Update: October 2018
Normal and timely delivery never begins suddenly and
violently. On the eve of the birth, the woman experiences their forerunners, and the uterus and
her neck is being prepared for the generic process. AT частности, шейка
the uterus begins to “ripen” and expand, that is, goes into a stage
раскрытия маточного pharynx. Childbirth is difficult and long
process and is largely dependent on the interaction of the uterus, cervix and
hormonal states, which determines their prosperous
The cervix is …
The lower part of the uterus is called its neck, which looks like
narrow cylinder and connects the uterine cavity with the vagina.
Directly in the neck distinguish the vaginal – the visible part,
which is issued into the vagina below its arches. Also available
supravaginal – upper part located above the arches. AT шейке
the uterus passes the cervical (cervical) canal, its upper end
called internal throat, respectively, lower – outer. ATо
while the mucosa is in the cervical canal
stopper whose function is to prevent penetration
infections from the vagina into the uterine cavity.
The uterus is the female genital, the main purpose of which
is the gestation of the fetus (fruit tree). The uterus consists of 3
layers: internal represented by the endometrium, the middle muscle tissue
and outer serous membrane. The bulk of the uterus is
muscle layer, which is hypertrophied and grows in the period
gestation. Myometrium of the uterus has a contractile function, due to
in which contractions occur, the cervix (uterus) is opened and
плод изгоняется из маточной полости в процессе generic act.
The generic process lasts a long time, and normally
perinatal mothers it is 10 – 12 hours, whereas
multiparous lasts about 6 to 8 hours. Birth itself
include three periods:
- I period – the period of contractions (opening of uterine throat);
- II period is called the period of attempts (the period of exile
- Period III is the period of separation and departure of a child’s place.
(aftermath), therefore bears the name of the post period.
The longest stage of childbirth is the period
открытия маточного pharynx. It is caused by uterine contractions, in
the process of which forms the fetal bladder, the head of the fetus
moves along the pelvic ring and is provided with a cervical
Period of labor
The first period of childbirth is the longest, and
primiparous women, it is longer and takes 8 – 10 hours on average. Have
New mothers who give birth again, the period of labor continues 6 – 7
hours The process of “opening” uterine throat consists of two phases:
latent and active. The latent phase takes an average of 5-6 hours.
from the entire period of contractions and proceeds either painlessly or with
minor painful sensations (read more about bouts
First arise and set
contractions – no more than 2 in 10 minutes. Moreover, the duration of uterine
reduction reaches 30 – 40 seconds, and relaxation of the uterus 80 – 120
seconds Long relaxation of the uterine muscles after each
contractions provide transition cervical tissues in the structure of the lower
segment of the uterus, resulting in the length of the visible part of the cervix
decreases (it is shortened), and the lower
the uterine segment is stretched and lengthened.
AT результате происходящих процессов предлежащая часть плода (как
usually the head is fixed at the entrance to the small pelvis, dividing
amniotic fluid, resulting in the formation of front and rear water.
A fetal bladder is formed (contains front water), which
acts as a hydraulic wedge, wedged into the inner mouth,
Have «первородок» латентная фаза раскрытия всегда длиннее, чем у
mothers giving birth a second time, which causes more
длительную общую продолжительность childbirth. Completion of the latent phase
marked by a complete or almost complete smoothing of the neck.
The active phase begins with 4 cm of cervical opening and
lasts up to 8 cm. At the same time contractions increase and their number
reaches 3 – 5 in 10 minutes, periods of contraction and relaxation
матки уравниваются и составляют 60 – 90 seconds Active phase
lasts for primiparous and multiparous 3–4 hours. Exactly at
the active phase of labor activity becomes intense, and the neck
the uterus expands quickly. The head of the fetus moves along the generic
the canal, the cervix is completely transferred to the lower uterine segment (merged
with it), by the end of the active phase, the opening of the uterine opening is complete or almost
full (within 8 – 10 cm).
AT окончании активной фазы происходит вскрытие плодного пузыря и
effusion If the cervical opening has reached 8-10 cm and the water has moved
– this is called timely discharge of water, the discharge of water at
opening up to 7 cm is called early, with 10 cm or more of disclosure
throat is shown amniotomy (procedure for opening the membran of the membranes), which
called late beaming of water.
Cervical dilatation does not have any symptoms, identify
it can only be a doctor, having a vaginal study.
