What does an obstetric pessary look like? Obstetric pessary during pregnancy: what is it

Today, much attention is paid to the family, in particular childbearing. Unfortunately, the problem of miscarriage is becoming more and more global. Pregnancy lasts 40 weeks, but medicine has reached such a development that the fetus becomes viable from 28 weeks of gestation. However, in some cases, before 28 weeks, a number of measures also need to be taken in order to maintain the pregnancy.

Causes of miscarriage

In fact, there are a lot of factors leading to abortion. Here are the immunological and endocrinological components, and infectious processes, etc.

In early pregnancy, the cause of abortion is most often various infectious diseases and mutational processes, that is, genetic disorders of the fetus. Among the causes of death are also gynecological diseases of the mother, which prevent the growth of the embryo.

After 22 weeks of pregnancy, termination is already a preterm birth. One of the reasons that cause childbirth is the opening of the cervix, which is perceived by the body as the beginning of labor. Changes in the cervix can occur due to physical activity, the presence of pathology of the organ, when it cannot withstand the load of the fetus, maternal disease, both chronic and acute. In the case when the cervix is ​​dilated, an obstetric pessary is used.

What is a pessary

There is nothing complicated in the design of the pessary: ​​it is just a small device of various shapes, made of silicone, rubber or plastic, which prevents the process of opening the cervix. As you know, during pregnancy, especially in the second half, as the fetus grows, the internal organs are displaced, and the fetus creates a load on the stomach, intestines, bladder and cervix.

Obstetric pessaries can be of various shapes and sizes, depending on their purpose. A pessary used to preserve pregnancy has the form of several rings connected to each other, or the shape of a dome with holes around the circumference.

Indications for using the device

This device may not be used in all cases. Here is a list of cases in which an obstetric pessary is installed:

• Multiple pregnancy, in which the load on the internal organs is doubled.
• The presence of isthmic-cervical insufficiency, in which there is a gradual opening of the cervix, causing labor.
• Prevention of isthmic-cervical insufficiency with burdened obstetric history.

A condition such as isthmic-cervical insufficiency (ICI) can occur in women who have had an abortion or curettage of the uterine cavity. After childbirth, which occurred with cervical ruptures, the risk of pathology is also increased. In addition to traumatic ICI, there may be cases of functional impairment of the cervix, when the proportion of muscle and connective tissue is disturbed, which makes it less elastic. In this case, an obstetric pessary (the type is selected by a doctor) is the most gentle method of preventing and treating CI.

Types of obstetric unloading pessaries

Speaking about the types of pessaries, they usually mean the size of the model, which depends on the length of the cervix, the number of previous births, and the size of the vagina. As a rule, the type of pessary required is determined by the gynecologist, measuring the necessary parameters.

An obstetric pessary has a significant range of costs, depending on the region of delivery and the type of pessary. For example, the Yunona pessary costs from 350 to 850 rubles, and the Arabin model costs from 3000 to 4300 rubles.

You can buy the device in pharmacies and medical equipment stores, information about the availability of one type or another can usually be found by calling help phones. You can even order the device for home delivery.

Most often in pharmacies you can find the obstetric pessary "Juno", produced in the Republic of Belarus. It is flat and made of plastic. There are 3 types of device, depending on the size.

Another type used in obstetrics is the Arabin obstetric pessary, which has the shape of a dome with holes and is made of silicone. There are 14 types of them in size, the cost is much higher than the first model. The instruction contains all the necessary information about the purpose of the model, and also contains a reminder of the rules for caring for a pessary, indications for its purpose, etc.

It cannot be said that the first type is worse, and the second is better. Each of them does not cause discomfort while wearing, does not cause difficulties either during installation or removal. But some gynecologists prefer the first, others - the second type, and the choice may be determined by financial capabilities.

Installation of a pessary

They put the device in the 2-3 trimester of pregnancy, this usually happens at 26-30 weeks, when signs of cervical dilatation are found, and the fetus begins to put pressure on the internal organs.

The procedure does not require special preparation. It should only be remembered that the obstetric unloading pessary is installed on an empty bladder.

The pessary is lubricated with glycerin and inserted into the vagina. With painful sensations, a woman can take an antispasmodic, for example, "No-shpu".

An obstetric pessary during pregnancy can change its position, therefore, after installation, an examination is carried out every few weeks to control its position. After installing the device, the doctor prohibits sexual intercourse, which should be remembered by the pregnant woman.

When not to install a ring

There are a number of contraindications for installing the device.

These include:

• The presence of bleeding during installation of the device.
• The impossibility of maintaining pregnancy.
• The presence of an inflammatory process of the vagina or cervix.

