Artificial preparation of the cervix for childbirth. Preparing the cervix for childbirth: a review of drugs and necessary measures What does it mean to prepare the cervix for childbirth

Normally, it is completely closed; towards childbirth it becomes softer and shorter. Its canal gradually expands and, when fully ripe, begins to let the finger inside. Such maturity of the uterus indicates the imminent onset of labor. During the birth of a child, the cervix shortens and smoothes, and directly opens by 8-10 centimeters.

In a healthy woman, the cervical canal remains closed until the onset of labor. However, in some cases premature disclosure occurs. This happens with the development of a pathology such as isthmic-cervical insufficiency. It can occur as a result of injuries caused by previous abortions, surgeries, ruptures in previous births, and for other reasons.

Usually, the cervix begins to prepare for labor gradually, 2-3 weeks before it begins. Signs of preparation are the presence of training contractions and the release of the mucus plug covering the cervical canal. As a rule, first-time women notice the presence of these symptoms earlier than with repeat births. The opening and smoothing of the cervix can begin directly in the child.

Determining on your own whether disclosure has begun is quite difficult. This can be done by the attending physician during a gynecological examination. Based on the results of the examination, he can judge the woman’s readiness for the birth process.

How to give birth without gaps: preparation

If by the 38th week of pregnancy the cervix is not yet ready for the birth of a child, medications are often used to soften it. The use of any medications should be carried out only on the recommendation of a doctor. An obstetrician-gynecologist may prescribe the use of antispasmodic drugs in the form of tablets or suppositories that relieve muscle tension, as well as prostaglandins that promote rapid maturation, and physical stimulation.

You can start preparing the cervix and perineum for childbirth at home. 4 weeks before the expected birth, gynecologists advise women to actively engage in sex without a condom. Due to natural massage during friction, contractions of the uterus during orgasm and the influence of prostaglandins contained in male sperm on the woman’s body, the cervix softens. However, sexual intercourse is possible only in cases where both partners are healthy.

Evening primrose oil is recommended to be used internally from 36 weeks, one capsule, and from 38 - two capsules. It should be taken before meals and washed down with plenty of water. The fatty acids contained in the oil increase the production of prostaglandins, but you should consult your doctor before using it.

Eating oily fish also helps prepare the cervix for childbirth. This method has no contraindications.

Gentle massage of the nipples with oil or baby cream stimulates the production of the hormone oxytocin, which is necessary for the contraction of the uterus and the onset of labor. This procedure is recommended to be carried out from 38 weeks twice a day for 5-10 minutes.

You can use a decoction of raspberry leaves. Place two tablespoons of dried crushed leaves in an enamel pan, add a liter of water, bring to a boil, strain and cool. From 38 weeks, before each meal you need to drink 100 ml of the resulting decoction.

At 36 weeks, you can start taking rosehip infusion, which not only softens the cervix, but also saturates the woman’s body with useful vitamins and microelements. For 150 grams of dried berries you need a liter of boiling water. Take 200 ml infusion on an empty stomach every morning.

Hawthorn tincture will prepare the cervix for childbirth. Thanks to the use of 10-15 drops of tincture dissolved in water at dinner, the pregnant woman’s sleep will also become more restful.

Strawberry decoction is very useful. It is made from fresh berries, leaves and water. From the 37th week of pregnancy it can be consumed in unlimited quantities instead of tea.

Perineal massage with baby oil or a special cream helps to avoid ruptures during childbirth. It is performed daily before bed with your fingers for 3-5 minutes, starting from the 36th week of pregnancy.

It should be remembered that it is undesirable to artificially induce labor without medical indications, as this can have negative consequences: painful contractions, oxygen starvation of the fetus, the risk of uterine rupture along the scar after a cesarean section in a previous birth, and unpreparedness of the fetus. Artificial stimulation may be necessary in cases of postterm pregnancy, large fetus, hypertension in a woman, or prolapse of the umbilical cord, but the decision on stimulation in any case must be made by the attending physician. Preparing the uterus for childbirth and stimulating labor are completely different things. If in the first case you can safely use most folk remedies at home, then in the second all procedures should be carried out exclusively under the supervision of medical staff.

Natalia BulakhObstetrician-gynecologist of the first category, Ph.D. honey. Sciences, MUZ Clinical Maternity Hospital, Astrakhan

When entering a maternity hospital for childbirth, any woman experiences stress associated with the change from a home environment to a hospital environment, and feels fear of the unknown. And unclear medical terms increase anxiety. Knowing these terms will make the expectant mother feel more comfortable.

Beginning of labor: cervical examination

Upon admission to the maternity hospital, and then several more times during childbirth, the doctor will say: “Now we’ll do a vaginal examination” or: “Let’s see how the cervix is, how the baby is progressing.” We are talking about an internal obstetric examination, which allows us to determine the condition of the birth canal, observe the dynamics of cervical dilatation during childbirth, the mechanism of insertion and advancement of the presenting part of the fetus (head, buttocks). The initial examination upon admission of a woman in labor to the maternity hospital is carried out on a gynecological chair, and during childbirth - on the birth bed. The frequency of vaginal examinations depends on the characteristics of the course of labor. In the physiological (normal) course of labor, they are carried out no more often than after 4 hours, and if indications arise (rupture of amniotic fluid, changes in the nature of contractions, the appearance of bleeding, changes in the fetal heartbeat) - as necessary.

During vaginal examination during childbirth, the shape of the cervix, its size, consistency, and degree of maturity are determined; the condition of the external opening of the cervix, the edges of the pharynx and the degree of its opening, one of the dimensions of the pelvis is measured - the diagonal conjugate - between the lower part of the pubis and the promontory of the sacrum protruding into the pelvic cavity. Then the cervix is examined in a mirror, but this is not always done, but only when there is bleeding and it is necessary to exclude the cervix as the source of this bleeding (this can be with extensive erosions, cervical cysts, vaginal varicose veins).

