Placement of a pessary during pregnancy. Obstetric pessary - what is it? Reviews of women on the use of a pessary. Possible complications while wearing

Obstetric pessaries are used to maintain pregnancy and correct isthmic-cervical insufficiency (ICI) without surgical intervention. According to statistics, they help women bear a child in 92% of cases.

This is a small device made of plastic or silicone. The product supports the uterus in a natural position and reduces the load on the cervix, thereby preventing its opening ahead of time.

Design features

The price of obstetric pessaries during pregnancy depends on the manufacturer and type of device:

Cup. They resemble a cup without a bottom with perforated walls designed to drain vaginal secretions.
Ring. Due to special recesses on the inside, the silicone ring takes the shape of a quadrangle after insertion, squeezing the cervix.
Butterfly. It has the shape of a trapezoid with rounded corners. Differs in the increased rigidity.

Cup and ring obstetric pessaries are easy to install. Squeezing the device, the doctor gently inserts it into the vagina, where it itself takes the desired shape. The Butterfly installation technique is more complicated - when inserting, the doctor must be careful to accurately place wide and narrow half rings.

Indications for use

Having decided to order an obstetric pessary, consult a gynecologist. They are placed in patients with the following medical indications:

isthmic-cervical insufficiency;
multiple pregnancy;
high intrauterine pressure;
for prevention purposes, if a woman has a high risk of developing ICI;
the threat of abortion due to high physical exertion;
complex correction of CI, including surgical and conservative methods.

A suitable period for installation is 13-25 weeks of pregnancy.

Contraindications

Before you buy an obstetric pessary, read the contraindications:

inflammatory diseases of the cervix, vagina, external genitalia;
spotting in the II-III trimester;
damage to the fetal membrane;
pronounced prolapse of the fetal bladder with ICI.

The device is allowed to use up to 37 weeks of pregnancy. If the patient after installation complains of severe discomfort, vaginal bleeding, increased uterine tone, then the product must be removed prematurely.

Advantages

For pregnant women, these devices help to cope with many problems:

protect the fetal membranes from the penetration of infections;
increase the effectiveness of the treatment of CI;
help prolong pregnancy without the use of surgical methods.

The design of products is carefully thought out. They are painless to put on, and when used do not cause discomfort. Even if childbirth begins unexpectedly, the device will not harm the mother and baby.

Where to buy obstetric pessaries in Moscow?

The VSEPESSARII.RU online store has all models of obstetric pessaries officially presented in Russia. Goods are certified and allowed for use in the Russian Federation.

Please note that site visitors can not only get acquainted with the prices of obstetric pessaries and buy the desired model, but also get an online consultation on the use of gynecological products. All questions are answered by a practicing obstetrician-gynecologist.

In Moscow, you can buy an obstetric pessary with delivery around the city. Also, the goods are sent to all regions of Russia. If necessary, expedited delivery is arranged. The site provides a large selection of payment methods - from bank transfer to cash upon receipt of the order.

An obstetric or gynecological pessary is a special ring that is installed during pregnancy on the cervix of the expectant mother in order to prevent her late miscarriage or premature birth. It is used mainly in pregnant women with a period of more than 18-20 weeks, that is, from the middle of the second trimester.

This removable device, which is simple in appearance, plays a very important role. If you do not go into physiology, then it relieves the burden on the cervix, which is created by the child and amniotic fluid. The special shape of the vaginal ring redirects this load to the anterior wall of the uterus. Also, the pessary allows you to keep the cervix closed, which prevents the mucous plug from leaving it and the penetration of infectious pathogens from the vagina into the uterine cavity.

With a cervical length of 30 mm, the risk of delivery in the next 7 days is only 1%. With a length of 25 mm - 6%. And with less than 15 mm, in almost all cases, childbirth begins in the next three days, if no action is taken.

The pessary does not bear any consequences for the child. It does not come into contact with the fetus and amniotic sac.

Pessary or sutures during pregnancy: which is better, indications

In addition to the pessary, there is another method, well known to gynecologists, to support the cervix in a closed state. This is her suturing or the so-called cerclage. Today it is the most reliable and proven way to prevent premature termination of pregnancy. However, it has a number of disadvantages:

it is possible to sew up the neck only in the first half of pregnancy, in the first trimester the sutures will definitely be more effective than the pessary;
the likelihood of prolapse (puncture) of the amniotic sac with instruments;
the need for general anesthesia;
psychological trauma, fear in a woman in labor, which again provokes the threat of interruption;
the likelihood of eruption of seams in the process of bearing a child;
neck injury;
mandatory hospitalization and stay in a hospital, etc.

