood

There is no blood when it opens. The appearance of blood indicates a pathological process, a rupture of the perineum, other injuries, bleeding.

Cervical dilatation without pain or contractions

Painlessness is observed in the latent phase. When the opening moves into the next stage, painful sensations arise. Pathological disclosure is usually painless, so you need to undergo timely examinations. The cervix can open without contractions, especially during the latent period.

Dilatation of the cervix in primiparas

The duration is determined by whether the woman is primiparous or multiparous. Primiparas do not have such experience; the body only adapts to new and unknown conditions. Changes in activity and new conditions cause additional stress in the body, like any other new and unexpected type of activity. The body spends part of its resources on adapting to new conditions. Muscular system and the connective tissue is not trained, nerve impulses enter the uterus more intensely, stimulating its contractile activity. This slightly increases sensitivity and pain.

Psychological readiness and self-regulation are at a lower level than in multiparous women. In addition, lack of experience and lack of knowledge of what actions to perform take their toll. Therefore, you need to relax as much as possible and follow the doctor’s recommendations. For first-time mothers, it lasts up to 8-10 hours.

Dilatation of the cervix in multiparous women

For those who have given birth before, the uterus is more prepared, stretched, and activated. In addition, muscle memory is preserved, which reproduces the process of pushing out the fetus, similar to the previous experience. Contractile activity is better regulated by nerve impulses because reflex arc has already been laid and there is experience on which it can rely nervous system to produce reflexes. The process becomes more regulated and automatic with the simultaneous activation of the body’s self-regulation mechanisms. The muscles of the uterus and pelvic area are also more prepared, developed and activated. Therefore, in multiparous women, it takes approximately 6-7 hours to fully dilate, of which the latent phase accounts for 5-6 hours, and the active phase lasts only 1-2 hours. The process is less painful, including due to physical and psychological readiness to the upcoming pain.

Premature dilatation of the uterus in the early stages

It often happens that the uterus cannot cope with its functions and may open prematurely. This is fraught with premature birth and miscarriages. This pathology is called isthmic-cervical insufficiency, in which the functional activity of the cervix and isthmus of the uterus is impaired. The obturator function is not performed, as a result of which the cervix softens and shortens, losing its ability to support the fetus. More often similar phenomenon observed in the 2-3 trimester. If at 20-30 weeks the cervix is ​​shortened to 25 mm, we are talking about cervical incompetence.

In this case, measures must be taken to maintain the pregnancy. Usually, measures are taken to prolong pregnancy. This is a wait-and-see strategy, which makes it possible to wait for the fetus to mature and be able to live outside the uterus. Traditional and non-traditional therapy is used.

Cervical dilatation at 30, 40 weeks of pregnancy

The closer the birth is, the more likely that the fruit is ripe. Accordingly, even premature birth carry less danger. The cervix should gradually dilate. The ideal option is when labor begins immediately after dilatation, but in practice it often happens that the cervix dilates without labor occurring yet. Many women do not even know about dilatation when they get to the maternity hospital. However, most births end successfully. The degree to which the uterus was dilated when entering the maternity hospital does not in any way affect the birth process itself. It is important that it opens during childbirth. Typically, normal dilation occurs at a rate of 1 cm per hour; in multiparous women, the dilation rate is higher. Usually the cervix becomes soft and ready for childbirth at 37 weeks, and the uterus begins to prepare for this at 30-32 weeks.

Degree of cervical dilatation

The initial stage is painless, with contractions. The second stage - the degree of disclosure is approximately 6-8 cm. Lasts 4-5 hours, ends with a gradual transition to the third stage, during which complete rapid disclosure occurs. This stage symbolizes the beginning of labor. Accordingly, there are 3 degrees of disclosure - initial (1-4 cm), medium (4-8 cm), full disclosure (8-10). Sometimes a dilation of up to 12 cm is required.

Dilation of the cervix to half a finger, 1, 2, 3, 4 fingers

Indicators of 10 cm are considered normal for childbirth, which corresponds to 5 fingers. If the uterus is closed, there is no lumen, and during palpation the doctor cannot move the finger deeper. Opening to half a finger means the possibility of passing half of the obstetrician's finger, to 1, 2, 3, 4 fingers - accordingly, there is space for passing 1, 2, 3, 4 fingers. If she misses at least one finger, the uterus can be considered mature.

