Foreign bodies. What to do if a child swallows something dangerous

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According to the observations of pediatric surgeons, most often children swallow what they do not need to swallow at all between the ages of 1 and 5 years. This is done through negligence, out of children's curiosity or through an oversight of parents.

Fortunately, most children ingest relatively harmless items that do not cause serious problems. These are coins, buttons, fruit pits, and whole nuts or nuts, such as cherries, apricots, or hazelnuts.

"Not particularly dangerous" items

In the event that the diameter of a foreign object swallowed by a child does not exceed 1 cm and this object has a rounded shape and a smooth surface , then, as a rule, it will pass through the stomach and intestines of the child on its own and will come out with a stool within 4 days.

4 days is a “critical” period during which a foreign body swallowed by a child must leave the intestines. In the event that this time has passed, and the swallowed object has not come out, the child urgently needs medical help.

Hospitalization during these 4 days is not required and, in principle, if the size of the swallowed object is known exactly (it is no more than 1 cm in diameter) and it is clear that it does not have sharp corners, then parents can cope with the unpleasant situation themselves without contacting a surgeon . However, the condition and any discomfort in the child's condition will need to be monitored very carefully. And with the appearance of pain in the abdomen, nausea, vomiting, stool retention, bloating, immediately contact a pediatric surgeon. All these 4 days of observing the child, it is necessary to feed him with mucous porridges and soups. It is better not to give laxatives and vegetable oil at this time - they can disrupt the normal functioning of the intestines and, instead of the expected effect, lead to problems with the exit of a foreign body. And, of course, check the child's stool all the time in anticipation of a swallowed object.You need to check very carefully - this is what pediatric surgeons advise.

Cause for serious concern

If the swallowed object is larger than 1 cm and also round in shape , then in this case it is worth contacting a doctor immediately after this unpleasant fact is discovered. Help for children when swallowing foreign objects in Yekaterinburg is provided by the Children's City Clinical Hospital No. 9.

The child is undergoing fluoroscopy (examination of the gastrointestinal tract using an X-ray machine) so that the doctor can see exactly where the foreign body is at the moment. If a foreign body has entered the stomach, then it is “released” with the help of FGS (under anesthesia or not - depends on the age of the child and his condition). Intestine such foreign bodies they usually leave on their own. But in this case, the child may be offered hospitalization for 4 days of observing the passage of a foreign body.

If the foreign body is sharp (for example, if a child has swallowed a needle, nail, or screw), then after an x-ray examination, if the object is still in the stomach, it is removed with the help of FGS. If the needle gets into the stomach, then the child is necessarily hospitalized and, under the constant supervision of surgeons and fluoroscopy, this needle is given a chance to go out on its own - more precisely, the child is given a chance to avoid surgery. Since very often swallowed needles from the intestines in children come out on their own, then without a direct threat of intestinal perforation (that is, when the needle pierces the intestinal wall), no one will do the operation for “preventive” purposes to the child. A prerequisite here is that the child must be in the hospital until the moment of release from the foreign body.

"Especially dangerous" foreign bodies

Much more dangerous for children than even needles and nails, swallowed parts of a magnetic designer (or any magnets), as well as helium balloons and batteries.

helium balloonsare funny little toys, sometimes the size of a pea, that "grow" when immersed in water. What is unpleasant is that they also grow in the stomach and intestines of a child. Having swallowed such a balloon, the child himself becomes an “incubator” for growing it, and after a couple of hours the “grown up” helium balloon is able to completely block the intestinal lumen of the child and cause complete intestinal obstruction. In the summer of 2013, the doctors of Children's Clinical Hospital No. 9 managed to save a child who was admitted to them with intestinal obstruction. During the operation, it was precisely the “overgrown” helium balloon that was found in the intestinal lumen. What is especially unpleasant is that such balls are not visible on x-rays due to their composition.

Magnets.If a child swallowed one magnet, then most likely there will be no big trouble. If several parts of the magnetic constructor are swallowed, then in the intestines of the child they begin to “interact” - stick to each other, even if they are in different loops of the intestine. As a result, the intestines are soldered and fistulas and passages form between them. All this will require very complex and even repeated operations. Therefore, pediatric surgeons strongly advise parents - do not give your child magnetic constructors until such time as you are sure that their parts will not fall into his mouth. And if the child “ate” the magnet, you should immediately consult a doctor.

Batteries.Here, too, the child needs the help of a doctor urgently. Because when a battery is swallowed, it burns the mucosa along the entire path of its passage, and any waiting and delay here sharply reduces the child's chances of a full recovery. Swallowed batteries should be removed immediately and should be dealt with pediatric surgeon in a well-equipped clinic with an operating room and all the necessary diagnostic services.