If a vaginal examination is carried out on the eve or at the very beginning of labor, then the doctor says that the cervix is mature or, conversely, immature, synonyms - ready or not ready for childbirth.

The maturity of the cervix is determined using a special scale (Bishop’s scale), taking into account the severity of four signs:

Consistency of the cervix (a soft cervix is favorable for childbirth):

dense - 0 points;
softened, but hardened in the area of the internal pharynx - 1 point;
soft - 2 points.

Cervical length (before birth, the length of the cervix is more than 2 cm, before birth the cervix is shortened to 1 cm or less):

more than 2 cm - 0 points;
1-2 cm - 1 point;
less than 1 cm, smoothed - 2 points.

Patency of the cervical canal (before childbirth, the cervix should be freely passable for one or two fingers):

external pharynx is closed, allows the tip of the finger to pass through - 0 points;
the cervical canal allows one finger to pass through, but a seal is detected in the area of the internal pharynx - 1 point;
more than one finger, with a smoothed neck more than 2 cm - 2 points.

The location of the cervix in relation to the pelvic axis (before childbirth, the cervix should be located in the center of the pelvis):

posterior – 0 points;
anterior - 1 point;
median - 2 points.

Each sign is scored from 0 to 2 points.

Score: 0-2 - immature neck, 3-4 - not mature enough, 5-6 - mature.

The doctor determines the opening of the cervix during a vaginal examination. The size of the opening of the uterine pharynx is measured in centimeters. Full opening corresponds to 10 cm. Sometimes you can hear the expression “opening of the cervix 2-3 fingers.” Indeed, old obstetricians measured the opening in their fingers. One obstetric finger is conventionally equal to 1.5-2 cm. However, the thickness of the fingers is different for everyone, so measurement in centimeters is more accurate and objective.

During a gynecological examination, the doctor also makes a conclusion about the condition of the amniotic sac and amniotic fluid. Then a woman may hear the term “flat amniotic sac” - a situation in which there is little amniotic fluid in front of the fetal head. Normally, during each contraction, an increase in intrauterine pressure is transmitted to the fertilized egg (membrane, amniotic fluid and fetus). Amniotic fluid, under the influence of intrauterine pressure, moves down to the exit from the uterus, as a result of which the fetal bladder in the form of a wedge protrudes into the canal of the cervix and promotes its opening. There is little water in front of the head due to low or polyhydramnios, the presence of a large fetus, and weakness of labor. In this case, it does not function as a wedge and inhibits the opening of the cervix; the doctor says that such a bladder needs to be opened or an amniotomy performed.

Another term associated with the amniotic sac is “high lateral rupture of the amniotic sac” - a situation in which the amniotic sac ruptures not at its lower pole, but much higher, tightly grasping and holding the fetal head, preventing it from descending and moving into the cavity pelvis, and amniotic fluid is poured out in small portions or drops. In this case, the obstetrician performs instrumental dilution of the membranes, that is, there is already a hole in the membranes, but the amniotic membranes must be diluted.

After the water has poured out, the doctor evaluates its nature. “The waters are good, light, normal” - this is what the doctor will say if the waters are clear or with a slight yellowish tint, without an unpleasant odor. It’s worse if the doctor says: “green waters”; cloudy, green or brown water with an unpleasant odor may indicate hypoxia (intrauterine oxygen deprivation of the fetus). When fetal hypoxia develops, one of its early signs is the entry of meconium (original feces) into the amniotic fluid. This occurs as a result of relaxation of the fetal rectal sphincter due to oxygen starvation. First, lumps of meconium appear in the waters in the form of a suspension, and then the waters turn green. The intensity of the color of the water (from green to dirty brown) depends on the severity and duration of the hypoxic state in the fetus.

Fetal assessment

During childbirth, the expectant mother usually listens very closely to what they say about the baby's condition. Listening to the fetal heartbeat, the doctor pays attention to the rhythm, heart rate, clarity of tones, and the presence or absence of noise. Normally, the heart rate is 120-160 beats per minute, the tones are rhythmic, clear, and there are no extraneous noises. In obese women, the clarity of tones is reduced due to the thickness of the abdominal wall (muffled heartbeat). The doctor may rate the heartbeat as "rhythmic, clear," or "muffled, rhythmic," or "arrhythmic, dull." The presence of noise during auscultation can occur when the umbilical cord is entwined around the neck and torso of the fetus, the presence of umbilical cord nodes, fetal hypoxia, or placental insufficiency. The clarity of tones is affected by the thickness of the abdominal wall, the degree of expression of subcutaneous fat, the location of the placenta on the anterior wall of the uterus, the presence of myomatous nodes, and polyhydramnios. During the initial examination, the doctor uses a conventional obstetric stethoscope, but to clarify the condition of the fetus, as well as for dynamic monitoring during childbirth, a more detailed study using cardiotocography (CTG) is required. Modern cardiac monitors are based on the Doppler principle, the use of which makes it possible to record changes in the intervals between individual cycles of fetal cardiac activity; they are displayed in the form of sound and light signals and graphic images on the cardiotocograph monitor. To do this, an external sensor is placed on the woman's anterior abdominal wall at the point of best audibility of fetal heart sounds. The second sensor is located in the area of the right corner of the uterus (the corner of the uterus is located in its upper part at the origin of the fallopian tube). This sensor records uterine tone, frequency and strength of labor contractions. Information about cardiac and labor activity is immediately reflected on the monitor in the form of two curves, respectively.

