Cervicometry: what is this procedure and in what cases is it necessary?

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There is a common saying that bearing a child is not a pathological condition. However, during this period, the woman’s health, and at the same time the health of the unborn child, is very vulnerable. Therefore, it is necessary to constantly monitor various indicators of the functioning of the body of both mother and baby. Careful observation will help you not to miss the onset of pathological changes, which will allow you to provide qualified assistance in a timely manner. The expectant mother undergoes a lot of different tests. One of these procedures is cervicometry during pregnancy.

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What is cervicometry during pregnancy

The cervix connects the vagina to the uterus. This is a narrow tube up to 5 cm long. When carrying a child, it is tightly closed, creating an obstacle to the premature exit of the fetus from the uterine cavity. In each trimester, it is required to evaluate its length.

Ultrasound cervicometry is the examination of the cervix using ultrasound. During the procedure, the density of the organ, its length, and the condition of the uterine pharynx are determined. The purpose of the examination is to predict the risk of premature birth and, if necessary, take appropriate measures to maintain pregnancy.

There is another method of examining the cervix - cervicography. This is an examination using x-rays. It is performed only on non-pregnant women, since the radiation is dangerous to the fetus. Cervicography is prescribed for women with recurrent miscarriage.

Indications for ultrasound of the cervix during pregnancy

If the pregnant woman’s condition is satisfactory, cervicometry can be dispensed with. However, some women are prescribed this test as part of screening ultrasound procedures. For this there are the following indications:

• suspicion of isthmic-cervical insufficiency, when the cervix begins to open even before the end of embryogenesis;
• multiple pregnancy;
• presence of spontaneous abortions, premature births and threats of termination of pregnancy in the anamnesis;
• past abortions, stitches on the reproductive organs;
• the presence of foci of inflammation and infection identified by screening ultrasound.

Indications for examination

Ultrasound screening is indicated for every pregnant woman. It is scheduled to be done three times during the entire pregnancy - simultaneously with an ultrasound of the uterus. The first ultrasound of the cervix during pregnancy is performed at 12-16 weeks. The next examination is carried out at 20-22 weeks. The last scheduled examination is scheduled two weeks before birth.

Additional procedures are prescribed to women if pregnancy pathology is suspected:

• previous miscarriages, premature births;
• consequences of operations on the pelvic organs;
• chronic inflammatory diseases of the uterus;
• multiple pregnancy;
• signs of intrauterine infection;
• underdeveloped reproductive organs.

These conditions are risk factors for preterm birth. There are no contraindications to ultrasound. The procedure is safe for the woman’s body and the fetus, so the examination can be done as often as the patient’s condition requires.

To view a review from a gynecologist on the topic of examining the uterus in pregnant women:

What does it show?

After the examination, a gynecologist, based on the data obtained, determines the characteristics of fetal development, the condition of the placenta and amniotic fluid. An ultrasound will reveal abnormalities in the patient’s reproductive organs, if any.

During an ultrasound examination of the cervix, attention is also paid to the following indicators:

1. To determine its normal condition, its length is measured. It must correspond to the period of fetal development. During the normal development process, the cervix is ​​not shortened, the external and internal pharynx are closed. Visualization of the smoothness of the organ is determined in the third trimester.
2. The condition of the myometrium is determined.
3. Detection of pathologies in the female reproductive organs. Thanks to this procedure, the early stages of inflammatory processes, cancer, and a predisposition to the possible development of severe forms of disease are identified.

Preparation rules

Preparation for the examination depends on the method of the procedure. Ultrasound of the cervix can be done in two ways:

• transabdominal - through the abdominal wall;
• transvaginal - through the vagina.

The transabdominal method is simple, but less informative. You need to prepare for an ultrasound in advance. Preparation includes a three-day diet. Avoid foods that can cause increased gas formation - milk, brown bread, cabbage, peas. Intestinal gases interfere with examining the internal organs, so without proper preparation, an ultrasound will be uninformative.

The transvaginal method gives more reliable results. There is no need to prepare in any special way for it. It is enough to carry out normal hygiene measures. You should bring a towel and a special condom that is placed on the sensor.

Technique

Cervicometry during pregnancy is done on an outpatient basis. If the transabdominal or external method was chosen, the woman is asked to lie down, exposing her stomach. The doctor performs an examination by running a sensor over the patient’s abdomen. The skin is pre-lubricated with sound-conducting gel.

Transvaginal, or internal examination of the cervix involves the use of a special sensor. Use a condom for hygienic purposes. The sensor is inserted into the vagina, moving it to the cervix.

Obtained results

The thickness and length of the cervix changes depending on the trimester.

1. Until the 12th week of pregnancy, the normal cervical length is 3-5 cm. The organ has a dense consistency and is shown in the picture as a uniform gray color. Both uterine pharynxes are tightly closed.
2. Until the 24th week, the length of the organ does not exceed 3 cm. In primiparous women, both uterine pharynxes are tightly closed; in multiparous women, the external one is allowed to open slightly.
3. By week 36, the length is 2 cm, the consistency softens. In the picture, the organ is shown in dark gray. The external os is completely open.