The advantages of an unloading pessary are that it is placed on an outpatient basis to maintain pregnancy (including multiple pregnancy - with twins or triplets) at any time. Typically, this is 20-30 weeks, and especially often 26-28 weeks is a critical period when many preterm births occur. Unlike cerclage, this type of medical care is not invasive. And he will never provoke childbirth or miscarriage by itself. Any gynecologist can put an obstetric ring on the neck, and even in the conditions of a antenatal clinic. It will take no more than 1-2 minutes. Anesthesia and any preparation for the procedure is not needed. The patient feels comfortable. And there are no restrictions until which week to install a pessary.

Particularly effective is the wearing of the uterine ring with prolonged vaginal use of the progesterone preparation - Utrozhestan suppositories.

In what cases, why put a pessary? Here are the main ones:

soft cervix during preterm pregnancy, especially if there is already a history of premature birth;
shortening of the neck (if its length is not more than 25-30 mm for up to 32-33 weeks);
ICI (isthmic-cervical insufficiency) during a previous pregnancy;
low placentation and (or) low position of the fetus.

The cons of the ring is that it does not really lengthen the neck, although the stitches are the same ... And most gynecologists do not consider it very effective, it happens that it does not help prevent premature birth, plus an inflammatory process that will persist in one way or another in the vagina throughout the time this object is there. Because of this, frequent thrush, unpleasant discharge.
After conization, it is not always possible to place a pessary if the cervix is initially (after surgery) short. Then only sutures remain, which are applied laparoscopically through punctures in the abdomen. Not even through the vagina!

There are not so many contraindications to the installation of this gynecological device. The main ones are bloody discharge from the vagina, colpitis or cervicitis. If a woman has a bad vaginal smear, there are signs of infection, the so-called sanitation of the vagina must first be carried out. At least an antiseptic like Hexicon (chlorhexidine).

Installing a pessary on the cervix: timing and technique

The ring is installed at any stage of pregnancy, usually more than 12-14 weeks, if there are indications for "insurance" of the cervix. The maximum installation time is 34-35 weeks. Later, there is no point, since full-term babies are already born at 37-38 weeks.

The introduction of the ring is carried out on an outpatient or inpatient basis. Manipulation takes no more than 2-3 minutes. Many women are interested in whether it hurts to insert a ring. It all depends on the woman's pain threshold. Someone yes. But for most, it’s just a little unpleasant, in principle, like any gynecological examination. Special gels - lubricants help to more comfortable and quick introduction, sliding through the vagina.

How to put a pessary (in this case, the brand Doctor Arabin) is well shown in this video.

Immediately after installation, there are pulling pains in the abdomen. This is due to the tension of the uterus as a result of medical actions. You can take "No-shpu" and use the candle "Papaverine" rectally. In a hospital setting, if necessary, they will put a dropper with "Ginepral" or "Magnesia".

The vaginal ring is removed at 37-38 weeks or earlier if labor has begun. It is believed that prolonged wearing of a pessary leads to a slow opening of the cervix during childbirth. There is no such dependency. And childbirth after removing the ring can begin both in the next day and in 2-3 weeks. Everything is individual.

Where to buy and how much

In pharmacies, shops selling various medical supplies, private clinics, you can also order via the Internet. Or even ask your doctor. Sometimes they themselves help patients in ordering pessaries, however, you still have to pay for the device.

In Russia, two companies or types of pessaries are popular - "Juno" and "DR. Arabin" (Dr. Arabin). Which one is better? The second one costs several times more and is made of silicone, produced in Germany. The first one is plastic. According to women, the one that is more expensive, that is, silicone, is better. And putting it on is not so painful. And German pessaries fly less often.

Although, the success of wearing is influenced, rather, by other factors, such as the right size. The doctor must first examine the woman, determine what size of the uterine ring she needs. There are 3 sizes in total. 1 and 2 are suitable for nulliparous. Young, first-time pregnant girls usually wear one. Three is only for women who have given birth several times.

1. Physical activity and sexual life. Since the pessary is placed in women who are at risk of premature termination of pregnancy, they need rest. Both physical and sexual. It is forbidden to have sex, both with and without a condom, as this can lead to displacement of the pessary and hypertonicity of the uterus. Some mothers try to lie almost all the time. Such severe restrictions are needed only if the fetal bladder prolapses into the cervix. If everything is not so bad, you are at home, the hospital is not shown, you can just not overstrain - do not walk a lot so as not to get tired.