The frequency of vaginal examinations depends on the characteristics of the course of labor.

For diagnostic use, a special scale has been developed on which all of the above indicators are assessed in a point system. Doctors often talk about the “Fisher score,” i.e., a score on a scale developed by W. Fisher. A score of 8-10 points characterizes the good condition of the fetus, 6-7 points - there are initial signs of oxygen starvation of the fetus - hypoxia (compensated state). In this case, the fetus experiences a slight deficiency of nutrients and oxygen, but with timely treatment and an adequate method of delivery, the prognosis for the baby is favorable. Less than 6 points - severe (decompensated) condition of the fetus, which requires emergency delivery due to the threat of intrauterine fetal death.

How is the birth process going?

After the water breaks and the head is inserted, to assess the correspondence of the size of the fetal head to the mother’s pelvis during labor, the doctor must check Vasten’s sign and can inform the expectant mother about the results. The woman lies on her back. The doctor places one palm on the surface of the symphysis pubis, the other on the area of the presenting head. If the sizes of the mother's pelvis and the fetal head correspond, the anterior surface of the head is located below the plane of the symphysis (pubic symphysis), i.e., the head extends under the pubic bone (Vasten's sign is negative). If the anterior surface of the head is flush with the symphysis (flush Vasten's sign), there is a slight size discrepancy. If there is a discrepancy between the sizes of the mother's pelvis and the fetal head, the anterior surface of the head is located above the plane of the symphysis (Vasten's sign is positive). A negative Vasten sign indicates a good match between the sizes of the woman’s head and pelvis. With the second option, a favorable outcome of childbirth through the natural birth canal is possible, subject to certain conditions:

good labor activity;
average fruit size;
no signs of post-maturity;
good fetal condition during childbirth;
presence of light waters;
good configuration of the head and its correct insertion when passing through the pelvic cavity.

A positive sign indicates that the mother’s pelvis is an obstacle to the passage of the fetus and natural childbirth is impossible in this case.

During a vaginal examination, the doctor evaluates how the fetal head is positioned. If everything goes well, then most likely you will not hear anything from the doctor on this score; if he wants to emphasize that everything is normal, he will say that the fetus is occipital presented. Normally, the fetal head descends into the pelvic cavity in a state of flexion, that is, the baby’s chin is pressed to the sternum, and the point in front of the birth canal is the back of the fetal head. In this case, it passes through all the planes of the pelvis with its smallest circumference quite easily. There are incorrect types of cephalic presentation, when the head is extended and either the forehead or the face of the fetus enters the pelvic cavity first. These types of cephalic presentation are called frontal and facial. In these cases, childbirth often ends with a cesarean section in order to reduce trauma to the fetus and mother. But with a small degree of extension of the head, good labor activity, and small size of the fetus, natural delivery is possible.

A woman may hear the expressions "front view", "rear view". No worries. With a cephalic presentation, this means that in the anterior view, the back of the fetal head faces the anterior wall of the uterus, and in the posterior view, it faces backward. Both options are normal, but in the latter case the pushing lasts longer.

After an external vaginal examination, the doctor can tell you how the head is moving through the birth canal.

The head is pressed against the entrance to the pelvis. Two weeks before the onset of labor in primiparous women, the fetal head begins to descend and press against the entrance to the pelvis. Due to this, pressure on the lower segment and cervix increases, which promotes the ripening of the latter. In multiparous women, the head drops 1-3 days or even several hours before the onset of labor.

The head is a small segment at the entrance to the small pelvis. In this obstetric situation, the head is motionless, its largest part is located above the plane of the entrance to the pelvis, it can still be palpated through the anterior abdominal wall. This happens in the first stage of labor - during contractions.

The head is a large segment at the entrance to the small pelvis. In this case, it is located with its large circumference in the plane of the entrance to the small pelvis; it can hardly be felt through the anterior abdominal wall, but during a vaginal examination the doctor can clearly identify it, as well as all the sutures and fontanelles. This is how the head is positioned at the end of the first stage of labor before pushing begins.

The head in the pelvic cavity is not detected during external examination; during vaginal examination, the doctor sees that it fills the entire pelvic cavity. This obstetric situation is observed during the period of pushing.

Birth of a baby

With each push, the head gradually passes through the pelvic cavity and begins to appear from the genital slit; doctors call this cutting in - the head appears from the genital slit only during pushing and through the eruption of the head (the head is constantly visible in the genital slit). This means the baby will be born soon. If there is a threat of perineal rupture, obstetricians often resort to dissection of the perineum - then they warn that they will do a perineotomy or episiotomy. This necessary measure helps prevent injuries to mother and baby. The perineotomy operation is a dissection of the perineum in the direction from the posterior commissure of the perineum to the rectal sphincter. Thus, the incision passes along the midline of the perineum. For an episiotomy, the incision is made on one side, through the labia majora (at an angle of 45° from the midline).

Immediately after birth, mucus is sucked out of the baby's nose and mouth using a rubber balloon so that it does not enter the lungs during his first breath. The condition of a newborn baby is assessed using the Apgar scale at 1 and 5 minutes. The following signs are taken into account: heartbeat, breathing, skin color, reflexes, muscle tone. The severity of each of the five signs is determined in points from 0 to 2. If the sum of points for all signs is from 7 to 10, then the condition of the newborn is satisfactory, 4-6 points - a condition of moderate severity, 1-3 points - severe.

After the baby is born, the obstetrician-gynecologist monitors for signs of placental separation. “It has separated, we are giving birth to the placenta” - this is what the doctor will say if, when pressing with the edge of the palm above the womb, the umbilical cord does not retract inward, if the clamp previously placed on the umbilical cord near the genital slit has dropped slightly.