The reaction to the injection can be divided in 3 main steps:

1. Immediately after injection, the skin appears papule. In its normal state, it has no more than 1 centimeter in diameter. She is observed about 15-20 minutes, after which it dissolves on its own. It does not differ in color from skin(may be slightly pink). There are no specific sensations, except perhaps a slight pain, as from any intradermal injection.
2. Through 1-2 months at the injection site, the main vaccination reaction appears. On average, it lasts 4-5 months. This is a pustule (rash, most often in a single form), which contains a small amount of pus. This is normal, and it is not recommended to remove the pus, unless it flows out on its own. As a rule, there are no painful sensations. Mild itching may be present.
3. After the lapse of 4-5 months the pustule turns into a characteristic seal. Its diameter is up to 1 centimeter. Sometimes a little more. After a few days, the induration turns into bubble with liquid inside. It doesn't need to be touched. Some time passes from 2 weeks to 3 months), and the bubble bursts on its own, after which a small wound with a crust forms on the skin.

Important! It is strictly forbidden to remove the crust formed in the third stage. Doctors do not recommend covering with antiseptics and moistening with water.

After the reaction to the BCG vaccination is over, a scar red (various shades are possible from pink to burgundy). It is in diameter up to 1 centimeter and does not cause any pain in humans.

Vaccination scar heals after 12-15 months, and the injection mark completely disappears from the skin, as in the photo. This is evidence that the vaccination was successful.

pain none of the steps. Mild itching or short-term, barely noticeable pain is the maximum.

Important! If you are in severe pain, see your doctor to make sure everything is okay.

Vaccination size. Is it normal or not if she swells up?

If the tumor appears at the very site of the BCG injection and does not exceed 1 centimeter in diameter is perfectly natural. Pustule, a small abscess, always has the form of a swelling of a small size.

You should not panic about this, just watch the vaccination. After a few months ( no more than 6) the pustule will heal on its own. The main thing is not to interfere with her with antiseptics and iodine nets, do not try to squeeze out pus.

If swollen skin around pustules are not quite normal anymore. This is a reason to see a doctor. In the case of a child, they turn to a pediatrician, with an adult - either to the one who was vaccinated or to a dermatologist.

Swelling of the skin around the abscess is in no way associated with tuberculosis, but only indicates an infection inside. In this case, the person is fully examined and, if necessary, prescribed additional measures treatment.

Important! First 1-2 days after BCG vaccination, the tumor must be obligatory. She is always present. Then it subsides, and if this does not happen, a consultation with a doctor is recommended. Somewhere after 1.5-2 months the tumor will appear again. Swelling at earlier stages (eg. In 2 weeks after vaccination) is not considered the norm.

What should be the color of the skin at the injection site. Why did BCG turn blue?

With redness after a BCG injection, the situation is almost the same as with swelling. If the vaccine itself turns red, then this is normal, but if a skin lesion forms around it, this is a reason to go to the doctor.

What are the possible scenarios for the development of events?

• Redness straightaway after BCG injection. Everything is fine as long as the redness does not exceed 1-1.5 cm in diameter. If it spreads, you need to consult a doctor.
• Redness at the stage of formation of "abscess" also normal.
• Change in skin color at the stage of scar formation is an almost indispensable element. A keloid scar is always slightly swollen and looks more red than the skin around it.
• red pustules, inside which is pus- this is completely normal. It can even be maroon, or turn blue, this does not mean anything bad. The diameter of the formation plays a key role. When he is significant more than 1 cm- you can worry.
• If pus or fluid oozes out of the pustule, that's fine. But when, after leaking on healthy skin redness is formed - consulting a doctor will be the best solution.

The color of the vaccine sometimes changes to yellow. This is due to the pus that is inside the pustule. If the skin is thin, then it is logical that the yellowish color of suppuration will be very translucent. It is pointless to worry about this, since the skin itself has not changed its color - suppuration has given it yellowness.

Important! Redness around the BCG injection site (damage to healthy skin) is a reason to consult a doctor. It is not normal if the injection site turns red in the first 1-1.5 months(before the appearance of pustules with pus).

You will also be interested in:

Vaccinations need to be taken care of. Basic principles and photos

To take good care of BCG, the main thing is forget about her generally. Do not touch, do not process, do not wet with water, do not try to squeeze out pus - the best option. But there is also additional principles care:

1. handle BCG antiseptics or iodine at any stage forbidden. It does not make sense, and in some cases it can do harm. Cotton wool, bandage, plaster - also not an option.
2. If pus or liquid is released from the pustule, then they are removed with gauze. Cloth or cotton wool is not desirable, as it may cause slight irritation. In the absence of gauze, a bandage is used. The wound is not bandaged, but simply wipe the selection.
3. Trying to get rid of pus strictly prohibited. When the time comes, it will flow out by itself. When squeezing out, there is a high risk of infection, and then you will have to undergo additional examinations, repeat the vaccination procedure.