Pessary Care

Since the installation of the device is carried out by a doctor, caring for it involves minimal procedures.

When visiting a doctor, a woman takes a smear for microflora, and with the development of an inflammatory process caused by a pessary, it may be necessary to carry out irrigation or baths. Each case of such care is agreed with the doctor, otherwise no special action is required when applying the mechanism.

Removing a device

The pessary is usually removed no later than the 38th week of pregnancy, unless there is an indication for its emergency removal.

Such indications are emergency premature birth, the appearance of signs of an inflammatory disease, signs of an inflammatory process of the membranes, as well as the discharge of amniotic fluid.

When removing a pessary, there is less pain than when it is installed.

One of the causes of miscarriage is isthmic-cervical insufficiency or incompetence of the cervix. This pathology can be of anatomical or functional origin.

An alternative to surgical treatment of isthmic-cervical insufficiency during gestation is the installation of an obstetric pessary. This device is made of flexible plastic or silicone, treated with gamma rays (sterility assurance) and is a concave pyramid of several interconnected rings with smooth and semicircular edges.

The wide base of the pessary is directed towards the rectum, and the narrower towards the pubic articulation. Due to the concave shape of the bases, the rectum and bladder are unloaded and not squeezed. In the center of the device there is a hole designed for the cervix, which is shifted to a wide base. On the sides of the central hole there are holes with a smaller diameter, necessary for the outflow of vaginal secretions. Jumpers located between the holes maintain the rigidity and strength of the device.

The mechanism of action of the pessary

The action of the obstetric pessary is carried out due to the following points:

• reducing the load on the incompetent neck due to the displacement of the pressure of the embryo;
• redistribution of pressure inside the uterus;
• the cervix is ​​​​closed by the walls of the central opening;
• the mucous plug in the cervix is ​​preserved, the risk of infection, membranes and the fetus is reduced.

Indications for installation

A pessary during pregnancy is installed in the following cases:

• isthmic-cervical insufficiency (both functional and organic);
• prevention of divergence of sutures on the cervix after surgical treatment of cervical incompetence;
• multiple pregnancy (high risk of preterm birth);
• high risk of isthmic-cervical insufficiency.

Photo: Madhero88 at en.wikipedia.org

Contraindications

An obstetric pessary should not be installed under the following circumstances:

• bloody or bloody discharge from the genital tract;
• frozen pregnancy is not excluded;
• the presence of inflammatory processes in the vagina and cervix (colpitis, cervicitis);
• prolapse of the fetal bladder into the vagina;
• the presence in a woman of diseases that are contraindicated for carrying a pregnancy;
• gross malformations of the fetus.

How to install a pessary

An obstetric pessary is installed after 20 weeks, but in some cases, its earlier introduction (12-17 weeks) is also possible.

Before installing the device (30 minutes) to prevent uterine hypertonicity, the doctor may advise taking antispasmodics (no-shpa, papaverine).

The procedure for installing a pessary takes a few minutes, but it can bring discomfort to a woman.

The device is introduced without anesthesia, at the reception in the antenatal clinic (less often in the hospital) after the woman has emptied her bladder. The doctor examines the pregnant woman on the gynecological chair, treats the pessary with glycerin (to facilitate its insertion) and places the device at the entrance to the vagina with a wide base down. First, the lower (wide) half ring is inserted into the posterior fornix of the vagina. Then, with a little pressure on it and on the back wall of the vagina, the upper (wide) half ring is inserted. Next, the entire pessary is introduced.

After insertion, the pessary is deployed into the vagina so that it is in an oblique plane with respect to the longitudinal axis of the pregnant woman's body. From the inside, it looks like this: the wide base is located in the posterior fornix of the vagina, and the narrow one is located under the pubic joint (which determines the picture of the "oblique" location). In this case, the cervix is ​​located in the central hole of the pessary.

After installation

After the establishment of the pessary, the woman regularly (every 2-3 weeks) takes swabs from the vagina (so as not to miss the development of colpitis). And also every 3-4 weeks, an ultrasound of the cervix is ​​\u200b\u200band an assessment of its condition. Every 14 days, the vagina and pessary (without extraction) are treated with antiseptic solutions (furatsilin, chlorhexidine aqueous solution).

The device is removed at 37-38 weeks or according to emergency indications (premature discharge of water, the appearance of bloody discharge, the onset of childbirth).

Side effects and complications

Of the side effects after installing an obstetric pessary, it is possible:

• the appearance of discomfort after prolonged sitting;
• displacement of the pessary into the vagina with the further development of colpitis;
• increased vaginal discharge.