To understand how the process of softening, shortening and
smoothing of the neck, you should decide on obstetric terms. AT
In the recent past, obstetricians determined the opening of the uterine mouth in
fingers To put it bluntly, how many fingers does the uterus pass through,
such is the discovery. AT среднем ширина «акушерского пальца» равна 2
see, but, as you know, everyone’s fingers are different, therefore more accurate
It is considered the opening measurement in cm. So:
- if the cervix of the uterus is open on 1 finger, then they talk about opening 2
– 3 cm;
- if the opening of the uterine pharynx reached 3–4 cm – this is equivalent
cervical dilatation on 2 fingers, which is usually
diagnosed already at the beginning of a regular labor activity (not
less than 3 fights in 10 minutes);
- about the almost complete opening of the cervix reveals 8 cm or
- full opening is fixed when the neck is completely flattened
(edges are thin) and passable for 5 fingers or 10 cm (lowered
head on the pelvic floor turning arrow-shaped suture in a straight
size, there is an overwhelming desire to push – it’s time to generic
room for the birth of the baby – the beginning of the second stage of labor).
As the cervix ripens
Appeared precursors of childbirth indicate the imminent beginning
childbirth (from about 2 weeks to 2 hours):
- the bottom of the uterus falls (for 2 – 3 weeks before
contractions), which is explained by pressing the predlagay part of the fetus to
pelvis, this sign a woman feels for relief
- the pressed head of the fetus puts pressure on the pelvic organs (bladder,
intestine), which leads to frequent urination and the appearance
- increased excitability of the uterus (the uterus “becomes stone” during movement
fetus, sudden movement of a woman or when stroking / pinching
- the appearance of false (training) contractions is possible – they
irregular and rare, pulling and short;
- the cervix begins to “ripen” – softens, skips
fingertip is shortened and “centered”.
Cervical dilatation before delivery is very slow and
gradually over the course of a month, and intensifies on the last day — two
on the eve of birth. In primiparous women, cervical dilatation
the canal is about 2 cm, whereas in multiparous the opening
exceeds 2 cm
To establish the maturity of the cervix use a scale
developed by Bishop, which includes an assessment of the following
- consistency (density) of the neck: if it is dense, it is
regarded as 0 points, when it softens on the periphery, but
dense inner throat – 1 point, soft from the inside and outside
– 2 points;
- neck length (process of shortening) – if it exceeds 2 cm – 0
points, length reaches 1 – 2 cm – a score of 1 point, the neck is shortened
и не достигает 1 см в длину – 2 points;
- permeability of the cervical canal: closed outer throat or
passes fingertip – score 0 points, cervical canal
we pass to the closed inner throat – this is estimated at 1 point,
and if the channel misses one or 2 fingers for the inner throat –
estimated at 2 points;
- how the neck is located relative to the wire axis of the pelvis:
directed backwards – 0 points, shifted anteriorly – 1 point, located
median or “centered” – 2 points.
By summing the scores, the maturity of the cervix is evaluated.
An immature neck is counted when the number is 0 – 2 points, 3 – 4 points.
regarded as not mature enough or ripening neck, and
5 – 8 points speak of a mature neck.
To determine the degree of readiness of the cervix and not only, the doctor
conducts mandatory vaginal examination (upon admission to
maternity hospital and at 38 – 39 weeks at the reception in the women’s
If the woman is already in the delivery room, the vaginal
study to clarify the process of disclosure of uterine pharynx through
every 4 to 6 hours or for emergency reasons:
- discharge of amniotic fluid;
- carrying out possible amniotomy (weakness of labor forces,
polyhydramnios or flat fetal bladder));
- with the development of anomalies of labor forces (clinically narrow pelvis,
excessive labor activity, discoordination);
- before regional anesthesia (EDA, AGR) for
finding out the cause of pain in contractions;
- the occurrence of discharge of blood from the genital tract;
- in the case of established regular labor
(the preliminary period, which passed into the bout).
When conducting a vaginal examination, an obstetrician evaluates
condition of the neck: its degree of disclosure, smoothing, thickness and
stretchability of the cervical margins, as well as the presence of scars on the soft tissues
genital tract. In addition, the estimated pelvic capacity, palpable
Presented part of the fetus and its insertion (swept localization
the seam on the head and the fontanelles), the promotion of the presenting part, the presence
bone deformities and exostoses. Be sure to evaluate the fetal
bubble (integrity, functionality).
According to subjective signs of disclosure and the vaginal data
studies compiled and maintained parogram childbirth.
Subjective signs of childbirth, in particular, the opening of the uterine
pharynx, are considered contractions. The criteria for evaluating contractions include their
duration and frequency, strength manifestations and uterine
activity (the latter is determined instrumentally). Partogram
birth allows you to visually fix the dynamics of the opening of the uterine
pharynx. A graph is drawn up, which horizontally indicates
the duration of labor in hours, and the vertical opening of the neck in cm. On
Based on the partograph, latent and active phases can be distinguished.
childbirth. Steep rise of the curve indicates efficiency
If the cervix dilates early
Cervical dilatation during pregnancy, that is, long labor,
referred to as cervical insufficiency. This pathology
characterized by the fact that both the cervix and the isthmus do not perform
its main function in the gestation process is a locking one. AT этом
case, the neck is softened, shortened and smoothed out, which is not
allows you to keep the fruit in the fruit center and leads to
spontaneous abortion. Abortion,
usually occurs in 2 – 3 trimesters. Insolvency
cervix says the fact of shortening it to 25 mm and less at 20-30 weeks
Cervical insufficiency can be organic and
functional. The organic form of pathology develops in
a result of various cervical injuries – artificial abortions (see
consequences of abortion), neck ruptures during labor, operational methods
treatment of cervical disease. Functional form of the disease
due to either hormonal imbalance or increased
load on the neck and isthmus during pregnancy (multiple pregnancy,
excess water or large fruit).