It is possible to wet the injection site only in the first weeks, when a pustule has not yet formed. After that for vaccination moisture ingress is avoided. Swimming is better clean water without adding potassium permanganate.

If BCG vaccination was carried out not properly, then redness is likely to spread to areas of healthy skin. It is pointless to be afraid of this, but you still have to consult a doctor. Additional examinations, observation, Mantoux test, re-vaccination are the most logical and correct course of action to check a person's condition. Maybe he has an innate immunity to tuberculosis.

Important! If there is no reaction to BCG, this is not normal. Perhaps the injection was done incorrectly. In the absence of swelling and redness, patients go to the doctor for an additional examination.

Results. How to make sure that the tuberculosis vaccination was successful?

Regardless of who is vaccinated with BCG - a child or an adult, it must be taken care of in exactly the same way. Her can't be disturbed, And this is the main point. Wetting, processing, squeezing, bandaging - all this strictly not recommended. But there is a reason to wear long and spacious sleeves, to try to pay as little attention as possible to the pustule. The easier it is for a person to forget about the injection site and ignore it, the more likely it is that everything will be successful.

Worrying about the long healing of BCG is pointless - this is the complete norm. All stages described in this article should be necessarily and waiting for every person. If no severe pain or discomfort- don't worry about BCG at all. When the time comes, the vaccine itself will cease to remind of its existence.

Photo 1. A properly healed BCG vaccination mark turns into a neat, almost imperceptible scar.

The passage of all stages of the BCG reaction takes 7-8 to 12 months, and sometimes more. Doctors do not recommend rushing things and trying to “help” the wound heal faster. Patiently waiting for the completion of a long reaction is the most correct option.

Useful video

The video talks in detail about how the BCG vaccine heals and when it can be given to young children.

Spinal hemangioma is considered one of the most common vascular tumors of the skeletal system. According to statistics, everyone suffers from it tenth inhabitant of the earth. Patients are predominantly women and average age sick - 20-30 years. It is believed that up to 80% of the fair sex after 40 years of age may suffer from this pathology.

Vertebral hemangioma can long time be asymptomatic, detected by chance, but the very first sign of a tumor is usually pain, with which the patient is sent for x-rays or MRI. Identified hemangioma requires a solution to the issue about the necessity and expediency of surgical treatment. The tumor does not show a tendency to malignancy, however the risk of dangerous complications require a serious approach to it.

The role of the spine cannot be overestimated. This is the main support for the whole body, internal organs, a receptacle spinal cord, which allows us to feel pain, temperature, touch, and perform purposeful movements. Functions of all internal organs obey the signals coming to them from the spinal cord. A neoplasm in a vertebra may not go beyond its limits for a long time and not affect the spinal cord in any way, however, the destruction of the structure of the vertebra, its fragility and instability are fraught with displacement, fracture and compression of very important nerve structures. Usually the lesion is localized in the thoracic (th12) or lumbar (l1-l4) spine, affecting one or several vertebrae at once.

Causes and types of hemangiomas

Hemangioma is a vascular tumor, which is a tangle of intertwining and altered vessels of various types. Damage to the vertebral bodies is usually observed, but tumor growth is also possible in the cartilaginous layers.

typical location of a hemangioma in the spine

Initially, defective vessels of the vertebra form a tumor inside it. Under the influence of injuries or heavy loads, hemorrhages, thromboses occur, the outflowing blood stimulates osteoclast cells to “cleanse” the damaged zone, and then the vacated space is filled with new defective tumor vessels. This process proceeds continuously, leading to the growth of the neoplasm. The size of a vertebral hemangioma rarely exceeds 1 cm.

Causes of vertebral hemangioma can be:

• hereditary predisposition;
• Female;
• Vertebral injury.

It has been established that in the presence of close relatives suffering from vascular tumors of the spine, the risk of hemangioma increases up to five times. Perhaps this is due to hereditary failure vascular walls promoting neoplastic transformation.

The role of estrogens in tumor formation is evidenced by the more frequent occurrence of pathology in women, who fall ill several times more often than men. In addition, during pregnancy, especially in the third trimester, there is an intensive increase in the tumor, not only due to the changed hormonal background, but also due to the increasing load on the spine.

Injuries and excessive stress can contribute to increased growth of the vascular component and the formation of a tumor. At the same time, if there is already a hemangioma, then repeated mechanical influences enhance its growth.