2. Wearing a bandage. There is no scientific evidence that it prevents premature cervical dilatation. However, most mothers are calmer with him. Some with a bandage even take a shower and go to the toilet. The main thing is calmness.

3. Pessary care and sanitation. You do not need to process it yourself. And try to get it, of course, too. No special measures need to be taken. However, the doctor should once every 3 weeks, or even more often, take swabs from the vagina in order to identify the inflammatory process in time and treat it. By the way, inflammation with a pessary is a very common side effect.

How is the sanitation of the pessary and vagina carried out? Usually, antiseptics are used for this - antimicrobial drugs. The doctor can periodically wash the vagina with chlorhexidine at the reception.

For independent use, candles with the same active ingredient are prescribed, they are called "Hexicon" or effective combination drugs, such as "Terzhinan", "Neo-penotran forte", "Pimafukort", "Polygynax", which successfully cope with both fungi that cause thrush and bacteria - provocateurs of bacterial vaginosis, gardnerella and others. If a woman has obvious vaginal candidiasis (thrush), may be prescribed "Pimafucin", "Clotrimazole", "Livarol"- proven safe antifungal drugs.

There is information on the use of candles for the same purpose "Vagisept" and solution "Tantum Rose". You can gently rinse or treat the vagina with a douche "Miramistin"- an excellent antiseptic. "Epigen"- a spray used for prophylactic purposes. There are a lot of resources. Your gynecologist will definitely advise a proven one.

4. Visiting the pool, baths, saunas. Yoga classes. The pool is not contraindicated for expectant mothers. As for the rest, it is only reasonable. No need to stand on your head, but some light exercises are not scary to do. It is not worth sitting in the steam room in the sauna for a long time. Save yourself.

5. Constipation. A common problem in pregnant women. Of course, it is better to avoid constipation. Although they will not lead directly to childbirth. Often, stool retention is provoked by drugs, vitamins. For example, iron or magnesium. Their cancellation helps to normalize the chair. The best remedy for constipation for expectant mothers is lactulose syrup (Duphalac, Normaze and the like). If the dosage is sufficient, daily gentle bowel movements can be expected.

6. Allocations. With a pessary, they are copious, like water, or slimy. This is due both to a change in the microflora of the vagina, and to the hormonal background, as well as drugs used vaginally.
Many women are afraid of these secretions, they take them for the leakage of amniotic fluid. In this case, it is useful to have a Frau gasket at home, which will help diagnose what it is. You can even cut it into 2-3 parts so that it is enough for more than once, since it is quite expensive.

You need to consult a doctor if the discharge has become greenish or has become a curdled consistency, yellow, itching is felt and the labia is reddened, there is an unpleasant smell from the vagina. All these are signs of various pathogens - fungi, bacteria and microbes that provoke colpitis and vaginitis. Thankfully, they are.

But especially dangerous are brown or spotting, along with mucus. They usually occur when the mucous plug comes out of the cervix. This is one of the signs of a very early birth.

7. Additional funds for the prevention of late miscarriage and premature birth. The most effective is vaginal progesterone. A drug "Utrozhestan". It comes in the form of capsules that can be taken orally or placed in the vagina. The second way is preferable.

Some women talk about the inconvenience of using suppositories with the ring installed. Especially if the pessary is quite large. But you need to get used to it. Look at the video that we have, even an ultrasound probe enters the vagina, it is important to choose the right angle of insertion and everything will work out. And someone cuts the candles into two parts and "slips" them from different sides.

Sometimes doctors prescribe tocolytics. This is if there is a frequent tone of the uterus - one of the adverse factors. Tablets may be given internally Ginipral, Nifedipine, Indomethacin rectally. And from the "light artillery" - "Papaverine hydrochloride" rectal suppositories, tablets "No-shpa" (droverin), "Magne B6" ("Magnelis"). Plus, a plant-based sedative is usually prescribed - valerian tablets.

The funny word "pessary" is currently called a device for vaginal use used in medicine: in urology, gynecology, obstetrics.

During pregnancy, a pessary is necessary in a situation where the expectant mother is not at all laughing: if the condition of her cervix makes it doubt that the current pregnancy will be full-term.

During pregnancy, a supporting pessary is used as a conservation measure, instead of, and, sometimes, in addition to this:

due to incompetence of the cervix;
to prevent premature opening of the cervix, if the patient has a history of "recurrent miscarriage";
in later periods during gestation (according to indications).

The task of the pessary:

keep the cervix closed and prevent it from opening;
remove part of the load from the severity of the fetus from the cervix, redistributing it to the walls of the uterus.

