Obstetric pessary during pregnancy
Installing a pessary scares most women. But in some cases, this is the only way to safely endure the child and give birth at the appointed time. What is a pessary, in which cases it is used, as well as the advantages and disadvantages of its installation will tell this article.
What is an obstetric pessary?
Obstetric pessary is a medical device used in obstetrics, gynecology and urology. For example, in gynecology, a pessary is installed on pregnant women in the uterus and is an alternative to implanting uterine sutures.
The word "pessary" is of Greek origin and is translated as round or oval stone. The pessary got its name because of the shape - the first devices had a round and ring-shaped form. Today, there are different in shape and appearance of the vaginal ring, for example, obstetric pessary arabin, Juno type 1 and Juno type 2.
An obstetric pessary is used to prevent and treat complications in pregnant women and is unloading. There are oval, cubic, cup-shaped, ring-shaped, mushroom obstetric pessaries, the photo shows their differences. In addition to form, they vary in size:
• Type I - used to install firstbirths, as well as those women who have given birth no more than two times. The installation of the device occurs when the cervix reaches a diameter of 25-30 mm, and the upper third of the vagina is 55-65 mm,
• Type II - installed in the same cases, but for women with the upper third of the vagina size 65-74 mm,
• Type III - used for women who become pregnant a third or more times. Anatomical measurements are 30-37 mm in diameter of the neck and 75-85 mm in size of the vagina (upper third).
For each woman, an individual approach and the choice of the size and shape of the gynecological pessary is carried out, since its parameters must fit the anatomical parameters of the internal structure of the genital organs.
It is important that the device was made of their hypoallergenic material, environmentally friendly and safe for health. Silicone pessaries are mainly used. An alternative to them are plastic uterine rings made from a special elastic material. The pessary is rounded and flattened on all sides, therefore, when worn, it does not cause discomfort and does not injure the internal genital organs.
Obstetric ring is used only once. Its shelf life is limited to the time during which it remains sterile. Installation of the pessary is carried out so that a smaller part of it is adjacent to the pubis, and the larger base is directed to the rectum. The ring around the cervix prevents its opening, and the vaginal secretions freely pass through the holes in the device.
Indications and contraindications for installation
This obstetric device is installed when there is a threat of premature cervical dilatation. That is, it is a way to prevent premature labor and the risk of miscarriage. Often establish a pessary during pregnancy with twins or triplets.
Pathologies that are indications for the installation of the uterine ring:
• ICN - cervical insufficiency,
• failure of surgical sutures in the treatment of ICN.
With the help of the vaginal ring from preterm labor, it is possible to keep the cervix closed and prevent its softening, since the device unloads the uterus and reduces stress from it. In addition to the physical functions of the ring to prevent preterm birth and has a psychological task. Most women say that they feel calmer with pessaries, as the probability of safely carrying and having a child increases.
As with any medical procedure, the installation of the ring with the threat of premature birth has its contraindications. It is impossible to put this device in case of suspected fetal freezing and other cases when prolongation of pregnancy is impossible. Also contraindications to installing a pessary are blood discharge from the vagina and inflammation in the genitals.
Pessary installation: timing, preparation and course of procedures
Suturing the uterus can be no earlier than 20 weeks of pregnancy, as in earlier periods the use of anesthesia is dangerous for the fetus. Installation of the vaginal ring is possible before 20 weeks, but most often it is set for a period of 28-33 weeks. Before installing the device, it is necessary to treat and prevent any infections, such as thrush. Basically, vaginal suppositories are prescribed for this.
The installation process pessary lasts a few minutes. Before the procedure, the woman should empty her bladder, then take a seat on the gynecological chair. The doctor bends the pessary in a certain way and inserts it into the vagina, setting it in the right place. To facilitate the introduction of devices it is pre-lubricated with glycerin or other moisturizing agent.