The thoracic spine (Th12) is most often affected, followed by the lumbar. Tumor cervical It is considered one of the most dangerous, as it carries the risk of impaired blood supply to the brain. AT lumbar arcs l1-l4 are usually affected, which leads to a variety of neurological disorders.

examples of spinal hemangioma growth

Depending on the nature of the flow, there are:

1. Aggressive hemangioma;
2. Non-aggressive.

An aggressive course is evidenced by a rapid increase in the size of the neoplasm, severe symptoms in the form of a compression syndrome, and pathological vertebral fractures. Every tenth detected tumor is aggressive.

Non-aggressive hemangiomas proceed relatively favorably, grow slowly and asymptomatically, and in rare cases of small neoplasms, even their spontaneous resorption is possible.

Depending on the volume of the lesion, the hemangioma may be limited to only the vertebral body, the posterior half-ring, the entire vertebra, and epidural growth over the pia mater is also possible.

The histological structure allows to distinguish different kinds neoplasms:

The structure, size and location of the hemangioma determine its course, symptoms, treatment approaches and prognosis.

Manifestations of spinal hemangioma

Symptoms of a tumor depend on its size and location in relation to the vertebral body. For a long time, the tumor proceeds hidden, without causing any concern. An asymptomatic neoplasm is detected by chance, during examinations in connection with an injury or other pathology of the spinal column.

by the most early sign growing hemangioma becomes pain, which at first is not intense, arising periodically. As the tumor grows, the intensity of the pain increases, it becomes unbearable. The dangerous size of the tumor (over 1 cm) contributes to the progression of not only the pain syndrome, but also neurological disorders, associated with a violation of the structure of the vertebra and compression of the spinal cord.

With small tumors, the pain is moderate, more often disturbs patients at night or after physical exertion, and is localized by the area of ​​the affected vertebra. With the involvement of the structures of the spinal cord, numbness, paresis and paralysis, dysfunction of the pelvic organs are possible.

Hemangioma thoracic spine manifests itself:

1. Pain in the area of ​​the affected vertebra;
2. Feeling of numbness in the limbs;
3. Paresis and paralysis (rarely);
4. Heart rhythm disturbances, functions digestive system, disorder of the pelvic organs.

With neck injury possible violation of blood flow in the brain, resulting in headaches, decreased mental performance, insomnia, dizziness, impaired hearing and vision.

Lumbar ranks second in frequency. With a hemangioma of this localization (l1, l2, l3, l4), the following are possible:

• Soreness in the lower back, groin, thighs;
• Numbness in limbs;
• Paresis and paralysis of the legs;
• Dysfunction of the pelvic organs (especially with damage to l3-4).

In adults, in addition to those described neurological symptoms Infertility and impotence can be a sign of an aggressive hemangioma.

Hemangioma with an aggressive course can provoke very serious complications- compression fractures of the vertebral bodies, compression of the spinal cord and its roots, when paresis, paralysis and dysfunction of internal organs can become persistent and irreversible. To prevent this from happening, when the above symptoms appear, you should consult a specialist.

It is important to detect a hemangioma in time before complications and irreversible changes in the spinal cord occur. Examination of patients with back pain, in whom hemangioma is suspected, requires the participation of a neurologist, neurosurgeon, vertebrologist.

Diagnosis of hemangiomas involves:

1. X-ray examination of the spine in different projections is the simplest, cheapest and most affordable method.
2. MRI - allows you to establish not only the degree of damage to the vertebra, but also the surrounding soft tissues.

hemangioma of the spine on a diagnostic image

Treatment of spinal hemangioma

Treatment of spinal hemangioma can be significant difficulties due to the peculiar localization. Simple removal of the tumor can lead to vertebral instability, compression fracture, and damage to the spinal cord or its roots. The choice of a rational method of treatment is reserved by the neurosurgeon after assessing the patient's condition and characteristics of the tumor.

Patients who have an asymptomatic small hemangioma may be offered dynamic follow-up with regular MRI monitoring.

Indications for surgery are:

• Rapid tumor growth;
• Damage to more than a third of the vertebra;
• Aggressive course of the tumor;
• The development of complications (compression of the spinal cord, its roots, pathological fracture).

Hemangiomas should be treated in specialized neurosurgical departments, while the experience and qualifications of the doctor are of no small importance. Medical treatment is only symptomatic and is aimed at eliminating pain and inflammation.

Various methods have been proposed for the treatment of vertebral hemangioma:

1. Classical removal of the tumor and resection of a section of the vertebra;
2. Alcoholization of neoplasm;
3. Embolization of tumor vessels;
4. Radiation therapy;
5. Percutaneous puncture vertebroplasty.