In addition to the size of the cervix, various diseases are detected using ultrasound.

• Polyp is a benign growth of the mucous membrane. It is located inside the cervical canal and is shown in the picture as a gray rounded formation.

• Cancer is a malignant tumor. Grows inside or outside the cervical canal. It is presented in dark gray or white color and has an irregular shape.

Endometriosis is the growth of the lining of the uterus outside of it. The image shows dark irregular growths inside the cervical canal.

These diseases can cause premature birth. When diagnosing a malignant tumor, a cesarean section is recommended.

Ultrasound of the cervix during pregnancy: possible diagnostic difficulties

It happens that the “purity” of ultrasound examination is hampered by the unusual anatomy of the genital organs of the expectant mother:

• a polyp has formed on the mucous membrane of the cervix, which makes it difficult to manipulate the device and partially obscures the view of the internal cavity of the organ;
• the cervix is ​​curved (which is natural for a pregnant woman), which is why the indicators may not be reliable.

Evaluation of results in points

An ultrasound of the cervical canal is done during pregnancy to predict the due date. A scoring system has been developed for assessing the condition of the cervix according to three criteria - length, size of the uterine os, consistency.

1. From 0 to 3 points - length more than 3 cm, both uterine pharynxes are closed, dense consistency. Immaturity of the organ, the woman is not ready for childbirth.
2. From 4 to 6 points - length is more than 2 cm, one uterine os is open, the consistency is dense. Incomplete organ maturity.
3. Over 6 points - length less than 2 cm, both throats are open, soft consistency. Full maturity, the woman is ready to give birth naturally.

Normally, maturity occurs by 36 weeks of pregnancy. If it occurs earlier, there is a risk of premature birth. If by the 37th week of maturity there is no birth canal, a cesarean section is recommended.

During pregnancy, the cervix is ​​tilted back. This ensures the preservation of the fetus inside the uterine cavity. When it matures, it leans forward. Based on this criterion, the due date of birth is judged. They also say “the belly has dropped, which means labor is coming soon.”

Patency of the cervix

One of the criteria for organ maturity is the patency of the cervical canal. It is more effective to determine it during a manual gynecological examination, but it is also possible using ultrasound. In the picture, the normal width of the canal is no more than 5 mm.

Throughout pregnancy, the cervical canal should be completely closed. If it expands and the uterine os opens slightly, a diagnosis of isthmic-cervical insufficiency is made. The woman requires hospitalization.

Short neck

The insufficiently large size of the cervical canal in pregnant women is considered one of the main reasons for the occurrence of arbitrary abortions and premature labor in women.

With such a disease, the uterine cavity cannot sufficiently contain the constantly growing and increasing its mass and volume of the fetus inside itself, which leads to early termination of pregnancy.
Children who were born prematurely are very premature as a result of this disease and often die after birth.

There may be several reasons why this disorder develops:

• Hereditary predisposition to the small size of the cervical canal and its short length;
• Hormonal imbalance, which led to an insufficient amount of progesterone in a woman’s body;
• Cervical injuries, consequences of surgery, as well as scars left after termination of pregnancy and curettage;
• Infectious processes occurring in the organs of the mother’s reproductive system;
• Uterine bleeding;
• Stress.

Aggravating factors may include the presence of two or more embryos, a fetus that is too large, or polyhydramnios.

In most situations, this disease occurs without obvious symptoms, so it can only be noticed on an ultrasound. However, in a number of situations, this pathology can be identified by pulling and bursting pain in the lower abdomen at the end of the uterus.

After diagnosing the pathology, the attending physician prescribes therapy designed to correct the disorders that have arisen in the body and prevent possible dangerous consequences. Depending on how long the pathology was detected and how much the cervical canal was reduced, the doctor prescribes the necessary treatment. This can be either standard drug therapy, based on the correction of hormonal levels with special drugs, or surgical intervention, which involves applying special sutures directly to the cervical mass itself. Thus, they keep it closed throughout the entire period of gestation and are removed before birth at the period when the fetus is considered to be normally full-term. Also, one of the ways to correct this pathology is to install a special obstetric ring, which prevents stretching of the cervical cervix and reduces the load placed on it. All these procedures do not cause any noticeable pain during implementation and are effective methods for maintaining pregnancy.

If you are diagnosed with insufficient length of the cervical canal:

• Most importantly, with such a deviation, you must strictly follow all the recommendations of your doctor and be under constant medical supervision. In a critical situation, hospital treatment may be required;
• With this diagnosis, absolute peace and the absence of any, even minor, physical activity and emotional upheaval are indicated. Any actions that may cause pressure or tension in the abdominal area are also highly discouraged;
• Doctors also strongly advise against sexual intercourse until the end of pregnancy, so as not to cause premature birth, provoked by increased activity of the reproductive organs.

Ultrasound cost

An ultrasound is performed in a antenatal clinic on the direction of a gynecologist. The procedure is free if you have a medical insurance policy.

You can get tested for a fee in private clinics and reproductive health centers.

Ultrasound of the cervix allows you to determine a woman’s readiness for childbirth and indications for cesarean section. During pregnancy, the procedure helps to promptly identify the threat of miscarriage.

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