Of course, during childbirth and then after the baby is born, you will have to deal with a lot of new words and concepts. And the more you learn about them from reliable sources, the more reliably you will rid yourself of unreasonable fears.

Natalya Bulakh, obstetrician-gynecologist of the first category,
Ph.D. honey. Sciences, MUZ Clinical Maternity Hospital, Astrakhan

The cervix is truly a unique organ with an amazing structure, without which it would be impossible to carry and give birth to a child. Throughout pregnancy, the cervix plays the role of a guard, closing the entrance to the uterus and protecting the fetus from external influences and infections. During childbirth, in a short time, the cervix smoothes out, becomes thinner and, together with the vagina, forms a single birth canal. Within literally a few days after birth, the cervix takes on its previous appearance, once again closing the entrance to the postpartum uterus.

Dilatation of the cervix before childbirth

Normally, throughout pregnancy, the cervix has a dense consistency, length from 3 to 5 cm, the cervical canal is closed and filled with a mucous plug, which serves as additional protection against infection. In multiparous women or in the presence of cervical scars from previous births, the canal may pass a finger to the internal pharynx.

From about 34-36 weeks of pregnancy, the cervix begins to ripen. The maturation process includes:

shortening of the cervix;
softening consistency;
centering the cervix along the axis of the birth canal;
gradual opening of the external and internal pharynx.

The closer the due date, the more pronounced the processes of ripening and dilatation of the cervix. Multiparous women and women with good labor dominance may already have a dilatation of the cervix of up to several centimeters at the time of the onset of labor in the absence of other signs of labor.

Symptoms and sensations when the cervix dilates

During the process of cervical ripening, a pregnant woman may not feel this at all, feel good and may not even know what changes are happening in her body. Before labor begins, a pregnant woman can sometimes observe:

periodic irregular painless or less painful contractions;
nagging pain in the lower abdomen, lower back, sacrum;
mucous discharge from the genital tract, sometimes streaked with blood.

All these sensations are normal and indicate that the woman’s body is preparing for childbirth. However, if such symptoms appear before 37 weeks of pregnancy - the period when the pregnancy is considered full-term, it is necessary to immediately inform the doctor about this.

How is cervical dilatation checked?

To find out what condition the cervix and birth canal are in, whether the cervix is ready for childbirth or, conversely, there is a threat of premature birth, it is necessary to periodically conduct an internal obstetric examination. This is a routine chairside examination in which the obstetrician inserts the index and middle fingers into the woman's vagina and examines the cervix and birth canal. During the examination, the doctor evaluates the length of the cervix, its softness, the degree of dilation of the canal, discharge from the genital tract, and also determines whether the amniotic sac is intact and what part of the fetus is present. In the same way, every two hours the dynamics of cervical dilatation during labor is assessed.

The second fairly reliable and objective method for measuring the length of the cervix and the degree of its dilatation outside labor is ultrasound diagnostics. This method is called ultrasound cervicometry and is the “gold standard” for early diagnosis of the risk of preterm birth. The method is applicable during pregnancy from 22 to 37 weeks.

Stimulation of dilatation and preparation of the cervix for childbirth

Sometimes it happens that the due date is about to arrive, and the doctor, during the next vaginal examination, states that the cervix is “immature” and is not ready for childbirth. Hearing this news, most pregnant women begin to panic and prepare for a cesarean section. An immature cervix is far from a final verdict. Modern medicine has an arsenal of means for artificial “ripening” of the cervix. Stimulation of cervical dilatation is a purely medical procedure, which is performed only in a hospital and for a number of indications:

post-term pregnancy over 42 weeks in the presence of signs of aging of the placenta and other signs of post-maturity;
the presence of pregnancy complications in which the further course of pregnancy is dangerous for the woman and the fetus - fetoplacental insufficiency, decompensation of extragenital diseases of the mother, for example, diabetes, cardiac and renal pathology.

The following techniques can be used to ripen the cervix:

Kelp sticks are dried seaweed compressed into pencil shapes. These sticks are inserted into the slightly open cervix, where, in a humid environment, the algae swell and mechanically open it.
Balloon dilatation of the cervix, when a special balloon is inserted into the cervical canal, which is gradually inflated with air or liquid.
The use of special preparations of prostaglandins, which accelerate the processes of ripening and dilatation of the cervix. These medications may be in the form of intravenous drips, vaginal gels, tablets, or suppositories. The discovery of prostaglandins was a real breakthrough in medicine, making it possible in a huge number of cases to speed up the onset of labor and avoid surgery.

All these techniques are used only in a hospital under the supervision of medical staff!

How to speed up cervical dilatation at home?

Very often, the obstetrician, having stated that the body is not sufficiently prepared for childbirth, sends the woman to the hospital for special measures. But in cases where the pregnancy is not yet critical, and the woman and child are healthy, the doctor chooses expectant management: the expectant mother goes home. There are many grandma's ways to speed up the ripening and dilatation of the cervix. To be honest, the effectiveness and safety of most of them is highly questionable. These include:

Washing floors, walking up stairs, cleaning the house. There is no harm from such activities, but excessive physical activity is not recommended for women with gestosis, and.
Taking castor oil. Indeed, castor oil has been used since ancient times by obstetricians to induce labor. In addition to the laxative effect, the drug stimulates uterine contractions and promotes cervical dilatation. However, these effects can appear already on a fairly mature cervix with good labor readiness. Otherwise, other than diarrhea, there will be no other effect.
Cleansing enema. The scenario is similar to taking castor oil. However, there is a danger in the presence of a movable head of presentation that is not pressed to the pelvis and prolapse of the umbilical cord loops.
Taking various herbal remedies, for example, a decoction of raspberry leaves, suppositories with belladonna extract, etc. It is harmless, but there is also no proven effectiveness.
Sex. This is perhaps the only scientifically proven folk method. Sperm contains the same prostaglandins that are used in maternity hospitals. Therefore, regular sex life can actually contribute to the dilatation of the cervix and the onset of labor. Just don’t hesitate to ask your doctor if you have any contraindications to such stimulation methods.