Full dilatation of the cervix

Full dilation is the third phase, which ensures the baby's unhindered exit. Dilation from 10 cm can be considered complete. Sometimes ruptures occur, requiring stitches. If there is a threat, an emergency caesarean section is performed.

Consequences and complications

Dilation may be complicated by weak contractions, during which the cervix practically does not dilate and remains at the prenatal stage. This often happens with polyhydramnios and multiple births. If the uterus is overstretched, its ruptures, decreased tone and contractile activity are possible. This also leads to weakening labor activity, risk of fetal hypoxia.

How is cervical dilatation determined and checked?

Since the dilatation is asymptomatic, investigation is required. They are mainly examined by palpation - the obstetrician probes with his finger. Dilation is determined by the number of fingers that can freely pass through the cervix. This method is outdated, but is still used today in almost all institutions. Measurements in centimeters are considered more accurate. Usually, if 1 finger passes freely, this indicates a dilation of 2-3 centimeters, respectively, 2 fingers are equated to 3-4 cm. Full dilation is indicated when the uterus dilates by 4 fingers or 8 cm. Full dilation is determined visually: when smoothing the neck, thin edges and free passage of 5 fingers.

To assess dilation, the Bishop scale is used, a gynecological examination, during which measurements are taken. Then the obtained data is presented in the form of a graph, which visualizes birth process. The graph is called a birth partogram. It clearly demonstrates changes; a sharp rise indicates the effectiveness of childbirth.

Cervical dilatation on ultrasound

The dilatation may be noticeable on ultrasound. Must visit routine examinations, which will make it possible to identify pathology and take the necessary measures.

Stimulation of cervical dilatation

This implies the use various methods, which speed up the opening process. There are medicinal and non-medicinal methods.

How to speed up cervical dilatation at home?

Promotes high levels of physical activity. Food must contain a large number of fresh vegetables and fruits. You need to take a decoction of raspberry leaves or tea with the addition of raspberry leaves. It is important to stimulate the nipples, massage the earlobe and little finger. Sex helps open the cervix because it is a natural stimulant. In addition, semen contains large amounts of prostaglandins, which are also strong stimulants.

Exercise is important. Squats make a huge contribution. Exercises with special balls and gymnastics equipment provide positive impact. Breathing exercises are very important, as they not only stimulate the uterus and improve blood circulation, but also trigger a number of biochemical transformations. Changes hormonal background and neuropsychic state. At the same time, tense areas relax, and relaxed areas become toned. Correct regulation of the contractile activity of muscles, including the uterine muscles, occurs. Breathing, especially through the stomach, stimulates the production of prostaglandins and nerve impulses, which directly affect the activity of the uterus. Smooth muscles are also trained and strengthened.

Meditation, relaxation practices, staying in silence, concentration and internal contemplation are important. These are the basic techniques of hatha yoga, which allow you to gain control over your own body and consciously regulate your feelings and sensations. Breathing and relaxation practices relieve excess tension and stress. As a result, muscle tension is relieved and pain goes away. Mental attitude plays vital role. Many women are afraid of pain and consciously or unconsciously slow down the birth process. Breathing and relaxation make it possible to get rid of internal blocks, block fear and reduce the threshold of pain sensitivity.

Aromatherapy sessions, taking a warm bath with essential oils, color therapy, water procedures, music therapy, sound-vibration therapy.

Cervical dilatation methods

Exist conservative methods, in which pharmaceutical agents aimed at stimulation are used. Can be applied radical methods V in case of emergency: amniotomy, perineal incision. Yes and no medications: kelp sticks, special catheters, gels and oils, suppositories. Physical exercise, sex, meditation work well, breathing techniques, local candles.

Catheter and foley balloon to dilate the cervix

A special catheter, which is presented in the form of a tube with a balloon. Injected into the cervix for 24 hours. The balloon is gradually filled with air, which expands the walls of the uterus. Has many disadvantages.

Can be described as a catheter containing a balloon. It is filled with air. It is inserted for a day, and gradual opening occurs due to the expansion of the cervical wall. The likelihood of developing an infection increases significantly.