Removal of the tumor with open access and resection of a section of the vertebra has been used since the 30s of the last century, but this operation is very dangerous with serious complications: bleeding from the vessels of the formation, malnutrition of the spinal cord, fracture of the vertebra. Due to the risk of such consequences, intervention is used occasionally and for serious indications, such as compression of the spinal cord or its roots. It is technically impossible to remove the tumor completely with an open operation, the surgeon can remove only the epidural part of it.

If there is no way out and such an intervention is necessary, then preference is given to decompression techniques aimed at eliminating compression of the structures of the spinal cord by the tumor. Surgery often carried out in children, when the introduction of a cementing substance can cause vertebral growth to stop and deformation of the spine in the future.

Alcoholization of neoplasm involves the introduction of a solution of ethyl alcohol into the tumor vessels, while the neoplasm is reduced due to sclerosis of the vessels. The immediate results of alcoholization can be satisfactory, because the tumor will decrease, but reverse side medals will be the depletion of the bone tissue of the vertebra, its destabilization and, as a result, a pathological fracture a few months after the procedure. This circumstance does not allow the widespread use of alcoholization in spinal hemangioma, although the effect may be good in tumors of other localizations.

Embolization of tumor vessels consists in the introduction of a special solution, leading to embolism of the vessels of the neoplasm and disruption of its nutrition. Active substance can be injected both directly into the tumor (selective embolization) and into nearby vessels. The disadvantage of this treatment can be considered a relapse due to the preservation of small vessels that feed the hemangioma, as well as a violation of the structure of the vertebra. In some cases, embolization is technically very difficult and even impossible, and a complication can be acute disorder circulation in the spinal cord.

Radiation therapy is one of the classic methods of treatment. spinal hemangiomas, it is safer than open operation to remove the tumor. This method of treatment could be used in many patients, because radiation is quite effective, but complications in the form of myelopathy, radiculitis, damage nerve fibers, skin reactions do not allow it to be widely used. In addition, a significant dose of radiation is needed to eliminate the tumor. Radiation therapy is contraindicated in children and pregnant women. Another unsolvable problem with radiation therapy is the violation of the integrity of the vertebra after tumor reduction, which contributes to pathological fractures after treatment. Currently radiation therapy may be prescribed for elderly patients with high operational risk.

A real breakthrough in the treatment of vertebral hemangiomas was the use of puncture vertebroplasty, proposed by French doctors. The essence of the method is the introduction into the vertebra of a special cementing substance mixed with barium sulfate (radiocontrast agent) and titanium. In this case, several goals are achieved at once: the tumor decreases and stops growing, the vertebral body is stabilized by bone cement and compacted, the risk of fracture is minimal. Puncture vertebroplasty is considered the method of choice for vertebral hemangioma, especially in cases of aggressive tumor progression. It is possible as the main method of therapy or as part of a combined treatment.

puncture vertebroplasty – modern “cementing” of hemangioma

For the operation, the patient is placed on the stomach, local anesthesia while the patient is conscious. A cementing agent is injected into the vertebra damaged by the tumor with the help of a special conductor. good effect achieved due to the high density of the cement, which eliminates destabilization, fragility and fracture of the vertebra.

If necessary, additional fixation of the vertebrae with screws and decompression of the spinal cord can be performed. In most patients, after puncture vertebroplasty, the pain syndrome disappears, neurological disorders and the habitual way of life and ability to work are restored. Postoperative period usually proceeds well, within 2-3 weeks the patient is discharged from the hospital.

It is worth remembering that there are contraindications to certain types of treatment in patients with a diagnosed hemangioma. So, you can not use vitamins and drugs that stimulate the immune system, as they can provoke an increase in the neoplasm. It is necessary to exclude physical activity when visiting the gym and at home, lifting weights. Solarium and tanning in the sun, all kinds of warming procedures (baths, sauna) are contraindicated.

It is better for lovers of physiotherapy to refuse all types of magnetotherapy. With hemangioma, massage cannot be performed, since a mechanical effect on the spine can not only cause tumor growth due to increased blood flow, but also provoke such dangerous complication as a compression fracture requiring immediate treatment.

It is almost impossible to prevent the growth of hemangioma of the spine, especially in predisposed persons, but it is advisable not to expose the vertebrae to excessive physical activity and avoid injury. If the tumor is already detected, does not progress and does not show any symptoms, then observation and MRI at least once a year are sufficient. For symptomatic and aggressive hemangiomas, the patient will be offered treatment. The prognosis for hemangioma of the spine in most cases is favorable.

Video: hemangiomas in the program “Live healthy!”

Video: spinal hemangioma, expert opinion

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not currently provided.