Complications include the development of colpitis (in the absence of the effect of treatment within 10 days, the pessary is removed) and chorioamnionitis (inflammation of the membranes of the fetal bladder and infection of the amniotic fluid).

Usage efficiency

According to statistics, the effectiveness of using a pessary during pregnancy (prolonging pregnancy to the expected date of birth) reaches 70-80%.

Some research on pregnancy

Installing a pessary is intimidating for most women. But in some cases, this is the only way to safely bear the child and give birth at the appointed time. What is a pessary, in what cases it is used, as well as the advantages and disadvantages of its installation, this article will tell.

What is an obstetric pessary?

An obstetric pessary is a medical device used in obstetrics, gynecology and urology. For example, in gynecology, a pessary is placed on the uterus of pregnant women and is an alternative to uterine sutures.

The word "pessary" is of Greek origin and in translation means a round or oval stone. The pessary got its name because of its shape - the first devices were round and ring-shaped. To date, there are various vaginal rings in shape and appearance, 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 has an unloading function. There are oval, cubic, bowl-shaped, ring-shaped, mushroom-shaped obstetric pessaries, the photo shows their differences. In addition to the shape, they differ in size:

Type I - is used to install primiparous, as well as those women who have given birth no more than two times. 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 - is established in the same cases, but for women with the upper third of the vagina measuring 65-74 mm;

Type III - used for women who have become pregnant for the third time or more. Anatomical measurements are 30-37 mm - in the diameter of the neck and 75-85 mm in the size of the vagina (upper third).

For each woman, an individual approach is carried out and the choice of the size and shape of the gynecological pessary is carried out, since its parameters must be suitable for the anatomical parameters of the internal structure of the genital organs.

It is important that the device is made of hypoallergenic material, environmentally friendly and safe for health. Mostly silicone pessaries are used. An alternative to them are plastic uterine rings made of a special elastic material. On all sides, the pessary is rounded and smoothed, therefore, when worn, it does not cause discomfort and does not injure the internal genital organs.
The obstetric ring is used only once. Its shelf life is limited by the time during which it remains sterile. The pessary is installed in such a way that its smaller part is adjacent to the pubis, and the larger base is directed towards the rectum. A ring around the cervix prevents it from dilating, and vaginal discharge passes unhindered through the openings in the device.

Indications and contraindications for installation

This obstetric device is installed when there is a threat of premature opening of the cervix. That is, it is a way to prevent premature birth and the threat of miscarriage. Often a pessary is installed during pregnancy with twins or triplets.

Pathologies that are an indication for the installation of the uterine ring:
ICI - isthmic-cervical insufficiency;

Prevention of ICI;

Failure of surgical sutures in the treatment of CI.

With the help of a vaginal ring from preterm labor, you can keep the cervix closed and prevent its softening, as the device unloads the uterus and reduces stress from it. In addition to physical functions, the preterm birth prevention ring also has a psychological task. Most women note that they feel calmer with a pessary, as the likelihood of safely bearing and giving birth to a child increases.

Like any medical procedure, the installation of a ring with a threat of premature birth has its contraindications. You can not put this device in case of suspected fetal fading and other cases when prolongation of pregnancy is impossible. Also contraindications to the installation of a pessary are bloody discharge from the vagina and inflammation in the genitals.

Installation of a pessary: ​​timing, preparation and course of procedures

It is possible to suture the uterus not earlier than the 20th week of pregnancy, since at earlier periods the use of anesthesia is dangerous for the fetus. The installation of a vaginal ring is possible before 20 weeks, but most often it is installed for a period of 28-33 weeks. Before installing the device, it is necessary to treat and prevent any infections, for example, thrush. Basically, vaginal suppositories are prescribed for this.

The installation process of the pessary takes several minutes. Before the procedure, the woman must 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 the device, it is pre-lubricated with glycerin or another moisturizer.

Feelings of a woman during the installation of a pessary

Each representative of the weaker sex has its own pain threshold. Therefore, everyone has different reviews about installing a pessary. Some say that this procedure brings some discomfort. Others complain of severe pain.

Doctors advise taking an antispasmodic half an hour before the procedure in cases where the uterus is hypersensitive. Painkillers are not used in this case, since the resulting pain is tolerable.

Recommendations of doctors after installing a pessary during pregnancy

After installing a vaginal ring for polyhydramnios or other indications, a woman should follow some recommendations, namely:

Do not have sex;

Do not overload yourself with physical activity;

To prevent the development of infections in the genitals, put vaginal suppositories;

Once every twenty days, take a smear for analysis of microflora;

Systematically visit a gynecologist who, upon examination, will control the location of the pessary;

Do not touch the uterine ring on your own during premature birth and do not try to get it.