Cervical dilation gel

IN cervical canal a special gel is introduced that contains prostaglandins. Hormonal stimulation occurs, the effect can be achieved after 2-3 hours.

Physical exercise

Squats are effective exercises. Twisting and jumping are contraindicated. At the same time, during practice you need to strive for maximum relaxation and control your breathing. Need to do static exercises, which train willpower and endurance. It is better to perform the exercises in a calm environment, with relaxing music. There are many video lessons for pregnant women, where all the exercises are shown clearly, selected in the optimal sequence, and smoothly transition from one to another. Such video lessons effectively combine static and dynamic complexes, breathing exercises and meditative practices.

The best option is yoga, pranayama (breathing exercises and internal contemplation), qigong, meditation, swimming, and water aerobics. You can enroll in special preparatory courses for pregnant women, where physical and psychological preparation For expectant mothers, training is carried out under the supervision of experienced specialists who can choose an individual pace and exercise regimen. Special gymnastic balls, fitballs. You can train at home even with the help of a regular staircase, making frequent ascents and descents.

Physical exercises will be more effective if you start preparing early. And even better - long before pregnancy. Trained muscles are the key to quick and successful opening of the uterus, since it is also essentially a muscle. But if preparations were not started when planning the pregnancy, it’s okay. It is better to start late than not to exercise at all. They are beneficial even if you start regular practice in the last weeks.

Fitball for dilation of the cervix

In modern clinics, it has long been recommended to take not the traditional position on a horizontal plane, but a vertical one. A sitting position is also recommended. But the surface should not be hard. The ideal fitball is a large inflatable ball, which is used in sports and gymnastics. If you sit on it and perform special exercises, you can relax tense areas and tense those areas that will be in good shape. It is better to spread your legs apart. Nervous and hormonal activity is activated, and the uterus is more stimulated. At the preparatory courses you can receive special training in exercises and positions on a fitball.

Squats to open the cervix

Squats stimulate the neck, both by activating nervous activity and mechanically. You need to perform regular squats, or squats according to a special pattern. The time gradually increases. First, you need to perform each stage for 10 seconds. Then increase the time to 1 minute for each stage. At the first stage, we slowly squat. The duration of the squat should be 10 seconds, that is, we should completely lower ourselves in 10 seconds. Then we sit in this position for another 10 seconds, and begin to relax as much as possible. Then we rise partially. You need to stop in such a position that your thighs are parallel to the floor. We remain in this position for 10 seconds, then slowly, over the next 10 seconds, we lower ourselves down. We rest, relax in a squat for another 10 seconds. We begin a slow rise for 10 seconds. Then rest for 10 seconds and begin squatting again. After we managed to complete 10 such squats in one approach, we move on to the next stage - the duration of each stage increases to 20 seconds, then to 30, 40, 50 seconds and one minute. After squatting 10 times at a slow pace, you definitely need to squat at a fast pace. The speed should reach 50 squats per minute. If this doesn’t work, it’s better not to squat completely; you can only lower yourself partially. Gradually you need to increase the depth of the squats.

Meditation to open the cervix

The “Shavasana” pose used in yoga is effective. You need to lie on your back, legs and arms slightly apart. Eyes closed. You can turn on relaxing music and an aroma lamp. The sounds of nature are good, especially the sound of a sea wave, the sounds of rain, and a waterfall. Birdsong, animal sounds, and instrumental music may be suitable. You need to try to relax as much as possible, not think about anything. Muscles should be relaxed consciously, directing attention to them. First, let's focus on the legs. We feel how the leg muscles relax, become soft and heavy. Relaxation covers the tips of the fingers, is understood along the shin, along the thigh. Knee cap falls. The pelvic area, perineum, and uterus relax. Both legs are relaxed, the pelvic area is relaxed, gradually relaxation covers the stomach, back, the lower back, and the muscles along the spine relax. The chest and arms relax. Relaxation of the hands rises from the fingertips, glides along the wrist, elbows, forearm, relaxes the elbow, shoulder, collarbone.

Once again, walk your attention throughout your body, feel the relaxation in every area. Special attention you need to pay attention to your face: feel how your forehead, nose, eyes, ears, cheeks relax. The chin is relaxed lower jaw relaxed and may be slightly open. Eyes closed. You are motionless and relaxed, your whole body is heavy. There are no thoughts in my head. There is only silence. If thoughts come, you need to let them go, not delay them. This meditation should last at least 30 minutes. There is no maximum limit. Ideally, it should be up to three hours. After this, you need to lie down and do not rush to get up. You can drink tea or herbal decoction. Raspberry leaf tea is ideal.