Normal and timely labor never begins suddenly and violently. On the eve of childbirth, a woman experiences their precursors, and the uterus and her cervix prepare for the birth process. In particular, the cervix begins to "ripen" and expand, that is, it enters the stage of opening the uterine os. Childbirth is a complex and lengthy process and largely depends on the interaction of the uterus, cervix and the state of the hormonal background, which determines their successful completion.

The cervix is...

The lower part of the uterus is called its cervix, which looks like a narrow cylinder and connects the uterine cavity with the vagina. Directly in the neck, the vaginal part is distinguished - the visible part that protrudes into the vagina below its arches. And also there is supravaginal - the upper part, located above the arches. In the cervix passes the cervical (cervical) canal, the upper end of it is called the internal pharynx, respectively, the lower end is the outer one. During pregnancy, there is a mucous plug in the cervical canal, the function of which is to prevent the penetration of infection from the vagina into the uterine cavity.

The uterus is the female reproductive organ, the main purpose of which is the bearing of the fetus (fetal container). The uterus consists of 3 layers: the inner one is represented by the endometrium, the middle one is the muscular tissue and the outer one is the serous membrane. The main mass of the uterus is the muscular layer, which hypertrophies and grows during gestation. The myometrium of the uterus has a contractile function, due to which contractions occur, the cervix (uterine os) opens and the fetus is expelled from the uterine cavity during the birth act.

Periods of childbirth

The birth process lasts quite a long time, and normally in primiparous women in labor it is 10-12 hours, while in multiparous women it lasts about 6-8 hours. Childbirth itself includes three periods:

• I period - the period of contractions (opening of the uterine os);
• II period is called the period of attempts (the period of expulsion of the fetus);
• III period - this is the period of separation and discharge of the child's place (afterbirth), therefore it is called the afterbirth period.

The longest stage of the birth act is the period of opening of the uterine os. It is caused by uterine contractions, during which the fetal bladder is formed, the fetal head moves along the pelvic ring and cervical opening is provided.

Contraction period

First, contractions arise and are established - no more than 2 in 10 minutes. Moreover, the duration of uterine contraction reaches 30 - 40 seconds, and relaxation of the uterus 80 - 120 seconds. Prolonged relaxation of the uterine muscles after each contraction ensures the transition of the cervical tissues into the structure of the lower uterine segment, as a result of which the length of the visible part of the cervix decreases (it shortens), and the lower uterine segment itself is stretched and lengthened.

As a result of the ongoing processes, the presenting part of the fetus (usually the head) is fixed at the entrance to the small pelvis, separating the amniotic fluid, as a result, anterior and posterior waters are formed. A fetal bladder is formed (contains anterior waters), which acts as a hydraulic wedge, wedged into the internal os, opening it.

In first-borns, the latent phase of disclosure is always longer than in women giving birth for the second time, which causes a longer total duration of labor. Completion of the latent phase is marked by complete or almost complete smoothing of the neck.

The active phase begins with 4 cm of cervical dilatation and lasts up to 8 cm. At the same time, contractions become more frequent and their number reaches 3–5 in 10 minutes, the periods of contraction and relaxation of the uterus equalize and amount to 60–90 seconds. The active phase lasts for primiparous and multiparous 3-4 hours. It is in the active phase that labor activity becomes intense, and the cervix opens quickly. The fetal head moves along the birth canal, the cervix has completely passed into the lower uterine segment (merged with it), by the end of the active phase, the opening of the uterine os is complete or almost complete (within 8–10 cm).

At the end of the active phase, an autopsy occurs amniotic sac and outpouring of water. If the cervical opening has reached 8 - 10 cm and the water has departed - this is called a timely outflow of water, the discharge of water at the opening of up to 7 cm is called early, with 10 or more cm of opening of the pharynx, an amniotomy is indicated (the procedure for opening the fetal bladder), which is called a belated outflow of water.

Terminology

The opening of the cervix does not have any symptoms, only a doctor can determine it by conducting a vaginal examination.

To understand how the process of softening, shortening and smoothing the neck is progressing, one should decide on obstetric terms. In the recent past, obstetricians determined the opening of the uterine os in the fingers. Roughly speaking, how many fingers the uterine pharynx passes through, such is the opening. On average, the width of the "obstetric finger" is 2 cm, but, as you know, everyone's fingers are different, so measuring the opening in cm is considered more accurate. So:

• if the cervix is ​​​​opened by 1 finger, then they say about the opening of 2 - 3 cm;
• if the opening of the uterine os has reached 3–4 cm, this is equivalent to opening the cervix by 2 fingers, which, as a rule, is diagnosed already at the beginning of regular labor (at least 3 contractions in 10 minutes);
• an almost complete opening is indicated by the opening of the neck by 8 cm or by 4 fingers;
• full disclosure is fixed when the cervix is ​​completely smoothed (the edges are thin) and passable for 5 fingers or 10 cm (the head falls to the pelvic floor, turning with an arrow-shaped seam in a straight size, there is an irresistible desire to push - it's time to go to the delivery room for the birth of a baby - the beginning of the second period childbirth).