Feelings of a woman during the installation of the pessary
Each representative of the weaker sex has its own pain threshold. Therefore, reviews about installing a pessary are different for everyone. Some say that this procedure brings some discomfort. Others complain of severe pain.
Doctors advise for half an hour before the procedure to take an antispasmodic in cases where the uterus is hypersensitive. Painkillers do not apply in this case, as the resulting painful sensations are tolerable.
Recommendations of doctors after installing a pessary during pregnancy
After installing the vaginal ring in case of polyhydramnios or other indications, the woman should follow some recommendations, namely:
• do not have sex,
• do not overload yourself with physical exertion,
• to prevent the development of infections in the genitals put vaginal suppositories,
• once every twenty days to take a smear on the analysis of microflora,
• systematically visit a gynecologist, who, upon examination, will monitor the location of the pessary,
• Do not touch the uterine ring during preterm labor and do not try to get it.
In the normal course of gestation, cervix is closed almost to the end of the gestation period. A few weeks before giving birth, the cervix opens up to 1-2 centimeters. It holds the unborn baby, the fetal bladder and the amniotic fluid in the uterus.
In ICN, the cervix is revealed earlier than the prescribed time limit. The most common causes of gynecology complications include 9 etiological factors:
- Tears of cervix in history.
- Surgical intervention on the neck.
- The presence of abortion in history.
- Bearing twins or triplets - multiple pregnancies increases the pressure on cervix.
- Congenital anatomical defect of internal organs.
- The focus of the infectious process in the genital tract.
- Persistent exercise during the gestation period.
- Increased amount of amniotic fluid.
- Enhanced secretion of male sex hormones.
Pessary is recommended for women with a cervix length less than 3 centimeters. Medical manipulation is also shown to expectant mothers with softened and smoothed uterine throat.
Additional indications for the introduction of obstetric devices - low placentation. Pathology is accompanied by a high risk of spontaneous abortion. The pessary prevents miscarriage and premature labor.
Also, the device is shown to future mothers with urological problems. The obstetric ring maintains the physiological position of the bladder and urethra. It is used for incontinence, neurogenic dysfunctions.
The use of obstetric pessary has a number of contraindications. To exclude them, the gynecologist conducts a thorough examination of the patient before installing the device.
The use of a medical device is strictly prohibited against the background of missed abortion. The pessary prevents spontaneous abortion and the release of a dead fetus from the uterus. Its preservation in the body of a woman is a risk factor for a serious infection process.
Obstetric ring is contraindicated in the perforation of the membranes in the vagina. If the amniotic bladder left the uterus, the imposition of a pessary will contribute to its traumatization and integrity.
It is strictly prohibited to install a pessary if the expectant mother has reddish or brown vaginal discharge. Blood from the genital tract indicates a spontaneous abortion. A woman needs urgent medical care.
The inflammatory process in the vagina is a strict contraindication for medical manipulation. An obstetric pessary can help carry the infection to the cervix and uterus.
Before the introduction of medical devices, the doctor prescribes a series of examinations. Their list includes gynecological examination in the mirrors, ultrasound examination of the cervix, smear on the microflora. When detecting pathogenic bacteria of the future mother shows a course of antibacterial drugs.
The pessary is installed on an outpatient basis - in a public or private clinic. After manipulation, a pregnant woman can go home. The procedure is performed by an obstetrician-gynecologist.
Sometimes the pessary is installed at a later date - at 30-33 weeks. The duration of the medical manipulation depends on the evidence. The introduction of the obstetric ring after 36-37 weeks of pregnancy is impractical. By this date, viable and healthy children are born.
The introduction of the ring - painless manipulation. Some expectant mothers experience mild discomfort during the procedure. Unpleasant feelings pass in 5-10 minutes after the manipulation.
Immediately before the procedure, the expectant mother empties the bladder. Then the woman is arranged in the chair of the gynecologist. The specialist makes the selection of the pessary for a specific patient.