There are also video lessons and audio materials for meditation, which explain in detail all the nuances and provide meditation accompaniment. The slow, calm voice of a specialist smoothly guides your attention, directing it to the right areas, reminding you to relax and not think. The voice does not accompany all meditation: it is effectively combined with moments of silence, a special background and musical accompaniment are selected. The rhythm intensifies and fades, which creates the desired tonality.

Drugs for dilation of the cervix

Various drugs are used. Oxytocin has proven itself well, intramuscular injection Sinestrol, suppositories with prostaglandin. Enzaprost is also administered intravenously. The use of synthetic prostaglandin is allowed. The dosage and frequency of administration can only be determined by a doctor, since it is strictly individual and determined by the results of the partogram.

Pills

Miropristone is used. It stimulates the contractile activity of the myometrium. Take 1 tablet every day, under the strict supervision of a doctor.

Oxytocin-MEZ is often used to stimulate uterine dilation and induce labor. This is a solution for intramuscular and intravenous administration.

The opening can be facilitated by no-spa, which is an antispasmodic drug, relaxes the muscles and makes them more elastic. Prescribed 1-2 tablets 2-3 times a day or in the form of injections.

Papaverine can be used both in the form of injections and in the form of tablets. The dosage depends on the speed of dilation and the condition of the uterus, and is determined exclusively after palpation and gynecological examination. Helps reduce blood pressure and relax smooth muscles.

Caulophyllum 30 is homeopathic remedy, which is used to stimulate labor. It makes giving birth much easier, it decreases pain threshold. A remedy of Indian origin, which has long been used in Indian medicine. Significantly reduces risk caesarean section, the need for oxytocin disappears. Eliminates trembling, fatigue and thirst, gives strength.

Castor oil, when taken orally, promotes rapid expansion. In the early stages it has abortifacient properties.

Many women, after being discharged from the hospital, say that they were given too many injections. And no one knows what drugs are used for this. In order to avoid unnecessary fears, it is better to understand this.

First of all, drugs are administered for pain relief. This narcotic drugs, which are administered in various ways. Most often - intramuscularly, intravenously. Epidural anesthesia (an injection in the back) is also used. She is the most in a safe way pain relief, since it does not affect either contractile activity or the fetus, the drug does not enter the blood. Other types are usually used only if there are 2-3 hours left before the baby is born, this eliminates the risk of developing hypoxia.

At birth weakness stimulation drugs are used. An amniotomy is often mistaken for an injection - a puncture of the amniotic sac. Depending on the situation, symptomatic remedies are used - to reduce swelling, pressure, heartbeat, and to stimulate the fetus.

If the contractions are long and painful, but unproductive, the woman weakens. She is given a sleep-rest drug, which allows her to quickly regain strength. This type of sleep lasts 2 hours. After it, labor activity intensifies.

Injections are often used to prevent or stop bleeding. When surgical intervention many injections are also used. Injections are also given to remove the placenta and postpartum rest.

A dropper is used to stimulate opening. It is based on saline or glucose, which provide maintenance and nutrition to the body. If necessary, drugs of various effects are added to the droppers.

Suppositories for dilation of the cervix before childbirth

Used for intravaginal administration with high content synthetic prostaglandin. Their effectiveness is high: the result is achieved within 2-3 hours.

Laminaria sticks for dilating the cervix before childbirth

They are sticks made from sea ​​kelp. Dried algae, small in size, is inserted into the neck. Gradually it becomes saturated with moisture and expands, the cervix also expands. As many sticks are inserted as required to completely fill.

Manual dilatation of the cervix

It involves artificial dilatation by inserting and expanding a finger during a gynecological examination.

Pessary and ball dilation of the cervix

It is used to prevent early dilation and maintain pregnancy. The pessary is presented in the form of a plastic device that provides support for the organs. It is formed from several rings connecting to each other. Provides reliable support and can even be performed on an outpatient basis. Duration – several minutes. For insertion, the ring is lubricated with gel and inserted into the vagina. After the procedure, sex is contraindicated. Every 2-3 weeks you need to monitor the state of the vaginal microflora and conduct ultrasonography.