How does the cervix mature?

The harbingers of childbirth that have appeared indicate the imminent onset of the birth act (from about 2 weeks to 2 hours):

• the bottom of the uterus descends (for 2-3 weeks before the onset of contractions), which is explained by the pressing of the presenting part of the fetus to the small pelvis, a woman feels this sign by easing breathing;
• the pressed head of the fetus presses on the pelvic organs ( bladder, intestines), which leads to frequent urination and constipation;
• increased excitability of the uterus (the uterus “hardens” when the fetus moves, the woman moves abruptly, or when the abdomen is stroked / pinched);
• appearance is possible - they are irregular and rare, pulling and short;
• the cervix begins to "ripen" - softens, skips the tip of the finger, shortens and "centers".

The opening of the cervix before childbirth proceeds very slowly and gradually over a month, and intensifies on the last day - two on the eve of childbirth. In nulliparous women, the dilatation of the cervical canal is about 2 cm, while in multiparous women, the dilatation exceeds 2 cm.

To determine the maturity of the cervix, a scale developed by Bishop is used, which includes an assessment of the following criteria:

• the consistency (density) of the neck: if it is dense, this is regarded as 0 points, if it is softened along the periphery, but the internal pharynx is dense - 1 point, soft both from the inside and outside - 2 points;
• the length of the neck (the process of its shortening) - if it exceeds 2 cm - 0 points, the length reaches 1 - 2 cm - a score of 1 point, the neck is shortened and does not reach 1 cm in length - 2 points;
• patency of the cervical canal: a closed external pharynx or skips the tip of a finger - a score of 0 points, the cervical canal is passable to a closed internal pharynx - this is estimated at 1 point, and if the canal passes one or 2 fingers through the internal pharynx - it is estimated at 2 points;
• how the neck is located in relation to the wire axis of the pelvis: directed backwards - 0 points, shifted anteriorly - 1 point, located in the middle or "centered" - 2 points.

When summing the points, the maturity of the cervix is ​​​​estimated. An immature neck is considered with a score of 0 - 2 points, 3 - 4 points is regarded as an insufficiently mature or ripening neck, and with 5 - 8 points they speak of a mature neck.

Vaginal examination

To determine the degree of readiness of the cervix and not only, the doctor conducts a mandatory vaginal examination (upon admission to maternity hospital and at 38 - 39 weeks at the reception in the antenatal clinic).

If a woman is already in the maternity ward, a vaginal examination to determine the process of opening the uterine os every 4 to 6 hours or according to emergency indications:

• discharge of amniotic fluid;
• carrying out a possible amniotomy (weak birth forces, or a flat fetal bladder);
• with the development of anomalies of generic forces (clinically narrow pelvis, excessive labor activity, discoordination);
• before regional anesthesia (EDA, SMA) to determine the cause of painful contractions;
• the occurrence of discharge with blood from the genital tract;
• in the case of established regular labor activity (preliminary period that turned into contractions).

When conducting a vaginal examination, the obstetrician assesses the condition of the cervix: its degree of disclosure, smoothing, thickness and extensibility of the cervical edges, as well as the presence of scars on soft tissues genital tract. In addition, the capacity of the pelvis is assessed, the presenting part of the fetus and its insertion are palpated (localization of the swept suture on the head and fontanelles), the advancement of the presenting part, the presence of bone deformities and exostoses. Be sure to evaluate the fetal bladder (integrity, functionality).

According to the subjective signs of disclosure and the data of the vaginal examination, a partogram of childbirth is compiled and maintained. Contractions are considered subjective signs of childbirth, in particular, the opening of the uterine os. Criteria for evaluating contractions include their duration and frequency, severity and uterine activity (the latter is determined instrumentally). Partogram of childbirth allows you to visually record the dynamics of the opening of the uterine os. A graph is drawn up, horizontally indicating the duration of labor in hours, and vertically opening the cervix in cm. Based on the partogram, one can distinguish between the latent and active phases of labor. The steep rise of the curve indicates the effectiveness of the birth act.

If the cervix dilates prematurely

The opening of the cervix during pregnancy, that is, long after childbirth, is called isthmic-cervical insufficiency. This pathology is characterized by the fact that both the cervix and the isthmus do not fulfill their main function in the process of gestation - obturator. In this case, the neck softens, shortens and smoothes, which does not allow the fetus to be kept in the fetus and leads to spontaneous abortion. Termination of pregnancy, as a rule, occurs in 2 - 3 trimesters. The failure of the cervix is ​​evidenced by the fact of its shortening to 25 mm or less at 20-30 weeks of gestation.