An obstetric pessary externally is a flat ring-shaped, oval or volumetric cup-shaped object of a primitive design, made of hypoallergenic material.

The peculiarities of its structure exclude trauma to the tissues of the genital organs and the paths of a woman, both during its wearing and during manipulations with it in the vagina.

Although various modifications of pessaries can be found on sale: cubic, mushroom-shaped, etc., they serve several other purposes and have the prefix "gynecological", however, on an individual basis, they are also used at the risk of miscarriage.

The need to install a pessary is determined by the obstetrician-gynecologist leading the pregnancy, based on an examination of the cervix and determining its maturity, as well as on the results of ultrasound of the cervix.

When choosing the shape of the pessary, it is also better to trust the doctor, who, depending on the anatomical features of the structure of the pelvic organs of the patient, will recommend the best option.

An obstetric pessary is indicated for use already from the 13th - 16th week of pregnancy, but, in practice, it is most often installed from the 20th - 22nd week, preferring to use suturing at an earlier time for isthmic-cervical insufficiency.

In this case, a combined technique is often used: sutures + pessary, then the main function of the pessary is to unload the cervix in order to reduce the risk of opening the cervix under the pressure of the weight of the fetus.

The effectiveness of using a pessary according to various studies is from 87 to 92% of saved pregnancies among women who have had this obstetric device installed.

It is forbidden to use a pessary, as well as a surgical method of treatment with a threat of late miscarriage or:

if there is a possibility of intrauterine death of the fetus;
if incurable fetal malformations are diagnosed;
if there are contraindications to carrying the current pregnancy;
against the background of infectious and inflammatory diseases of the pelvic organs;
on the background ;
when expressed: the bottom of the fetal bladder protrudes into the vagina.

Specially, without other indications, the process of installing a pessary does not require hospitalization and can be performed by an obstetrician-gynecologist on an outpatient basis. This procedure is very simple and short.

However, during pregnancy, self-installation of a pessary is highly not recommended, since it is always preceded by special preparation of the vagina, and the procedure requires careful observance of sanitary conditions, which is difficult to achieve at home.

In addition, manipulations involving an incompetent cervix require special care and professional experience.

The mechanism for installing a pessary during pregnancy

On the eve of the procedure for installing a pessary, a woman must undergo a gynecological examination, the purpose of which is to take a sample for the degree of purity of the patient's vaginal microflora, as well as an external assessment of the condition of her genitals and tracts.

In addition, during the examination of the patient, the doctor determines the optimal shape and size of the obstetric pessary.

At the pessary appointment, the woman will be asked to come with an empty bladder. The patient is offered to sit on a gynecological chair and, if possible, relax the muscles of the vagina. After that, an antiseptic treatment of the female genital organs and tracts is performed, and the pessary is disinfected and injected according to the instructions.

The process of introducing a pessary depends on the shape and material from which it is made:

Plastic flat pessary, type "Juno".

It is introduced into the perineum, placing it with the narrow side forward, turning the ribs parallel to the pharynx of the vagina.

It is advanced along the genital tract, unfolded and set in such a way that the cervix is located in the central ring, the wide part rests on the back wall of the vagina, and the narrowed part rests on the pubic part. Thus, the pessary, as it were, props up the uterus, while simultaneously releasing the cervix from the pressure of the presenting part of the fetus.

Cup-shaped silicone pessary type "Dr. Arabin.

Before introduction into the perineum, the sides of the wider lower ring are closed. The pessary is straightened under the cervix, placing it in the upper ring (smaller diameter), while the bottom of the pessary (larger diameter ring) is turned towards the sacrum, closing the uterus.

In order to facilitate the promotion of the obstetric pessary through the genital tract, its edges are lubricated with glycerin or vaseline (in some cases, clotrimazole) ointment.

Does it hurt to put in a pessary?

The sensations of a woman during the procedure depend on her sensitivity, as well as on the professionalism of the doctor performing the manipulations. Basically, future mothers share, rather, about unpleasant, but quite tolerable than painful sensations during the introduction and installation of a pessary. There are a lot of those for whom the procedure turned out to be completely painless.

Almost all women who have been fitted with a pessary note immediate relief from discomfort from increased uterine tone.

With the correct size of the pessary and its correct installation, discomfort when wearing it should not be felt. The opposite situation indicates that the pessary has been displaced, or the size has been chosen incorrectly.

How to choose a pessary

The type of obstetric pessary corresponds to the size parameters of the upper part of the expectant mother's vagina (placement of the pessary) and the transverse diameter of the cervix, as well as the number of births in the woman's history.