To mechanically open and stimulate the uterus, a special plastic ball is inserted into the cervix and left for a day.

Raspberry leaf for cervical dilatation

Raspberry leaves are very effective in dilating the cervix. Can be used in tea or as a decoction.

Cervical dilatation according to Rogovin

The full name is the Rogovin-Zanchenko method. This external method measurement, which allows you to assess the degree of opening of the external pharynx. At the height of the contraction, measure the distance from the xiphoid process to the fundus of the uterus, in centimeters. The resulting indicators are subtracted from 10 cm to obtain height indicators. The method is approximate.

How to prevent cervical dilatation during pregnancy?

Prolongation means are used: bed rest. Emotional peace medications, especially sedatives. Treatment is required to produce surfactant in the fetal lungs, which accelerates their maturation. Also possible surgical methods treatment, in particular, suturing the cervix, or using a special obstetric pessary.

Ring on the cervix to prevent dilatation

In order to prevent premature dilatation, a special plastic ring is inserted into the uterus. It reduces the load. Administration can be done on an outpatient basis, on an empty bladder. To prevent the uterus from contracting, you can take an antispasmodic before the procedure. The ring is lubricated with glycerin and inserted into the vagina. Then they are turned in the desired direction. The doctor will do everything necessary. The patient will only need to attend an appointment every 2-3 weeks for a bacteriological examination. You also can't have sex. Dilatation of the cervix before childbirth occurs naturally, since the ring is first removed.

Cervical dilatation begins shortly before birth, as the cervix of the hollow organ matures. When it is ready, it will completely soften and smooth out, and during a vaginal examination, the opening of 1 finger will be determined, that is, the doctor will be able to freely pass his internal pharynx forefinger.

Labor does not always begin in such conditions; you may go through several more days, despite the fact that your uterus is already in a state of readiness.

Cervical dilatation during pregnancy

If a woman is healthy, the hollow organ can remain closed until the final date, but for many, 2-3 weeks before this joyful event, the cervix undergoes major changes, leading to a gradual process of readiness of the body.

The smoothing and opening of the cervix is ​​called ripening. Its symptoms are obvious: training contractions are disturbing and the mucus plug is coming off. Of course, there is no exact method for expectant mothers; a vaginal examination is required, which is carried out by a doctor.

Using this indicator, the doctor can judge how soon your labor will begin. As a rule, changes in the cervix in primiparous women begin earlier; in multiparous women, this process can go much faster and therefore can begin immediately before childbirth.

If the pregnancy has come to an end, and the cervix is ​​still not ready for childbirth, in order to speed it up, you may be prescribed auxiliary measures. There are medicinal and non-medicinal medicinal methods accelerating the maturation of a hollow organ.

So, physical activity, squats and walking contribute to this matter, sex in the last weeks of pregnancy also helps, and it’s not just about physical impact on the cervix itself, but the fact that male sperm contains a large amount of prostaglandins, substances that accelerate maturation. Of course, no special exercises have been invented to open the cervix, but still many women note that their labor began precisely after physical exertion. It is worth warning that active walking on stairs, long walks that leave you exhausted, and moving furniture around the house is not the right and even dangerous way. You should not test your strength before the most crucial moment in your life; instead of accelerating the onset of labor, you may end up with complications, for example, premature rupture of water or placental abruption.

If all the deadlines have passed, or the child’s condition requires accelerating labor, and the body is not yet ready, drug stimulation is possible.

How is cervical dilatation checked?

A doctor examines a pregnant woman on a gynecological chair. He inserts 2 fingers of his right hand into the woman’s vagina and assesses the condition of the hollow organ by simple palpation. During pregnancy, the cervix is ​​normally turned back, and it is very difficult to reach it during examination. By the time the mother gives permission, the cervix unfolds in front, along the axis of the pelvis, becomes easily accessible and soft. Its canal gradually expands and when it matures completely, it easily passes the doctor’s index finger inside the uterus, to the child. Of course, it separates him from the baby near amniotic sac, but this degree of maturity of the uterus indicates that labor is about to begin.