Isthmic-cervical insufficiency is organic and functional. The organic form of the pathology develops as a result of various cervical injuries - artificial abortions (see), cervical ruptures during childbirth, surgical methods for treating cervical diseases. The functional form of the disease is due either to a hormonal imbalance or an increased load on the neck and isthmus during pregnancy (multiple pregnancies, excess water or a large fetus).

How to keep a pregnancy when dilating the cervix

But even with a cervical opening of 1 - 2 fingers in a period of 28 weeks or more, it is likely to keep the pregnancy, or at least prolong it until the birth of a completely viable fetus. In such cases are appointed:

• bed rest;
• emotional peace;
• sedatives;
• antispasmodics (magne-B6, no-shpa,);
• tocolytics (ginipral, partusisten).

Be sure to carry out treatment aimed at the production of surfactant in the lungs of the fetus (glucocorticoids are prescribed), which accelerates their maturation.

In addition, treatment and prevention of further premature opening of the cervix is ​​​​surgical - stitches are applied to the neck, which are removed at 37 weeks.

The cervix is ​​immature - what then?

The opposite situation is possible, when the cervix is ​​“not ready” for childbirth. That is, the hour X has come (the expected date of birth), and even several days or weeks have passed, but there are no structural changes in the cervix, it remains long, dense, rejected backwards or forwards, and the internal pharynx is impassable or passes the tip of the finger. How do doctors act in this case?

All methods of influencing the neck, leading to its maturation, are divided into drug and non-drug. To medical methods includes the introduction into the vagina or into the cervix of special gels and suppositories with prostaglandins. Prostaglandins are hormones that accelerate the process of maturation of the cervix, increase the excitability of the uterus, and in childbirth they intravenous administration practice in case of weakness of tribal forces. Local administration of prostaglandins does not have a systemic effect (no side effects) and contribute to the shortening and smoothing of the neck.

Of the non-drug methods of stimulating the opening of the cervix, the following are used:

Sticks - kelp

Sticks are made from dried kelp algae, which are highly hygroscopic (absorb water well). Such a number of sticks are introduced into the cervical canal so that they fill it tightly. As the sticks absorb liquid, they swell and stretch the cervix, causing it to dilate.

Foley catheter

The catheter for opening the cervix is ​​represented by a flexible tube with a balloon fixed at one end. A catheter with a balloon at the end is inserted into the cervical canal by a doctor, the balloon is filled with air and left in the neck for 24 hours. Mechanical action on the neck stimulates its opening, as well as the production of prostaglandins. The method is very painful and increases the risk of infection of the birth canal.

Cleansing enema

Unfortunately, in some maternity hospitals they refused to conduct a cleansing enema for a woman who came to give birth, but in vain. The free intestine, as well as its peristalsis during defecation, increases the excitability of the uterus, increases its tone, and, consequently, accelerates the process of opening the cervix.

Question answer

How can you speed up the opening of the cervix at home?

• prolonged walks in the fresh air increase the excitability of the uterus and the production of prostaglandins, and the presenting part of the baby is fixed at the entrance to the small pelvis, further stimulating the opening of the cervix;
• follow bladder and intestines, avoid constipation and prolonged abstinence from urination;
• eat more salads from fresh vegetables seasoned with vegetable oil;
• take a decoction of raspberry leaves;
• stimulate the nipples (when they are irritated, oxytocin is released, which causes uterine contractions).
• Are there any specific neck opening exercises?

At home, walking up the stairs, swimming and diving, bending and turning the torso accelerates the maturation of the neck. It is also recommended to take a warm bath, massage the ear and little finger, breathing exercises and exercises to strengthen the perineal muscles, yoga. In maternity hospitals there are special gymnastic balls, the seat and jumps on which, during the period of contractions, accelerate the opening of the uterine os.

Does sex really help prepare the cervix for childbirth?

Yes, sex in last days and weeks of pregnancy (subject to the integrity of the fetal bladder and the presence of a mucous plug in the cervical canal) contribute to the maturation of the cervix. First, during orgasm, oxytocin is released, which stimulates uterine activity. And, secondly, the semen contains prostaglandins, which have a beneficial effect on the process of maturation of the cervix.

At what opening do attempts begin?

Pushing is a voluntary contraction of the abdominal muscles. The desire to push arises in a woman in labor already at 8 cm. But until the cervix opens completely (10 cm), and the head sinks to the bottom of the small pelvis (that is, it can be felt by a doctor by pressing on the labia) - you can’t push.