Some manufacturers, when creating a standard line, also take into account the fertility of pregnancy and changes in the condition of the uterus after surgical procedures.

The most affordable and common flat plastic pessary "Juno" is produced in three sizes (see Table 1):

Table of sizes of obstetric pessaries

Cup-shaped pessaries Dr. Arabin have 10 sizes, and Portex rings - 16 options.

Types of pessaries by manufacturers

Specialty stores selling medical devices offer the following types of pessaries:

The selection of the type of pessary is carried out by the doctor, depending on the structural features of the genital organs and the paths of the patient, as well as their own experience with the device.

What about after installation?

The installation of a gynecological pessary significantly improves the quality of life of a pregnant woman with a threatened miscarriage and allows you to remove some restrictions on physical activity.

However, the pessary itself does not solve the problem of the risk of miscarriage, and therefore its wearing is accompanied by general recommendations for patients with a threat of termination of pregnancy, including:

a ban on sexual contact;
a ban on bathing in the bathroom, swimming in open water, swimming pools, etc.
prohibition of heavy physical activity, weight lifting, etc.

When is the obstetric pessary removed?

If the period of application of the pessary proceeds without complications, then its removal is carried out at the 37th week of pregnancy, waiting for the development of labor, as a rule, during the next week.

However, removal of the pessary may become necessary early if:

the patient was diagnosed with chorioamnionitis;
premature delivery of a woman is necessary for medical reasons;
labor activity has begun;
leakage/outflow of amniotic fluid was detected.

After removing the pessary, the genital tract is sanitized.

Possible complications while wearing

Often, future mothers note the appearance of unusually abundant vaginal discharge after the installation of an obstetric support device. This may be a normal reaction of the body to the placed foreign object, an attempt to get rid of it. However, it is worth excluding, first of all, (for example, with the help of) and other complications of pregnancy.

Cervical insufficiency is often infectious in nature, a foreign body in the vagina (pessary) can provoke an exacerbation of the disease, and also cause a manifestation. This is evidenced by characteristic color and smell.

To prevent such troubles, once every 2 weeks, a patient with a pessary is shown an outpatient intravaginal lavage with antiseptic agents without removing the obstetric device, application, etc.

In order to timely detect during pregnancy while wearing a pessary, a woman should regularly, at the request of the doctor, take a test for the purity of the vaginal microflora (about once every 14 days).

In some cases, the treatment of colpitis requires the temporary removal of the pessary. In this case, the sanitation of the vagina is carried out in stationary conditions, since the patient, after removing the obstetric device, falls into the risk group for the development of premature labor.

If in the process of wearing a pessary a woman feels discomfort, constant or only in a certain position, when changing position, etc., it is quite possible that this indicates a displacement of the device in the genital tract. The same may be indicated by the appearance of abundant whitish discharge.

The displacement of the pessary will be easily detected by the doctor during a gynecological examination and will also easily put it in place.

In general, the method of prolonging pregnancy with the insertion of a pessary can be considered a panacea, especially in late pregnancy, when the use of surgical intervention for suturing is not possible.

Spontaneous termination of pregnancy is a frequent occurrence that seriously affects the future life of a woman. This affects their reproductive function - a serious psychological shock can turn into chronic depression. Installing an obstetric pessary will help reduce the risk of miscarriage.

One of the priorities of modern medicine is to minimize the number of early births. At a scheduled checkup at the gynecologist the woman finds out if she is in the so-called risk group, and if there is a risk of preterm birth. If there is a threat of untimely labor, a set of preventive measures is carried out.

Not so long ago, in obstetric practice, doctors, suspecting a potential prematurity of the fetus, resorted to suturing the cervix. This is extremely painful and uncomfortable procedure for the expectant mother. The method involves emergency intervention of obstetricians in the birth process - it is necessary to immediately remove the sutures so that the baby can pass the birth canal without problems.

Today, non-invasive methods that do not involve incisions and suturing include the use of an obstetric pessary. Thanks to this gynecological device, the natural position of the cervix, bladder and rectum is maintained during pregnancy.

What is an unloading pessary: types and types of pessary

From Latin, "pessarium" literally translates as "vaginal", but linguists are more inclined to believe that the name of this medical invention came from Greece: in some types of Olympic disciplines, a round stone was used, referred to only as "pessos". It is because of the shape that the product is often simply called the uterine ring.