If you need to speed up ripening, use different methods. For example, you can act on it locally; a gel containing prostaglandins causes a fairly rapid softening.

Some methods force the body to produce these substances itself. For example, you can use non-drug effects, special sticks made from dried seaweed(kelp). They are introduced into the canal, and here they swell under the influence of moisture, significantly increasing in volume; under their pressure, they open both mechanically and due to increased production of prostaglandins in its tissues. In any case, suppositories, tablets and other medications are prescribed by the doctor; do not try to speed up labor on your own.

Childbirth, cervical dilatation

How does the cervix dilate?

The wall of a hollow organ consists of two powerful layers of muscle, longitudinal and circular. The circular layer resembles rings and is concentrated mainly in the lower segment of the uterus, including the cervix. Throughout pregnancy, the circular layer in the cervical area is tense and holds it in place like a lock, while the longitudinal layer is relaxed so that the baby is comfortable and gets everything he needs.

The onset of labor changes muscle function to the opposite. Now, strong contractions of the longitudinal muscles at each contraction stretch the lower segment of the woman’s hollow organ, pull the neck in different directions, and the circular layer relaxes, not resisting this pull. As a result, the cervix opens more and more and becomes thinner. The opening of the cervix by 2 fingers, which is usually present in the first hours of labor, progresses to the final result when the cervix freely passes all 5 fingers (10 cm).

Throughout the birth, doctors monitor the progress of labor using these indicators. Many women describe vaginal examination during labor as extremely unpleasant and painful. When the doctor checks the dilation of the cervix, the sensations are really not pleasant, because the uterus reacts to this with another contraction.

Sometimes there is a violation of the coordination of contractions of the hollow organ for one reason or another, and, despite the fact that the contractions are strong, the cervix does not react. Stimulation, in such cases, is carried out using labor anesthesia and the use of antispasmodics. Manual dilatation of the cervix, when in its last stages the midwife stretches and tucks the cervix with her hand behind the head of the rapidly advancing birth canal child, is rarely used, mainly in cases where the woman in labor cannot resist pushing, although it is too early to push, and this measure helps prevent ruptures.

The function of a hollow organ during pregnancy allows a woman to carry and give birth to her baby. The uterus, damaged by abortions, may subsequently become incompetent and begin to open long before birth, or due to scarring it will not respond properly. Take care of yourself, do not allow abortions that could damage her, so that nothing will interfere with your motherhood in the future.

The first stage of labor is called dilatation and is the longest. It begins with the onset of regular contractions, during which the cervix shortens and ends with complete effacement and dilatation of the cervix. In primiparous women, the internal os opens first, then the external os of the cervix. In multiparous women, the internal and external pharynx opens simultaneously.

The first period in primiparous women lasts 8-12 hours, in multiparous women - 6-8 hours.

The process of dilation of the cervix

The first stage of labor is divided into 3 periods based on the duration, frequency and intensity of contractions:

• 1st phase – latent;
• Phase 2 – active;
• Phase 3 – transitional.

1st phase (latent) begins with regular contractions with a frequency of 1-2 per 10 minutes, and ends with smoothing or pronounced shortening of the cervix to 4 cm. The duration of the latent phase averages 5-6 hours. In primiparous women, the latent phase is always longer than in multiparous women. During this period, contractions are usually not painful. The rate of cervical dilatation is 0.35 cm per hour.

Phase 2 (active) characterized by increased labor and rapid opening of the uterine pharynx from 4 to 8 cm. The average duration of this phase is almost the same in primiparous and multiparous women and averages 3-4 hours. Frequency of contractions in active phase the first stage of labor is 3-5 in 10 minutes. The rate of cervical dilatation is 1.5-2 cm per hour in primiparous women, 2-2.5 cm per hour in multiparous women.

Contractions most often become painful. Pain sensations predominate in the lower abdomen. During active behavior of a woman (standing position, walking) contractile activity the uterus increases. At a certain intensity pain The question of pain relief may arise. In order to endure contractions less painfully, you can use self-anesthesia methods such as deep breathing during contractions; stroking the lower abdomen from the midline to the sides; pressing thumbs on the sacrum or rubbing the sacrum.