The diagnosis of "threatened miscarriage" today put 20% of pregnant women. However, modern medicine has learned to cope with the difficulties that arise in the process of bearing a baby. Some mothers-to-be are encouraged to use a device such as a pessary. Why is it needed and how does a pessary help during pregnancy? Are there any restrictions in everyday life when wearing it and when the product is removed?

What is a pessary?

An obstetric pessary, which is also called an unloading pessary, is a product widely used in urology and obstetrics. Its main purpose is to support the cervix to reduce pressure on the fetus, distribute the load and prevent premature birth. The most commonly used design is in the form of a plastic or silicone ring, but there are products in the form of a bowl, cube, cone or mushroom.

The introduction of the obstetric ring ensures the preservation of pregnancy until the moment of natural childbirth. The device is made of a material that does not provoke allergies and easily adapts to the anatomical features of the uterus. It is soft, but elastic enough to perform its function.

Indications for the installation of a ring on the cervix

The introduction of the ring is carried out only according to indications. The use of a pessary is prescribed for isthmic-cervical insufficiency (ICI), characterized by such signs as:

• weak walls of the uterus;
• short neck;
• opening of the uterine os due to damage.

Pathology develops as a result of abortions, various gynecological diseases complicated by previous births and is capable of provoking a miscarriage. The design is designed to relieve tension and prevent cervical dilatation. Installation is also required for:

• exacerbation of inflammation;
• multiple pregnancy;
• anatomical features of the genital organs;
• the presence of sutures on the cervix.

In 85% of cases, the installation of an unloading pessary saves the situation, helping to calmly bear the fetus. Such a product (but of a different form) is also placed in the treatment of bladder hernia, urinary incontinence, uterine prolapse, etc.

Contraindications for use

The use of an obstetric device is not always appropriate. It is contraindicated for use in:

• protrusion of the fetal bladder;
• the presence of discharge with blood;
• bladder dysfunction;
• suspected miscarriage;
• inflammatory diseases of the genital organs;
• severe somatic ailments;
• the last degree of ICI (as the main method of correction, it is not advisable to use a pessary).

Sometimes inflammation of the genital mucosa occurs after the installation of the product. In such cases, antiseptic treatment of the birth canal and constant monitoring of the vaginal microflora are required.

Varieties of obstetric pessaries

Gynecological devices are produced by many companies and differ in shape, as can be seen in the photos provided. The pessary is selected individually, taking into account the specifics of the structure of the patient's genital organs. In obstetrics, the following types are often used:

• ring. The design is made in the form of silicone rings with holes that allow secretions to pass through. The lack of a product in an unreliable fastening - it can fall out.
• cube. A cube-shaped design that ensures the normal outflow of vaginal secretions.
• Dount. The product looks like a donut, does its job well, but leads to stagnation of the vaginal secretion.
• cellhorn. Reliable gynecological pessary that protects against preterm birth. It does not delay the discharge and is tightly fixed in the vagina, but it can provoke discomfort.

The choice of a pessary depends on the diameter of the upper third of the vagina, the cervix itself and the number of births in the patient. There are three sizes of this fixture:

1. The product is installed for women who have not given birth or for those who have already become a mother twice. The diameter of the cervix should not exceed 30 mm, and the length of the upper 1/3 of the vagina should be up to 65 mm.
2. It is used under similar conditions, but the length of the upper third of the vagina is 66–75 mm.
3. The device is placed in women who have given birth many times with a length of 1/3 of the vagina of more than 76 mm and a neck diameter of 37 mm.

When is the pessary put in?

The optimal time for the introduction of a pessary is the period from 16 to 34 weeks after conception. Installation time varies depending on the characteristics of the course of pregnancy. Usually the device is inserted after the 20th week, but sometimes it has to be done at 12-14 weeks. At what time should the product be installed, the doctor decides. In the first trimester, regardless of the number of births, a first size ring is suitable for a woman.

The expectant mother will have to wear the device throughout the pregnancy, so infection prevention is carried out before it is installed. Most often, vaginal suppositories are used for these purposes.

Installation process

Installation of a pessary is carried out in 15 minutes. Depending on its form, the method of administration may differ, but the process looks something like this:

• a pregnant woman after the act of urination and defecation is placed on a gynecological chair;
• the ring is treated with glycerin oil to facilitate its advancement;
• the device is inserted and positioned so that its wide end is deep in the vagina, and the narrow end is under the pubic bones.