Modern designs have a different appearance, shape and even purpose. It must be said that these silicone or plastic rings are used not only in gynecological practice, but also in other medical fields, for example, urology. Of greatest interest are pessaries used to treat and prevent a number of complications that occur in late pregnancy. Depending on what form the pessary has, the following types of the uterine ring are distinguished:

In addition, there is a division of uterine pessaries according to geometric parameters. In obstetric practice, three types of vaginal ring are used:

First type. It is shown mainly to first-time mothers and those who have no more than two children. Such a uterine ring is indicated for ladies with a cervical diameter ranging from 25 to 30 mm and a size of the upper third of the vagina from 55 to 65 mm.
Second type. It is intended for the same group of women as the uterine ring of the first type, but differing in the anatomical structure of the reproductive system: the lower segment of the uterus should be from 25 to 30 mm in size, and the upper third - from 66 to 75 mm.
Third type. Recommended for persons who have already had more than two births and have the following intravaginal anatomy: the diameter of the cervix is in the region of 30-37 mm, and the upper third of the vagina fits into the interval between 76 and 85 mm.

For each woman who needs an obstetric pessary, its size and shape are selected individually, taking into account the physiological characteristics of the reproductive system.

For the manufacture of an unloading obstetric pessary, biologically pure, hypoallergenic and safe material is used. Mostly uterine rings made of silicone or special plastic. The material must be sufficiently dense, but at the same time flexible and elastic, easily adapting to the anatomical specifics of the weaker sex.

Such a vaginal device is disposable, has a certain service life, during which it remains sterile.

The uterine pessary has a "fulcrum" that allows it to be securely fixed inside the vagina. Most of the base is directed towards the end segment of the colon, and the smaller one is pressed against the pubis. device ring, surrounding the cervix, prevents it from opening. The rest of the holes are for the disposal of female secretions. When factory-made, all edges of the rings are rounded and smoothed, therefore, during operation, the woman practically does not feel it, and the pessary is not able to damage the mucous membranes of the internal genital organs.

Indications and contraindications

Who should use an obstetric retention pessary? During pregnancy, the vaginal ring is installed in such conditions when there is threat of cervical dilatation before the expected date of birth, which is fraught with prematurity of the fetus or miscarriage.

Pessary gynecological

A pessary is placed if a pregnant woman has:

Isthmic-cervical insufficiency (Under the influence of a group of negative factors, the cervix loses its locking ability, which threatens with premature opening, provoking expulsion of the fetus).
Insolvency (inefficiency) of sutures placed during surgery for CCI.

An obstetric unloading pessary is installed in order to prevent a reduction in the time for full delivery, as well as to maintain a pregnancy that is threatened with interruption.

It is common practice to install a uterine ring for women who are carrying several children at once, since physical impact two or more embryos per uterus increases significantly as they develop. The pessary is designed to compensate and redistribute pressure, which significantly reduces the likelihood of childbirth ahead of schedule.

Whatever the benefit of a pessary for a pregnant woman, it still has contraindications. Yes, his installation is strictly prohibited when prolongation of pregnancy is not possible, or the vaginal flora does not allow the wearing of a vaginal ring.

So, the uterine ring can not be placed in the presence of:

An inflammatory process that disrupts the natural flora of the vagina.
Discharges with an admixture of blood during pregnancy.
Severe isthmic-cervical insufficiency as a key corrective agent.
Frozen pregnancy.

Installation of a pessary for pregnant women

Many women who have an indication for the installation of a uterine ring experience fear of this gynecological procedure. In fact, putting this medical device does not hurt at all. Due to the fact that obstetric intervention is kept to a minimum. the patient does not experience any pain. Of course, the presence of minor discomfort from such a conservative operation is allowed, but everything is tolerable. All manipulations last no more than 5-10 minutes. During this time, the doctor manages to disinfect and insert the ring into the woman's vagina.

What should a pregnant woman do before an obstetric pessary is inserted? First of all, she needs to visit a gynecologist who will perform a visual examination of the internal genital organs. using a vaginoscope and take a swab. The sample is sent for cytological examination, where the pathogenic microflora of the vagina is studied. If laboratory diagnostics did not reveal hidden infections, then the patient is allowed to install a pessary.

When an infectious agent is detected, for example, candidiasis, the doctor prescribes medications, most often vaginal suppositories. Untreated infectious diseases during the installation of the uterine ring tend to exacerbate, so the expectant mother must take care of her health in advance.

The procedure is performed with a completely empty bladder. The patient must not forget this. The woman is located in the gynecological chair, legs wide apart. The doctor prepares glycerin or clotrimazole. Imi process the uterine ring before the introduction. The health worker then carefully places the pessary into the vagina, positioning it in the right place, before squeezing the ring. After that, the procedure can be considered completed.