Amniotic fluid is poured out at the end of the first stage of labor due to an increase in intrauterine pressure, with about 150-200 ml being poured out. light and transparent amniotic fluid. If spontaneous rupture of amniotic fluid has not occurred, then when the uterine pharynx is dilated by 6-8 cm, the doctor performs an amniotomy. Simultaneously with the dilation of the cervix, the fetal head moves along the birth canal. At the end of the active phase, the uterine os opens completely or almost completely, and the fetal head descends to the level of the pelvic floor.

3 phase (transition) characterized by some slowdown. It begins after the uterine os is dilated by 8 cm and continues until the cervix is ​​fully dilated to 10-12 cm. During this period, it may seem that labor has weakened. This phase in primiparous women lasts from 20 minutes to 1-2 hours, and in multiparous women it may be completely absent. The opening speed is 1-1.5 cm per hour.

IN normal conditions The first period ends with complete dilatation of the cervix, rupture of the membranes and discharge of amniotic fluid.

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The cervix is ​​a continuation of the uterus itself, which consists of the isthmus (the junction of the uterine body into the cervix), the vaginal and supravaginal parts. The opening of the cervix facing the uterine cavity is called the internal os, the opening facing the vaginal cavity is the external os, and the canal of the cervix itself is called the cervical canal.

It is important that the body of the uterus is represented by smooth muscles, and the cervix consists of connective tissue, collagen and elastic fibers, as well as smooth muscle cells. This information about the structure of the cervix will help us understand the mechanisms of its opening in normal and pathological conditions.

How to determine cervical dilatation?

Dilatation of the cervix during pregnancy is a process that normally corresponds to the first stage of labor. In obstetrics, cervical dilatation is measured using the obstetrician's fingers with internal obstetric study. When fully dilated, the cervix allows 5 fingers of the obstetrician to pass through, which is equal to 10 centimeters.

Symptoms of cervical dilatation are as follows:

• nagging pain in the lower abdomen. The sensations during dilation of the cervix are similar to those that occur during menstruation, only as the degree of opening increases, the pain increases;
• discharge of the mucous-bloody plug, which is located in the cervical canal during pregnancy and prevents infection from entering the uterine cavity.

The main signs of cervical dilatation are regular contractions that repeat after a certain period of time. Initially it is 25-30 minutes, and as the opening increases it is reduced to 5-7 minutes. The duration and intensity of the contraction also depends on the degree of dilatation of the cervix. The rate of cervical opening during labor is 1 cm/hour from the moment the cervix opens by 4 cm. During normal labor, the degree of cervical dilatation is checked every 3 hours.

What causes the cervix to dilate?

In a normal pregnancy, the due date is considered to be 37-42 weeks. The trigger point for the onset of labor is a decrease in the level of progesterone in the blood (a hormone that is necessary for the normal course of pregnancy).

By the beginning of labor, dilation of the cervix by 1 finger is one of the signs of its maturity. Contraction of the uterus leads to a decrease in its cavity and pressure of the presenting part of the fetus on the cervix. In addition, the amniotic fluid of the fetal bladder is divided into the upper and lower poles. During a contraction, the lower pole of the amniotic sac is wedged into the cervical canal, which in turn also contributes to its opening.

Premature cervical dilatation

Early dilatation of the cervix different dates pregnancy has its reasons. At 28-37 weeks, the cause of the onset of labor may be hormonal deficiency. Such births are called premature, and they end with the birth of a viable fetus.

The cause of premature cervical dilatation in the early stages of pregnancy up to 20 weeks can be infections, inflammatory diseases of the pregnant genital organs, hormonal deficiency, placental abruption. In such cases, in the absence of timely qualified medical care pregnancy may result in spontaneous abortion.

You can suspect earlier dilatation of the cervix by the presence of nagging pain in the lower abdomen in early. In this case, you should immediately consult a doctor. If concerns about premature dilatation of the cervix are confirmed, then the woman is offered a suture on the cervix for the entire duration of pregnancy, bed rest and, if necessary, hormonal drugs which will help maintain pregnancy.

Basically, labor begins naturally, after approximately 37 weeks, and logically ends with the birth of the baby. But there are cases when this does not happen or there are other medical indicators for the start of labor.

Also, labor that began spontaneously may not proceed so well, and then stop altogether. Contractions may stop or be insufficient to dilate the cervix further. Doctors call such labor activity weak.