The design is made in such a way that it covers the cervix and does not allow it to open. If a woman has uterine hypertonicity, she needs to take an antispasmodic half an hour before the manipulation.

Feelings during the installation of the device depend on the professionalism of the doctor and the pain threshold of the patient. Many expectant mothers say that it is more unpleasant than painful. In addition, women are ready to endure pain, since this procedure is often the only way to save a pregnancy. Sometimes a doctor may apply a local anesthetic. The installation process of the product is shown in the video.

Wearing features and restrictions

After installing the pessary, the woman's lifestyle remains the same, but with few restrictions. The expectant mother is advised in detail about what she can and cannot do. Key recommendations:

• stop intimate contacts;
• limit physical activity - a pregnant woman needs more rest;
• try not to squat or bend over;
• avoid constipation;
• do not take baths and do not swim in water bodies;
• visit the gynecologist every 14 days (he will conduct examinations to make sure that the pessary has not fallen off and is in its original place);
• regularly use candles to prevent the occurrence of infections;
• take a vaginal swab every couple of weeks.

No special care is required for the installed gynecological pessary. The device is well fixed and does not interfere with the expectant mother. In no case can it be removed or corrected on its own, any manipulations are performed by a doctor.

Possible Complications

Since the obstetric holding pessary is a foreign body that stays in the body for a long time, complications may occur when wearing it:

• frequent and heavy vaginal discharge (if it is clear and odorless, no need to worry);
• some women find it uncomfortable to sit - if you stay in this position for a long time, discomfort may occur;
• the device can jump off the spot, which provokes the development of colpitis (the problem is eliminated by returning the product to the optimal position and taking medication);
• one of the serious complications is inflammation of the fetal bladder and infection in the amniotic fluid;
• it is also possible to wear the walls of the vagina, the appearance of bleeding or ulcers of the mucosa.

A woman with a pessary installed needs to be careful and undergo regular examinations. An alternative to wearing a device is surgery, in which the cervix is ​​​​sutured, but it entails more negative consequences.

What does a pregnant woman feel if the pessary has shifted?

If the doctor has correctly selected the size and correctly placed the product, the woman should not feel discomfort. The silicone or plastic pessary has rounded edges so it cannot injure soft tissues.

Many women who require a fixture are interested in whether it can fall out. In the literal sense, this will not happen, but the product is able to change its position (which happens very rarely). You can understand that the pessary has shifted by the pronounced discomfort and the feeling of the presence of a foreign body in the vagina. The ring will press, which will be especially felt when bending over and in a sitting position. At the same time, white discharge may appear.

Most often, the design is not held in place due to the wrong size or the unprofessionalism of the doctor who installed it. If discomfort occurs, it is better to consult a doctor as soon as possible - delay threatens with inflammation of the vagina. In case of errors in choosing the size or shape of the product, it will need to be replaced.

When and how is the pessary removed?

A pessary is needed until 36–38 weeks - during this period, the fetus is already considered fully formed. It is removed at the next visit to the gynecologist. The procedure is performed without anesthesia for a couple of minutes, pain occurs very rarely. When the device is removed, the woman can begin to actively prepare for delivery. The removal of the structure leads to the relaxation of the uterus, as a result of which the tissues begin to soften - within a week you can wait for the baby to be born. With a planned caesarean section, the ring is removed before the operation.

Sometimes the removal of the unloading obstetric pessary needs to be done ahead of schedule. The procedure is carried out according to indications:

• infection of the amniotic sac;
• emergency childbirth;
• inflammatory diseases of the vagina, which could not be eliminated with medicines;
• early discharge of amniotic fluid.

At the beginning of contractions, the device must be removed immediately. Otherwise, pressure on the genitals will increase, which can lead to venous congestion and uterine damage.

Issue price

Women, taking care of their health and well-being of the baby, want to choose the safest and most convenient pessary. It must be bought after consulting a doctor so that he indicates the shape and size of the device. How much does the construction cost? Approximate prices are shown in the table.

So, the topic of today's review: an obstetric unloading pessary, the preservation of pregnancy in ICI.

Prehistory. Pregnancy.

It was not a planned and unexpected pregnancy and the most anticipated event. During which, as it turned out, I had to learn a lot about "miscarriage in the course", about miscarriage, about a bunch of drugs from vitamins, remedies for hemorrhoids and up to hormones and drugs for tachycardia caused by some drugs to prevent premature birth.

This pregnancy was different from the happy and peaceful expectation of the future baby, our morning began and ended with medicines according to the schedule - and everything was done to ensure that the pregnancy ended in happy motherhood, so that it would be possible to bring the child to the maximum term.