There are three main sizes of rings. The smallest is shown to young future mothers who have no pregnancy or childbirth in history. The second diameter of the pessary is intended for women with 1-2 children or older patients. The third ring size is recommended for expectant mothers with two or more births in the past.
Before the introduction of the pessary is processed using an antibacterial drug. The procedure reduces the risk of infection. Sometimes the doctor lubricates the ring with glycerin - a substance that facilitates the promotion of an obstetric device.
After processing, the gynecologist inserts a device into the genital tract, reaching the cervix. A properly installed pessary does not cause feelings of pain and discomfort in the expectant mother.
Installation of pessary for obstetric Doctor Arabin:
Problems after installation
In 0.5-1% of cases, after the administration of the pessary, complications are observed. The most common of them is a violation of the position of the obstetric ring. It shifts due to the onset of contractions or improper installation. Symptoms of dislocation device - discomfort and tenderness in the vagina and cervix.
A rare complication of wearing a pessary is an infection of the cervix. It is accompanied by greenish or yellowish secretions from the genital tract, with a rotten smell. Rarely on the background of the pathology there is pain in the lower abdomen and fever. Infection of the device is an indication for its immediate removal and antibacterial therapy.
Other complications are very rare:
- ulcers of the vaginal mucosa,
- bleeding from the genital tract,
- fistula formation.
Pathologies are accompanied by sharp pains in the lower abdomen, fever and the appearance of atypical discharge. They require immediate medical attention.
Selections after installation
Normally, against the background of wearing a pessary, the expectant mother has some slim mucous discharge. They have a transparent or whitish hue, are not accompanied by an unpleasant smell. In case of discharge with other characteristics, a gynecologist's consultation is shown to a pregnant woman.
Red or brown discharge indicates a spontaneous abortion that has begun. Premature termination of pregnancy is often accompanied by cramping pain in the lower abdomen.
In the presence of an infectious process, whites acquire a yellow, green or gray tint. They become abundant, have an unpleasant smell.
Clear and watery secretions may indicate amniotic fluid leakage. When they appear, there is a risk of disrupting the integrity of the amniotic bubble. Sometimes abundant liquid discharge is a variant of the norm.
To keep the pessary and bring the baby to the due date will help the future mother to follow the rules for the obstetric ring. A woman should not touch the device and try to change its position. Regular examinations of the attending obstetrician-gynecologist are necessary - at least once every 3 weeks.
In the presence of evidence, the doctor produces a sanitation pessary using antiseptics. The procedure prevents the infection of a medical device.
After installing the obstetric ring in the life of the expectant mother of restrictions. She is forbidden to conduct sexual life, strong physical exertion. Pregnant women should exclude sports, trips to the bath and sauna.
In the absence of complications, the removal of the pessary is performed at 38-39 weeks of pregnancy. The dates coincide with the date of physiological childbirth. Longer wearing the ring is impractical.
Sometimes the future mother shows an earlier removal of the medical device. Premature removal of the pessary is necessary during the development of an infectious process. Reproduction of pathogenic microflora increases the risk of infection of the fetus.
Removal of the ring up to 38 weeks is indicated at the onset of labor. Frequent and regular labor, the discharge of amniotic fluid - the main symptoms of the completion of pregnancy.
An additional indication for removing a medical device is the need for an urgent delivery. Induction of labor or cesarean section up to the 38th week is shown against the background of eclampsia, acute oxygen starvation of the fetus, massive bleeding with low placentation.
Pessary removal is performed on a gynecological chair. For most expectant mothers, the procedure is painless. Sometimes the manipulation is accompanied by a slight discomfort.
Pessary or stitches
Cerclage - suturing the cervix to prevent its premature disclosure. The procedure has a higher efficiency compared to the pessary.
However, the cerclage is assigned up to 20 weeks of gestation, its use later is impractical. Stitching is a complete surgery performed under general anesthesia in a hospital setting.