A woman with a pessary installed must certainly take special precautions. The doctor should tell her about the care of the obstetric ring. It should be said that pessary is a contraindication to sexual acts. Do not touch the device or attempt to move it. Any manipulations are performed only by a doctor.

Therefore, if there is pain at the installation site of the unloading ring, you need to urgently visit the gynecologist's office and solve the problem.

After the medical device is in the vagina, every month you need to undergo an examination by a gynecologist. He must exercise control for proper placement of the pessary and prevent potential complications. Twice a month, the expectant mother should take a smear for screening the bacterial flora.

What complications can a woman face when wearing a pessary?

It is not uncommon for pregnant women to complain of heavy vaginal discharge after they have had an obstetric support fitted. Such a reaction on the inside of the vagina a foreign object may be the norm - this is a natural rejection. However, first of all, the release of amniotic fluid and other complications associated with pregnancy should be excluded.

Poor functioning of the cervix is often due to an infectious disease. A foreign object in the internal genital organ can exacerbate the disease, as well as provoke thrush. Candidiasis is easy suspect by characteristic discharge and bad smell. To prevent such troubles, a woman on an outpatient basis should periodically wash the vaginal cavity with an antiseptic solution. In this case, the uterine ring is not removed.

For the timely detection of the inflammatory process of the vaginal mucosa (colpitis) against the background of wearing an obstetric ring, the patient must necessarily take a test for the state of the pathogenic flora of the female genital organs.

In some clinical episodes, the treatment of colpitis may require temporary removal of the uterine device. In such cases sanitation of the vaginal cavity is carried out in a hospital, since a woman, after removing the pessary, is automatically at risk for the occurrence of premature delivery.

If wearing an obstetric pessary is accompanied by discomfort, constant or in a certain position, then most likely this indicates that the device has moved from its usual place. This is also indicated by the appearance of abundant white discharge.

When is the obstetric pessary removed?

A pregnant woman should know at what point she should remove the supporting uterine ring. If pregnancy proceeds without visible disturbances, then the pessary is removed at 37 weeks. An experienced doctor removes the pessary as quickly as he installs it. After removing the device, the birth canal is carefully sanitized.

Indications for removing the pessary ahead of schedule:

Detection of infection in the gynecological area.
The entry of an infectious agent into the fetal bladder.
Opening of the membranes, leading to the outflow of amniotic fluid.
Premature labor.

On the Internet, you can find a lot of laudatory reviews about the obstetric pessary. many young mothers It was the pessary that helped to bear the fetus without shocks. This is extremely important, because the life and health of the baby is at stake.

Even 50-40 years ago, pregnant women could lose a healthy fetus at the end of the first trimester of pregnancy or at the beginning of the second due to premature opening of the cervix. The fact is that in those days the only way to deal with such a phenomenon was to sew up the cervical canal, and since such an operation can only be performed under anesthesia, it had to be postponed to a later date. Fortunately, today such situations are extremely rare, as doctors use special devices - obstetric pessaries. They are not sold in pharmacies and it is not recommended to try to install them yourself.

Pessary: what is it

To refer to the problems associated with premature opening of the cervix, the term “isthmic-cervical insufficiency” is used in medicine. To prevent its negative consequences, such as miscarriage, doctors often recommend the installation of an unloading pessary. The classic version of such a device, created taking into account the anatomical features of the structure of the woman's body, is several plastic or silicone rings connected to each other.

Kinds

Reviews about which are presented at the end of the article are of several types. In particular, the pharmaceutical industry produces such devices in three sizes:

First. Such pessaries are suitable for women who have given birth less than 2 times, as well as for pregnant women with a length of the upper third of the vagina from 55 to 65 mm or with a cervical diameter of 25 to 30 mm.
Second. Devices of this size are used for pregnant women who meet the criteria of the first paragraph, but whose upper third of the vagina is between 66 mm and 75 mm long.
Third size. These are the largest pessaries that obstetricians install for mothers who have given birth many times, as well as for women whose upper third of the vagina is longer than 76 mm or whose cervical diameter ranges from 30-37 mm.

Surely, many people think about a pessary that it is one or more interconnected rings. However, there are many types of such a device of a completely different form. For example, a cup-shaped pessary is sometimes inserted into pregnant women, designed to support the cervix, reduce pressure on the fetal head and prevent the opening of the cervix. In addition, with isthmic-cervical insufficiency, a device in the form of a donut (thick ring) made of polyvinyl chloride can be installed. This material has the property of thermoplasticity and, being inside the body of a woman, becomes soft, taking the shape of the organ in which it was placed. Also, for the manufacture of a pessary, silicone is often used, which does not cause allergic reactions. Such devices are pre-sterilized using gamma radiation.