Perhaps the most important thing in childbirth is the birth dominance of the woman herself, her positive attitude, focus on working in a team with a doctor and midwife. Believe in the best, trust your doctor and everything will work out!

Alexandra Pechkovskaya, obstetrician-gynecologist, especially for the site

Useful video

Probably everyone knows that you need to prepare very carefully for childbirth. This applies not only to shopping and mental preparation, but also to physical preparation. An indispensable part of the preparation is the preparation of the uterus for childbirth, in which the baby develops throughout pregnancy. Of course, organs can independently prepare for the birth of a child. But it will still be very nice if you help your body, because it is not always able to do it on its own.

And one of the most important signs that labor is approaching is changes in the shape of the cervix. By the time she gives birth, she becomes completely different, while the woman does not see these changes at all. But not everything always happens strictly according to the norm. This is a unique female organ that would be worth learning a little more about.

Cervix in a mature state

When the time comes for childbirth, it is very important that the uterus meets all standards for location, length and softness. Moreover, its softness at the time of birth is measured by passing two fingers of the gynecologist. It is at this level of softness that a woman’s plug comes off in most cases. At the same time, its length also changes. If you believe the results of most ultrasounds, then its length before the birth process should not exceed 1 cm. Plus, in addition to all this, it should gradually take a position in the middle of the pelvis, and not be tilted back, like a month before. It is by these three signs that the level of maturity of the cervix is determined.

Uterus unprepared for childbirth

The uterus consists of muscle and fibrous tissue and has an elongated shape, and ends at the bottom with a cervix. When the moment of birth comes, the uterus begins to actively contract, thereby causing contractions in the woman. In the first period, namely when a woman is having contractions, the cervix must open completely so that the baby can be born. At the same time, an interesting event occurs in the woman’s body. The uterus contracts and rises slightly, and the fertilized egg with the baby very slowly descends into the cervical canal.

When can the baby's head pass through it? Then doctors say that the uterus is completely open and ready for childbirth. This means that the second stage of labor begins, in which expulsion and pushing occur. While a child is born, he has to go through a very difficult path. For example, if the cervix is not fully open, the baby still makes its way and in such cases ruptures often occur.

Such complications arise because of this. That the muscles of the cervix are not elastic enough. Of course, there are other reasons for ruptures, but elasticity plays an important role. An interesting fact is that during pregnancy the uterus independently prepares itself for future birth.

Already in the last weeks of gestation, the uterus begins to actively add collagen fibers to its tissues so that during childbirth it can stretch sufficiently. This state of the uterus and its cervix is called maturity. The maturity of the uterus can be determined as early as 39 weeks of pregnancy. In this case, the cervix should be soft and elastic. And its length should not exceed 2 centimeters.

It is very important that the cervix is in the center of the vagina. If there are deviations from the above norms, then doctors begin to talk about the immaturity of the cervix. In such cases, the body needs help in preparing.

How to prepare the uterus for childbirth?

There are many ways to prepare the cervix and uterus for childbirth. If doctors determine that the uterus is immature, they begin to prescribe a lot of different drugs and medicines. They should stimulate the processes that are responsible for the maturation of the reproductive organ. But in order not to use medical methods, you can choose several methods yourself. But only if you have no contraindications.

For example, many pregnant women practice active sex in the last weeks of pregnancy. During orgasm, the uterus not only begins to contract. But he also trains his muscles. Sperm also has a very good effect, as it softens the cervix. Some women also take evening primrose oil, and sometimes doctors also prescribe it, since this remedy is completely harmless and there are no negative effects on the body.

It is also worth taking care of exercises in which you will alternately tense and relax your intimate muscles to train them and actively prepare for labor.

Cervical stimulation

Stimulation is used only when the water has broken and there are still no contractions. During stimulation, it is necessary to take into account the condition of the pregnant woman. Depending on this, choose the type of stimulation: medicinal or non-medicinal. If a woman has diabetes mellitus or histosis, stimulation will be carried out without fail. Also an indicator are multiple births, a distended cervix or a large baby. If the contractions are very weak or there are none at all. For problems with cardiac activity. Stimulation is also used if the pregnancy is post-term. All procedures must be carried out under the strict supervision of a physician.

Types of stimulation

Drug stimulation can be in the form of injections of the drug Sinestrol, which has a greater effect on the dilation of the cervix, but not the contractions themselves. Another option is kelp sticks. They are inserted into the uterus, where they swell and after a while open the cervix.

Very often, doctors use gels, which are also injected into the cervix. This method causes faster opening. In the second case, non-medicinal, puncture of the amniotic sac is used. It is used only if the contractions stopped at a dilation of 2 cm. The dilatation process occurs due to the fact that the baby’s head, after piercing the bladder, begins to put a lot of pressure on it. This is one of the safest methods of stimulation as it is considered to be the least harmful to the child. It is also often used to avoid oxygen starvation of the baby or premature aging of the placenta. Today, such problems occur in almost half of all women giving birth.

But be that as it may, a woman should not independently determine whether she is ready for childbirth or not. This is the responsibility of the doctor, who must determine all indicators as accurately as possible in order to avoid any unpleasant complications with both the expectant mother and her child.