Problems began At week 6, I was put on hormones, at 10 weeks, however, there was an urgent hospitalization for preservation due to the onset of placental abruption and a miscarriage almost happened (Review with details about all the delights). At 13 weeks I was discharged home, I take care of myself like a crystal vase, instead of work I go to the Women's Consultation. They take care of me at home, I do nothing at all. Everything is fine, the baby is developing. I calm down, I forget everything I have heard and seen enough about while I was kept in a state hospital.

At 19 weeks, the doctor sends for an ultrasound scan, which shows the cervix is ​​shortening, the internal os is open, the diagnosis of CCI and I urgently need to go to the preservation, so I got to the antenatal department of the 1st Maternity Hospital of St. Petersburg, even when I was sent for hospitalization, I learned from my doctor that I will most likely be given an obstetric unloading pessary, so I first encountered this "curiosity", before that I had only heard about suturing the neck. The pessary will sometimes be called simply "The Ring".

Notes.

The opening of the internal os is

The internal os is the lower part of the uterus. It is this opening that closes the entrance to the uterus, and therefore, normally, it must be closed before the onset of labor. From the moment of conception until the very birth of the baby, the tightly closed cavity of the internal os protects the future child from possible external infections. This cavity is a kind of barrier that is necessary in order to protect the fetus at the stage of its growth and formation and prevent possible complications.
It is important to understand that the opening of the internal pharynx in the early stages indicates the risks of a possible miscarriage. After all, if this cavity opens too sharply, then the fetus simply will not stay in the uterus.

What is ICI - Isthmic-cervical insufficiency:

Isthmic-cervical insufficiency (ICN) is a frequent pathology of the cervix, the characteristic features of which are spontaneous abortions in the II and III trimester of pregnancy and premature birth.

The mechanism of termination of pregnancy in ICI is that due to shortening and softening of the cervix, gaping of the cervical canal and internal os, the fetal egg does not have a functional support in the lower segment.
With an increase in intrauterine pressure as pregnancy progresses, the fetal membranes protrude into the dilated cervical canal, become infected and open.

Obstetric pessary- this is what I call it - fixture- designed to prevent miscarriage due to dilatation of the cervix or premature birth. This is how the doctor from my LCD explained to me, and I found out the same later, when I got to the department of the maternity hospital, where obstetric "rings" are installed.

A pessary is made of silicone or surgical plastic, as far as I remember, it was plastic, but don’t think - the pessary is flexible and resilient and you don’t need to be afraid that such a “ring” inside you, installed on the cervix, will be felt or put pressure on the child, the pessary adjusts under the anatomy of the body and relieves pressure on the cervix, preventing its disclosure. At the sight of the pessary, it visually seemed to me that it was huge and hard - but later it turned out that, being located inside, it becomes not noticeable.

"My" pessary looked exactly like the one in the title photo in this thread.

I will put in a review an image of a pessary in a collage with my pregnant photo (my photo, from a "pregnant" photo shoot, I have a lot of duplicates of this picture, if anything :)), 30 weeks and the pessary has been inside me for 10 weeks:

Description of the action of the unloading pessary:

The pessary has a “fulcrum”, a base that is securely fixed during installation. For the most part, it rushes towards the rectum, the smaller base is adjacent to the pubis. The ring in the pessary surrounds the cervix, preventing it from opening. Other openings serve to pass vaginal secretions through them.

The use of obstetric pessaries also reduces the incidence of preterm birth.

The mechanism of the protective action of the pessary consists in closing the cervix, transferring the main pressure of the fetal egg from the cervix to its anterior wall and pelvic floor due to the ventral-oblique position of the pessary and the asymmetric location of the central opening of the pessary. The combination of active ingredients provides reliable protection of the lower pole of the fetal egg.

The installation of a pessary is a non-surgical method of treating CCI and this is its advantage over surgical methods (for example, when suturing the cervix), because. the installation of the pessary is carried out in an ordinary examination chair on an outpatient basis, without blood and instruments.

Cons or when non-surgical correction of CCI is ineffective

- with severe manifestations of cervical insufficiency

- with prolapse of the fetal bladder,

- with deep ruptures of the cervix,

- with a very short neck.

Indications for the installation of an obstetric unloading pessary:

- isthmic-cervical insufficiency (ICN);

- the need to prevent isthmic-cervical insufficiency;

- suture failure due to surgical treatment of CI.

Ring Insertion Procedure and My Feelings on Insertion:

⚫ They put me a "ring" for a period of 20 weeks.