How to keep a pregnancy when opening the neck
But even with a cervical opening for 1 – 2 fingers in a period of 28 weeks
and more, it is likely to keep the pregnancy, or at least
prolong it before the birth of a fully viable fetus. AT таких
cases are assigned:
- bed rest;
- emotional rest;
- спазмолитики (магне-AT6, но-шпа, папаверин);
- tocolytics (ginipral, partusisten).
Be sure to undergo treatment aimed at producing
сурфактанта в легких плода (назначаются глюкокортикоиды)
accelerates their maturation.
In addition, treatment and prevention of further
premature cervical dilatation is performed surgically – on the cervix
stitches are applied, at 37 weeks which are removed.
The cervix is immature – what then?
ATозможна обратная ситуация, когда шейка «не готова» к родам. Thats
there is, the hour X has come (estimated delivery date), and even passed
a few days – weeks, and structural changes in the neck are not
observed, it remains long, dense, rejected backwards or
anteriorly, and the inner pharynx is impassable or skips the tip of a finger.
What do doctors do in this case?
ATсе методы воздействия на шейку, ведущие к ее созреванию,
divided into drug and non-drug. To the drug
methods include insertion into the vagina or cervix
special gels and prostaglandin suppositories. Prostaglandins are
hormones that accelerate cervical ripening increase
the excitability of the uterus, and in labor their intravenous administration is practiced in
case of weak tribal forces. Local administration of prostaglandins is not
has a systemic effect (no side effects) and
promote shortening and smoothing of the neck.
From non-drug methods of cervical dilatation stimulation
Sticks – kelp
The sticks are made from dried kelp algae, which
possess high hygroscopicity (well absorb water). AT
the cervical canal is inserted so many sticks so that they are tight
filled it up. As the liquid absorbs the sticks, they swell.
and stretch the cervix, provoking its disclosure.
A catheter for opening the cervix is represented by a flexible tube with
fixed on one end of the balloon. Catheter with balloon at the end
is injected into the cervical canal by a doctor, the balloon is filled with air and
leave in the neck for 24 hours. Mechanical effect on the neck
stimulates its disclosure, as well as the production of prostaglandins. Method
very painful and increases the risk of infection of the birth canal.
Unfortunately, in some maternity hospitals refused
cleansing enema to a woman who has given birth, but in vain. Free
intestine, as well as its peristalsis in the process of bowel movements increases
the excitability of the uterus, increases its tone, and, consequently, accelerates
cervical dilatation process.
ATопрос – ответ
How can you accelerate cervical dilatation at home?
There are several recommendations, the observance of which
Prepares a neck for the patrimonial certificate:
- prolonged outdoor activities increase excitability
uterus and prostaglandin production, and the presenting part of the baby
fixed at the entrance to the pelvis, further stimulating the opening
- watch your bladder and intestines, avoid constipation and
prolonged abstinence from urination;
- eat more fresh vegetable salads,
seasoned with vegetable oil;
- take a decoction of raspberry leaves;
- stimulate nipples (when they are irritated, oxytocin is released,
which causes uterine contractions).
- There are any special exercises. for disclosure
AT домашних условиях ускоряет созревание шейки ходьба по
stairs, swimming and diving, bends and turns
torso. A warm bath, ear massage and
little finger, breathing exercises and exercises to strengthen
perineal muscles, yoga. AT роддомах имеются специальные
gymnastic balls, seat and jumps on which during fights
ускоряют открытие маточного pharynx.
Does sex really help prepare the neck for childbirth?
Yes, having sex in the last days and weeks of pregnancy (with
the condition of the integrity of the membranes and the presence of mucus plug in
cervical canal) contribute to the maturation of the cervix. ATо-первых, во
the time of orgasm is oxytocin, which stimulates the uterine
activity. And, secondly, prostaglandins are part of the semen,
beneficial effect on the process of maturation of the cervix.
At what disclosure begin the attempts?
Attempts are an arbitrary contraction of the abdominal muscles.
The desire to get tighter arises in women in labor already at 8 cm. But while the neck is
will not fully open (10 cm), and the head will not sink to the bottom
pelvic floor (that is, it can be felt by a doctor by pressure on
labia) – you can not push.