For quotation: Glagoleva E.A., Mikhailova O.I., Balushkina A.A. Methods of preparing the cervix for childbirth // RMZh. 2010. No. 9. P. 613

The problem of a rational approach to pre-induction preparation of the cervix is one of the most complex and pressing in modern obstetrics. The readiness of a woman’s body for childbirth is determined by a number of signs, the appearance of which indicates the possibility of spontaneous onset of labor in the near future or allows one to count on a positive effect from the use of labor inducing drugs.
Timely and correct assessment of the state of readiness (“maturity”) of the cervix for childbirth is of great importance in determining the prognosis of the course of the upcoming labor and especially in clarifying the indications and timing for induction of labor. This is primarily due to the fact that the condition of the cervix is a reliable indicator of the readiness of a pregnant woman’s body for childbirth. If the degree of maturity of the cervix is poorly or insufficiently expressed, spontaneous onset of labor in the near future is unlikely. On the other hand, with premature rupture of water and an immature cervix at the beginning and middle of the first stage of labor, pathological deviations in the contractile activity of the uterus may be observed, which manifest themselves in hypertonicity of the lower segment, in the absence of synergism of contractions of all parts of the uterus, etc. In this state, spontaneously beginning labor takes on a pathological (protracted) course associated with the development of discoordinated labor, its weakness, etc. According to the literature, with an immature or insufficiently mature cervix, labor in 57.2% of cases is accompanied by premature rupture of water, in 44.2% - by anomalies of labor, and as a result, in 16.3% of cases, surgical interventions are performed.
The presence of an immature cervix before timely birth is 16.5% in primiparous women, and 3.5% in multiparous women. However, with concomitant somatic diseases, these indicators increase. For example, with class II obesity during full-term pregnancy, an immature cervix occurs in 15.4% of cases, with class III obesity - in 30.4%. In addition, in case of extragenital pathology (hypertension, heart disease, diabetes mellitus, etc.) and complicated pregnancy (preeclampsia, postmaturity, chronic fetal hypoxia, immune-conflicted pregnancy, etc.), there is often a need for early delivery. In such cases, before inducing labor, it is necessary to prepare the cervix for childbirth.
Back in 1960, studies were conducted that showed that all changes in the cervix during pregnancy, childbirth and the postpartum period can be explained by connective tissue transformations. The cervix is a heterogeneous organ consisting of fibroconnective tissue, smooth muscle fibers, epithelium of blood vessels and crypts that penetrate deeply into the stromal tissue. The upper part of the cervix contains more smooth muscle fibers, and in its vaginal part fibrous tissue predominates. The extracellular basis of the fibrous connective tissue of the cervix is made up of collagen fibers and elastin, separated by a ground substance. Collagen gives the fabric stability, and elastin provides its elasticity. During pregnancy, muscle tissue is gradually replaced by connective tissue, “young” collagen fibers are formed, which are highly hydrophilic and flexible, which ensures cervical resistance and the uterus plays the role of a fetal receptacle. By the time of delivery, the concentration of collagen decreases and its physicochemical properties change. Degradation (partial resorption) of collagen is the main sign of a ripening cervix. In 1978, increased amounts of partially degraded collagen were found in biopsies taken from the cervix before and immediately after delivery, whereas it was low in biopsies obtained from non-pregnant fertile women. The process of collagen degradation is caused by the surface-concentric detachment of molecules from the core fibers in combination with the destruction of some of them. Partial resorption of collagen fibers, changes in the concentration of glycoprotein and glycosaminoglycan begin in the vaginal part of the cervix, spreading gradually from the external pharynx to the internal pharynx. This observation made it possible to put forward the concept of the connective tissue “nucleus” of the cervix, the presence of which explains why, in the process of “maturation,” the area of the internal pharynx softens and opens last. By childbirth, a system of branched lacunae located in the thickness of the tissue of the cervix reaches extraordinary development. An increase in cervical volume was detected due to the deposition of arterial blood in them. This creates a dilatation effect that exerts a force on the internal structure of the cervix and provides “additional stretching” of the cylindrical part of the lower segment of the uterus. The moderate effect of post-stretching is one of the mechanisms of cervical ripening. Changes in the microvasculature of the cervix are used by many researchers to assess its maturity. These structural and biochemical changes are the rationale for the appearance of clinical signs of cervical maturity.
Palpation determination of the condition of the cervix is not only a reliable method of assessing a pregnant woman’s readiness for childbirth, but also the simplest. For the first time in 1942, De Snoo proposed calling the cervix “ripe for childbirth” when loosening, shortening and gaping of the cervical canal is detected in it by palpation. Later, they also began to take into account the location of the cervix relative to the wire axis of the small pelvis and the location of the presenting part of the fetus. In our country, methods for assessing the “maturity” of the cervix during vaginal examination were developed by M.V. Fedorova (1969), A.P. Golubev (1972), G.G. Khechinashvili (1974), etc. Quite often in Russia the M.S. scheme is used. Burnhill (1962) modified by E.A. Chernukha. With this technique, during vaginal examination, the consistency of the cervix, its length, its location in relation to the pelvic axis and the patency of the cervical canal are determined. Each sign is scored from 0 to 2 points. With a total score of 0-2 points, the cervix should be considered immature, 3-4 points - insufficiently mature, 5-8 points - mature. However, the E.N. scale is most widely used abroad. Bishop (1964), where, in addition to the above characteristics, the location of the presenting part of the fetus is taken into account. Each sign is scored from 0 to 2 points. With a score of 0-4 points, the cervix is considered immature, 5 points - insufficiently mature, more than 5 - mature.
In connection with the above, methods of preparing the cervix for childbirth when its maturity is insufficiently expressed and the need for rapid delivery are becoming relevant. Despite the availability of various methods for preparing the cervix for childbirth, research in this area continues.