⚫ Before installing the pessary, tests, a smear for inflammatory flora and for STIs must be taken.

⚫ The pessary is placed with a clean smear and no infection.

⚫ The pessary is installed on the gynecological chair, before insertion, you need to relax the muscles, breathe, as the doctor asks.

⚫ The size of the obstetric pessary is selected by the doctor, based on your individual sizes of female organs, usually the size of the ring is divided, both for those who have given birth and those who have not given birth. But only your gynecologist can determine the size.

⚫ The doctor lubricates the ring with glycerin and inserts it inside, placing it on the cervix. At the same time, the sensations are not very, painful, unpleasant due to the expansion and stretching of the muscles of the vagina, and everything else depends on the doctor. At first I was put by one doctor, I didn’t like how he acted, probably, hence the soreness. and a day later I asked another doctor to check the installation and she twisted the pessary inside me on the chair, changed the position and there was no pain, after that he stopped feeling at all. In general, the procedure can be easily experienced, everything happens very quickly and is forgotten.

If a woman has an increased tone of the muscles of the uterus, then half an hour before the proposed procedure, it is mandatory to take an antispasmodic, which will reduce uterine contractions

⚫ In addition to ICI, I had tone, upon admission to preservation, I was prescribed therapy to relieve tone, and three days later a pessary was installed.

⚫ Immediately after installation, there was some feeling of a foreign object inside, but when the pessary was corrected a day later, it “sat down” and was no longer felt. I know from my own experience that at first it’s scary to even sit on the “ass straight”, the feeling that the “ring” will dig into the walls of the uterus under the weight of the body and will put pressure on the child, but you can not be afraid and sit quietly, and generally live a normal life, of course, considering the existing threat of termination of pregnancy. It is necessary to rest more often, I think it is clear that sports and exercise are contraindicated for pregnant women with the threat of interruption.

The unloading pessary will reduce the burden of the baby's weight on the cervix, thereby reducing the risk of dilatation and premature birth, the name unloading already explains a lot about the purpose of the "ring". BUT, if you neglect the recommendations, violate them, then the pessary will not save.

⚫ After installing the pessary, I felt better and even calmer mentally.

A control ultrasound in a day showed that the process of opening the internal os was stopped and then the neck closed, the ring and drug therapy helped. But with the increase in the duration of pregnancy and the weight of the child, I began to notice heaviness and pressure in the lower abdomen, after walking on foot, this feeling passed after resting lying down. Therefore, frequent rest is necessary. And, apparently, if it were not for the pessary, then the neck could not withstand the load with the increase in the duration of my pregnancy.

Pessary care, pessary sanitation:

Since the “ring” is still an implanted foreign body for the body, as a reaction to it, thrush, candidiasis may occur, and discharge will appear. Therefore, the installed pessary needs care, namely washing once every 10-14 days with solutions of chlorhexidine, furatsilin or the like. The gynecologist does it! THE RING WILL NOT BE PULLED OUT!

It is impossible to wash the pessary well on your own. BUT, for use at home, you may be advised to suppositories, in addition, a pregnant woman should carefully monitor personal hygiene, this does not mean poking her fingers into the vagina, trying to find a pessary or picking out discharge, you need to monitor the occurrence of discharge in order to take action in time, consult a doctor .

Allocations, with a pessary installed, can be the same as with thrush, as well as similar to water, this is, in principle, the norm. But you have to be on the alert to understand when the discharge does not meet the standards.

In my case, the discharge was very copious, watery, so it seemed to me that amniotic fluid was leaking. And the situation with discharges was aggravated by inadequate washing in the district LCD. At the same time, I used candles, as recommended, but it did not help.

My local doctor was not able to carry out high-quality washing, as it turned out, the consultation did not have the necessary tools in the form of a special obstetric mirror used in maternity hospitals, and the standard viewing dilator is not suitable for thorough washing. After two such washings in the LCD. I began to have a strong leakage of fluid, no one could exclude the leakage of water, there were not even special tests in the residential complex, and I went to the same maternity hospital where the ring was installed.

At the maternity hospital, the Obstetrician-gynecologist began the examination and used a special mirror, similar, according to my recollection, to a curved shoehorn :) the bend pulls the lower wall of the vagina without expanding it, as happens with a standard familiar examination with a dilator. As soon as the doctor introduced the mirror, its recess was filled with liquid, sooooo much, it just flowed like a stream. The gynecologist did a test for amniotic fluid in front of me, and, thank God, it was negative.

They also took a smear on the flora, because such discharge indicates an inflammatory process. The pessary is washed as follows: the solution is poured abundantly inside the vagina along the mirror, in addition to this, the doctor wiped the inside of this pessary with a swab.