If 12 hours after the water breaks, labor does not begin, doctors advise using stimulation. Accordingly, it is carried out very carefully and only under the supervision of a doctor. Be sure to take into account whether the woman is allergic to any medical supplies.

There are medicinal and, accordingly, non-medicinal methods of influencing the cervix. There are also several signs that stimulation is a must:

• if a woman suffers from gestosis, diabetes mellitus or high blood pressure;
• premature rupture of amniotic fluid (there is a risk of infection);
• the uterus is too stretched (may be a consequence of polyhydramnios, twins or a large child);
• the uterus does not open;
• short and weak contractions, or their cessation altogether;
• complications with the heart or Rh conflict can also serve as a reason for stimulation;
• premature placental abruption. This is very dangerous, as it can threaten the life of the child;
• some have late toxicosis;
• deterioration in the condition of mother and baby.

Induction of labor is recommended in cases where the baby is post-term. A pregnancy is considered post-term if it lasts more than 40 weeks. Each doctor must make his own decision: stimulate or wait. Moreover, the waiting period may vary. For some it’s a week, for others it’s two. IN in this case It is best to place the woman in a maternity hospital in order to fully control the process and, if necessary, promptly allow childbirth.

The decision on stimulation and how to speed up the dilatation of the cervix before childbirth is made by the doctor. He must determine what is more dangerous: continuing to wait or inducing labor.

A non-medicinal method is puncture of the amniotic sac or amniotomy. This procedure is carried out if the dilation occurs only by 2 cm and stops. The result is increased labor activity. When the amniotic sac is punctured, amniotic fluid is released, resulting in a decrease in blood pressure. The baby's head presses on the pelvic bones, which further dilates the cervix. This method is considered quite safe and painless, since no harm is caused to the child and nerve endings the amniotic sac simply does not exist. If sufficient dilation does not occur after amniotomy, then doctors then use medications to speed up the dilation of the cervix.

One of medicinal methods stimulation is the use of prostaglandins. They help prepare the cervix for dilation. The method of using prostaglandins is good because the side effects are minimal. The doctor inserts the suppository deep into the vagina. Such actions are carried out for only one purpose - to help the cervix open faster. And this is already the beginning of labor. Suppositories are absolutely harmless and act only on the mother’s body, without causing any harm to the baby. The effect of the suppositories begins after 30 minutes, and before that you can calmly move around the room and wait for the medicine to take effect.

Oxytocin stimulation. This is another type of medication to speed up the dilatation of the cervix before childbirth. Oxytocin can be in the form of tablets, as a solution for subcutaneous or intramuscular injections, and especially intravenous administration. Side effects: increased pain during childbirth (therefore, it is used, for the most part, in conjunction with antispasmodics), too much contractile activity of the uterus, and, as a result, poor circulation and harm to the health of the child.

If oxytocin is taken through a drip, then the woman is completely immobilized, which can also negatively affect the further dilatation of the cervix. For some expectant mothers, in a natural way dilatation of the cervix, walking around the room can serve. It is worth remembering that each person is individual.

There are several ways to prepare the uterus before childbirth:

• eat more salads dressed with vegetable oil;
• walking and swimming, especially diving, is necessary as much as possible. Walking barefoot works especially well;
• ear and little finger massage;
• use a decoction of raspberry leaves;
• oddly enough, have more sex (especially in the position on all fours);
• drink tea with lemon, dark chocolate and honey.

All of the above can be used only after 37 weeks. But before doing anything, you should definitely consult a doctor. You should make sure that there are no contraindications.

So, of course, to allow labor to occur, many doctors use medications. At the same time, all psychologists say one thing: childbirth is as stressful for a child as it is for its mother. Therefore, no matter how difficult it may seem, a woman should think first of all about the baby. Usually, after stimulation, labor enters the active phase. Pain is an integral part of labor, but you always need to control yourself and think not about yourself, but about the tiny person who is even worse off than she is.

The expectant mother should definitely study the literature, which describes in detail how to behave during childbirth. Even the minimum of information received will help during contractions. It is also necessary to do physical exercises. All this will lead to the fact that the fear of childbirth will decrease and, as a result, the woman will be able, for her part, to control and help resolve childbirth. The most important thing is to “listen” to your body - this is the best stimulation of labor before childbirth