The procedure is shown in the presence of high risk factors for the development of ICN. Cerclage is the “gold standard” in the treatment of future mothers who have a history of miscarriages due to ICN.
In the absence of serious indications for suturing on churches, the use of a pessary is recommended for a pregnant woman. The obstetric ring is easily installed, general anesthesia is not required for manipulation.
Pessary obstetric unloading Juno
Pessary obstetric unloading Juno It is a hard plastic device in the form of a complex ring, with a central hole for the cervix and additional holes for the outflow of vaginal secretions. The obstetric pessary Juno is inserted into the vagina in a certain position to support the uterus.
Pessary size selection Juno
A plus use of the Belarusian pessary Juno: high efficiency, low price. The presence of all three sizes allows you to choose the right size, based on 2 indicators - the diameter of the cervix and the size of the upper third of the vagina.
Minus the use of the Belarusian pessary Juno: the rigidity of the material, the installation can be painful, the displacement of the pessary causes discomfort and requires an urgent visit to a doctor.
Dr. Arabin's Obstetric Pessary
Dr. Arabin's obstetric pessary is a bowl-shaped device made of flexible blue or light blue transparent silicone (due to the update of the production line). The perforated pessary model (type ASQ) (with holes on the sides) is preferable, as it provides the best outflow of fluid with increased vaginal secretion. Dr. Arabin's pessaries differ in external diameter (65 mm or 70 mm), as well as in height of curvature (each 17 mm, 21 mm, 25 mm, 30 mm). Internal diameter for all models is 32 mm or 35 mm. There are 13 sizes in total.
A plus use of the German pessary Arabin: painless installation, due to the flexibility of the silicone does not shift, almost does not cause discomfort when moving, does not cause irritation.
Minus use of the German Arabin pessary: the high cost of the product, it is necessary to obtain accurate information about the size of the product from the doctor, since the bowl-shaped pessaries include 13 sizes and the required size is selected based on three indicators (external, internal diameter and height of the curvature), which may hinder the correct selection or the purchase of the required size, silicone can “stick” to the neck, which can cause discomfort or pain when removing.
When an obstetric pessary is installed and removed during pregnancy
The optimal term for the introduction of obstetric pessary is the second and third trimester from 16 to 34 weeks of pregnancy (usually set after the 20th week of pregnancy). Terms vary depending on the individual characteristics of the body of a pregnant woman. The decision to install a pessary during pregnancy is made by the doctor after examining the cervix.
Remove the pessary in a planned manner before delivery at 37 - 38 weeks of pregnancy. Premature (urgent) removal is performed at the onset of labor, the discharge of amniotic fluid, the appearance of bleeding, signs of chorionamnionitis (infection of the membranes of the fetal bladder).
After removal of the obstetric pessary, childbirth begins within one to two weeks.
Is it possible to replace obstetric pessaries for pregnant women with urogynecological ones?
The similarity of these types of pessaries is only in the fact that in both cases they are silicone products, but their purpose is completely different. Gynecological pessaries serve to prevent uterine prolapse, urogynecological pills - for additional support to the bladder and are used for urinary incontinence in women.
And obstetric unloading pessaries are designed for pregnant women with a high risk of miscarriage during early diagnosis of the formation of cervical insufficiency and women at risk are fixed on the cervix to prevent its further opening and provide support to the lower uterus segment, which is an alternative to surgical correction of the cervix stitching).
After installing the pessary
After the installation of the pessary, the psychological discomfort from the awareness that there is a foreign body is present in the first place.
After the pessary is inserted, the pregnant woman needs to make sure that there are no unpleasant sensations, she is comfortable to sit, there is no difficulty during urination and the pessary does not fall out when straining. The correct size helps to establish the ring as accurately and physiologically as possible. A pessary can fall out only in the case of an incorrectly chosen size or incorrect installation on the cervix.
A number of pregnant women using a pessary, notes the appearance of abundant whiter (discharge), often without microbes.