If an “immature” cervix is determined at 39 weeks, then the following measures can be taken to prepare the cervix for childbirth:
. non-drug methods;
. instrumental (methods of acupuncture, massage, intranasal electrical stimulation, acupuncture, electrical stimulation of the nipples of the mammary glands, etc.);
. local use of prostaglandins;
. introduction of kelp;
. prescription of antispasmodics.
Non-medicinal methods of preparing the cervix for childbirth after 36 weeks include regular sexual activity without a condom. Sperm softens the cervix, preparing it for childbirth. This is why a condom is necessary during pregnancy itself. Many doctors believe that sex is the best way to prepare the cervix for childbirth. From 34 weeks you can take evening primrose oil in capsules - 1 per day, from 36 weeks - 2, from 39 - 3 capsules per day. Drink a collection of herbs to prepare the cervix for childbirth: rose hips (chopped) - 1 tbsp. - St. John's wort herb - 2 tsp. - dried herb - 1 tbsp. - hawthorn fruits (chopped) - 1 tsp. - motherwort herb - 1 tbsp. - birch buds - 1 tsp. - horsetail herb - 1 tbsp. - lingonberry leaves 2 tbsp. - strawberry fruits or leaves - 1 tsp. Pour 1 liter of boiling water. Boil for 30 seconds. Leave for 10-15 minutes. Strain and drink 100 ml hot 3 times a day for 30 minutes. before meals for 35 days. 10 days break and again 35 days. Those. 80 days before the expected date of birth. It is also advised to prepare salads seasoned with vegetable oil, brew and drink raspberry leaves, tea from raspberry leaves - 1 tsp. per glass of boiling water. At 36 weeks 1 cup per day, at 37 - 2, from 38 to 3, from 40 to 4 cups per day. After 40 weeks, you can drink sage and use tampons with sage (it is advisable to consult your doctor about this).
The development of medicinal methods of preparation for childbirth is based on the fact that the main factors in the development of labor are hormonal factors: maternal (oxytocin, prostaglandins), placental (estrogens and progesterone) and fetal hormones of the adrenal cortex and posterior pituitary gland, which change the metabolism of steroids at the level of the placenta. hormones (decreased progesterone production and increased estrogen levels).
PGs are local hormones and are synthesized in many tissues: seminal vesicles, uterus, brain, platelets, myocardium, endocrine glands. The most important physiological effect of PGs is their ability to cause contraction of smooth muscles.
The initial purpose of using PG was to soften and smooth the cervix, i.e. its maturation, which makes it easier to induce labor. If this could be achieved, the usual method of inducing labor could begin. Later, initiated cervical ripening began to be perceived as the actual induction of timely labor, without separating these processes.
The indication for prescribing PG is an “immature” cervix. Moreover, they are most often used when the degree of “maturity” of the cervix according to Bishop is 0-4 points. Various routes of administration of prostaglandins have been proposed. The initially used intravenous route of PG administration is effective. However, it has been revealed that this method of administration requires relatively large doses, since prostaglandins are quickly inactivated in the lungs and, in addition, side effects often occur (in particular, tachycardia, nausea, vomiting, diarrhea, pallor of the skin, muscle tremors, etc. ). The desire to avoid such nonspecific (systemic) complications led to the creation of dosage forms for topical use.
Gels and vaginal suppositories are the most commonly used dosage forms of PG for topical use. Less commonly used are tablets, cervical caps, and vaginal rings. Experience with the use of the gel has shown a longer duration of action of the drug and a significant reduction in the frequency of side effects. Typically, local administration of one dose of PG is performed the day before the planned induction of labor. Thus, most studies have tried to accelerate the process of cervical ripening (which physiologically can last several days) and accommodate it for 18-24 hours.
It should be noted that quite often a significant proportion of patients develop labor without further treatment and with intact membranes. In the majority of those pregnant women who failed to induce labor, there is a significant improvement in the degree of “readiness” of the cervix, and after the administration of oxytocin, the time interval between the induction of labor and the birth of the child is significantly reduced.
Local application of prostaglandins involves the following routes of administration: extraamnial, intravaginal and intracervical. In recent years, it is the local use of GHGs that has become most widespread. However, in most clinics the extra-amnial method is not used due to the large number of complications (premature rupture of water, placental abruption, myometrial hypertonicity, etc.).
In obstetric practice, the most commonly used PG is PGE2 (dinoprostone), less often PGE1 (misoprostol), which is almost exclusively used for intravaginal administration. Rarely used nowadays PGF2 α due to higher therapeutic doses, which lead to an increased incidence of side effects and reduce effectiveness.
The effectiveness of a single use of PG depends on the dose, route of administration (intravaginal, intracervical or extra-amnial) and the pharmaceutical form of the drug (tablets, suppositories, gels). With repeated use of PG, the effectiveness of cervical ripening increases significantly. For example, with daily administration of vaginal suppositories with 0.1 mg of enzaprost (PGF2 α ) cervical ripening is observed in 92.2% of women in labor. In this case, the authors use a very different interval between procedures (as a rule, it is a 4-6 hour interval). Large intervals (1-2 days) are used in outpatient practice.
The doses used in practical medicine and the frequency of their administration are selected so that with maximum efficiency there is a minimum number of side effects. In general, uterine hypertonicity is the most common complication: from 0.8% to 1.6-3.6%. Frequent cramping pains in the lower abdomen and lower back occur much more often (up to 38%), which do not affect the health of the mother and fetus and do not require medical intervention.
There are contraindications for prescribing PG: bronchial asthma, active phase of ulcerative colitis, glaucoma, sickle cell anemia, tuberculosis, bleeding disorders, fibroids and uterine malformations.