In what cases is it set

An obstetric pessary during pregnancy is installed in order to keep the uterus and neighboring internal organs in the correct position. And very often it is prescribed in case of multiple pregnancy. In addition, various types of pessaries are also used to solve health problems of non-pregnant women. In particular, they are effective in the case when it is necessary to prevent prolapse of internal organs (uterus) or to alleviate the condition of a patient who is experiencing incontinence.

Contraindications and possible negative consequences

Although obstetricians usually answer all the concerns of pregnant women about the pessary, that it is completely safe, there are cases when it is forbidden to put it. In particular, this cannot be done if:

there is a suspicion of a frozen pregnancy;
the lower part of the fetal bladder is already in the vagina;
bloody discharge and / or ichor is observed;
revealed inflammatory processes of the genital organs.

If such a device is chosen or installed incorrectly, or has shifted for some reason, then the pregnant woman may develop inflammation (colpitis), which can be eliminated by correcting the position of the pessary and applying medication.

How to put a pessary

Before such a procedure, it is necessary to undergo an examination and, if any infections of the genitourinary organs are detected, they should be treated. In addition, if a pregnant woman has an increase, then 30-60 minutes before installing the ring, she is given an antispasmodic that relieves contractions, and medical glycerin is used to reduce friction. Only then can a pessary be placed. That this is quite unpleasant, any woman will confirm. However, sometimes this procedure is the only way to save the pregnancy, especially in the early stages, when it is impossible to perform a surgical operation to sew up the cervix.

When can you bet

Most often, a pessary, reviews of which are mostly positive, are placed after the 20th week of pregnancy. However, as already mentioned, sometimes, due to the threat of miscarriage, you have to do this already at 12-14 weeks. In this case, regardless of how many times the pregnant woman has already given birth, the ring of the first size is always used.

Do's and don'ts after inserting a pessary

After such an auxiliary device has been placed on the cervix of the pregnant woman, the woman does not need to do anything special. The only thing that doctors recommend after installing a pessary is from time to time (1 time in 14-21 days) to take a smear to study the bacteriological flora, and to prevent infection, treat the vagina every 2-3 weeks, and, of course, refrain from sexual activity. Moreover, the woman would have to follow the last advice, even if she had not been given a ring. After all, when it comes to the expediency of such a procedure, this fact itself indicates the presence of a threat of premature termination of pregnancy.

childbirth

Usually, the device we are considering is left until the 36-38th week of pregnancy. Then the gynecologist on an outpatient basis or in a hospital removes the pessary. This procedure is done without anesthesia, but lasts only a few seconds, so pain, if any, is extremely short. Sometimes it is done in a hospital, in the pathology department, and sometimes on an outpatient basis. The removal of the pessary leads to the fact that the cervix relaxes, and under the pressure of the fetus, it very soon softens, followed by shortening and opening. After that, somewhere within a week (sometimes this period can be a little longer), the woman begins childbirth. However, there are situations when this device has to be removed ahead of schedule. For example, this must be done if there is an outflow of amniotic fluid, the fetal bladder is infected, or an emergency delivery is necessary.

Obstetric pessary: reviews

Today, the installation of such devices is a fairly common occurrence. Therefore, many comments can be heard regarding their effectiveness and the problems associated with the use of pessaries. In particular, women complain about the discomfort they experience when they have to make long trips by car or just sit for a long time. In addition, deterioration is also observed, the cause of which is the pessary. The reviews also show that the procedures for installing and removing it can give women quite a noticeable pain. But the most unpleasant thing, according to pregnant women who have such a protective obstetric device, is a sharp increase in the amount of discharge 3-4 weeks after the insertion of the pessary, which is associated with the body's desire to get rid of the foreign body. Some patients even say that there can be so many of them that there are suspicions of amniotic fluid discharge and you have to constantly wear pads.

Now you know what an obstetric pessary is, reviews of which you may have heard from friends and acquaintances. In any case, we can say with confidence that at the moment there are no cases recorded when the use of the mentioned medical device would cause serious health problems - neither before childbirth nor after. However, doctors warn that even with a pessary installed, sometimes (though very rarely) a miscarriage can still occur. At the same time, statistics show that after the installation of such devices in early stages of isthmic-cervical insufficiency, the number of positive pregnancy outcomes has increased significantly.