Considering the above, we can conclude that prostaglandins have the following advantages: 1) PG is a highly effective agent for cervical ripening; 2) cause not only ripening of the cervix, but also induction of labor; 3) when used correctly, they rarely cause side effects; 4) relatively easy to use (especially vaginal forms of drugs that can be administered independently on an outpatient basis).
Along with the noted advantages, the use of PG has its disadvantages: 1) the presence of a fairly large list of contraindications for use; 2) with an individual overdose, side effects are possible in both the mother and the fetus; 3) special equipment is needed to diagnose the main complications; 4) relatively high price of one procedure.
A mixed method of preparing the cervix includes the use of natural and artificial kelp.
Natural kelp is seaweed that is found in the northern and Far Eastern seas. In obstetrics and gynecology, two types of kelp are used: Laminaria digitata (digitate) and Laminaria japonica (Japanese).
The main active principle of kelp is polysaccharides (mainly sodium, calcium and magnesium salts of alginic acids). Alginic acids are polyuronides in chemical structure and are linear polymers. Thanks to polysaccharides, dried kelp is able to quickly absorb water from the environment, increasing in size. In addition to these polysaccharides, kelp contains proteins, amino acids, mannitol, microelements (including iodine), and vitamins.
Sticks 6-7 cm long and 2-3 mm in diameter are made from specially processed kelp. A strong silk thread is passed through the stick, through which the used dilator is removed. Due to its hygroscopicity, already 3-4 hours after entering the liquid, kelp swells in diameter, reaching a maximum expansion of 3-5 times after 24 hours, and its consistency turns from dense to much softer and resembles rubber. An important positive feature is that, expanding the cervical canal to 9-12 mm, the kelp after swelling remains unchanged in length.
Laminaria acts on the cervix not only by applying radial force, but also by removing water from the cervical stroma. As mentioned above, the cervix is formed mainly of fibrous connective tissue. Dense muscle constitutes little more than 15% of the cervical mass and is not concentrated into muscle. Most cervical tissue consists of long, complex proteoglycan molecules stretched across hyaluronic acid cores. The side chains of the hyaluronic acid core are loaded, and due to the fact that the load is uneven, the molecule curls into a long spiral. Inside the spiral molecules are water molecules. The process of cervical dilation appears to involve the extraction of water molecules from coils of helical molecules.
The disadvantages of using kelp are the acute pain that rarely accompanies their administration, as well as moderate, spastic pain when the sticks are in the cervical canal. Possible displacement of the sticks in the vagina, pinching of the swollen kelp in the cervix.
Thus, an analysis of the literature data made it possible to determine the following positive aspects of using kelp to prepare the cervix for childbirth: a fairly high efficiency of cervical ripening, a low incidence of complications and side effects, a relatively low cost of kelp sticks, the presence of a complex of biologically active substances that have a beneficial effect on mucous membrane. At the same time, kelp has the following disadvantages: an indefinite number of sticks are required for sufficient expansion of the cervical canal (from 2-3 to 10-12), it takes a fairly long time to obtain a clinical effect (up to 16-24 hours or more), there is a risk of infectious complications, as well as allergic reactions.
In most cases, according to the literature, to prepare the cervix for childbirth, you can limit yourself to prescribing antispasmodics from 38 weeks of pregnancy. One of the most commonly prescribed is hyoscine butyl bromide.
Hyoscine butyl bromide is a selective blocker of m-cholinergic receptors; m-anticholinergic, antispasmodic. Reduces the tone of the smooth muscles of internal organs, reduces their contractile activity, and causes a decrease in the secretion of exocrine glands. Hyoscine butyl bromide is a semi-synthetic derivative of hyoscyamine, an alkaloid found in belladonna, henbane, datura, and scopolia; quaternary ammonium compound.
One of the main indications for the use of this drug in obstetric practice is the preparation of the cervix for childbirth during full-term pregnancy, as well as its antispasmodic effect to accelerate the dilatation of the cervix during childbirth.
The main characteristic of hyoscine butyl bromide is the ability to cause local muscle relaxation due to the effect on m-cholinergic receptors of smooth muscles (suppression of intracellular calcium current occurs) in combination with poor absorption into the systemic circulation. Taking into account the selectivity of hyoscine butyl bromide (impact only on the m-cholinergic receptors of spasmodic muscles) and its low bioavailability, international practice has experience of its use for late dilatation of the uterine pharynx during childbirth. It is noted that in some cases its effect exceeds the effect of drotaverine and papaverine. Many years of clinical experience has been accumulated in the use of hyoscine butyl bromide in obstetrics, reflected in the Cochrane Library database. In 1952, the results of its clinical use in obstetrics practice in Germany were described. It has been established that the use of hyoscine butylbromide to prepare the cervix for childbirth has a beneficial effect on its course and outcome. In 2005, results were obtained indicating the high effectiveness of hyoscine butyl bromide in shortening the duration of the first stage of labor (dilatation period) in women who received hyoscine butyl bromide suppositories during the active phase of labor, compared with those women in labor who were not prescribed hyoscine butyl bromide. The duration of the first stage of labor in the first group was 123.86±68.89 minutes, in the second group - 368.05±133.0 minutes (p<0,05) .
Thus, the experience we have accumulated and data from domestic and foreign literature indicate that the administration of the m-cholinergic receptor-selective antispasmodic hyoscine butylbromide in the form of rectal suppositories, which has a good range of effectiveness and tolerability, is a highly effective means for preparing the cervix for childbirth at full-term pregnancy, as well as to accelerate the dilatation of the cervix during childbirth.

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