Before such a thorough washing, I felt a burning sensation, heaviness at the bottom of the uterus, after washing, I immediately felt comfortable and all sensations disappeared. But the smear taken showed inflammation, advanced colpitis, which had to be treated. Inflammation can provoke very undesirable consequences. That is why it is important to put a pessary after treating the infection beforehand, and wash the ring in time, otherwise complications are possible. I made a conclusion for myself and came to the same maternity hospital for washing on a paid basis, visited the same gynecologist and the removal of the pessary also took place there in the maternity hospital, because. in my Women's clinic, they flatly refused to perform this procedure because of the possible imminent delivery immediately after removing the ring from the cervix.

Pessary removal time:

Usually the ring is installed from 20 weeks to 37-38 weeks of pregnancy, after removing the ring, the cervix relaxes and begins to open under the pressure of the weight of the child. It is believed that childbirth can occur within a couple of days, and in some cases immediately after the removal of the pessary.

There are times when premature rupture of amniotic fluid occurs, so the ring is removed immediately.

Prohibitions:

The gynecologist explains all this and you must strictly adhere to the rules:

- It is IMPOSSIBLE to have a sexual life with an installed pessary.

Do NOT try to move the pessary inside the vagina on your own, try to change its position, deepen it, etc.

Sex, independent manipulations with the ring and so on - and girls are such inventors! - can lead to premature birth!

Therefore, the pessary DO NOT extract when washing, and I read on the Internet and such a version that the girl was removed the ring with each washing! ... If the ring is removed every 10 days and returned to the cervix ... the threat of interruption will only worsen, these actions stimulate cervical dilatation.

Feelings when removing the pessary:

The removal takes place in a matter of seconds, I had the impression for a moment that it was as if the vagina was slightly turned inside out and immediately after relief - and all this very quickly and without pain.

I had my ring removed at 37 weeks and 3 days.

After the procedure, I went home, the difference in uterine pressure without unloading the ring was noticeably noticeable. As soon as I got off the chair, there was a feeling that my cervix would disintegrate under the load that had fallen on it :) but they let me go home to carry the pregnancy home. At 37 weeks, the baby is already out of danger for term.

Then several times there were cases that the stomach pressed so hard on the cervix that I waited - the birth was about to begin.

In the photo, I am 37 weeks pregnant - a couple of days before the removal of the pessary, with which I went through almost half of the entire period, endlessly stretching and flying so quickly, such a big belly and a valuable load in it helped to carry the pessary .. And on the right in the collage a great fear of the end of pregnancy, in the period from the removal of the pessary until the day of delivery, I think many pregnant women are familiar with this :)

And there was a case when this fear practically came true, I decided to take a ride on a trolleybus and I was specifically shaken and thrown up in it, so that the child inside twitched along with the uterus and all my internal organs, I even felt a distinct "splash". It seemed to me that everything, now the water will pour right on the feet of those around me) I already immediately imagined how I should behave, how to call for help, etc. But, a miracle happened, and I got home without bursting.

And almost a week after the removal of the "ring", the amniotic sac still could not withstand the load and burst, and there was a premature discharge of water. I was lucky - it happened at home!) The term was already 38 weeks, completely safe for the onset of labor, the baby is already full-term)

Of the girls in my antenatal ward, who also had a pessary, I was the only one who was able to carry the pregnancy to such a term. We all had a threatened miscarriage, short cervix, CCI. One of the girls had a very short neck and she remained in storage for the longest time, she was warned that in her case a pessary would help carry the child to the very maximum term, but this is not a guarantee, while she needs bed rest and the complete absence of any loads, drugs , but with full observance of everything, a discharge of water occurred and premature birth began, the child was born prematurely, but everything worked out, because. at the time of the incident, the expectant mother was on conservation. Without the installation of the "ring" the cervix would not have survived at all. The pessary increased the chances and allowed me to become a mother. Another girl also gave birth prematurely, at 37 weeks.

If you have indications for the installation of a pessary, if the doctor directs you to put a pessary, I recommend taking this chance to keep the pregnancy.

I read advice on the Internet from some girls not to put a pessary, they say you can do it and lie down at home, some dissuade because of discomfort and pain during the installation of the ring, others scold the rings for the occurrence of discharge, inflammation, etc. But writing and advising not to take advantage of the opportunity to install a pessary is irresponsible., even if some girl managed to "lie down" and give birth safely. That .. This is more luck than the lack of need for a pessary. After all, even a pessary, medicines and bed rest in other situations do not guarantee the preservation of pregnancy, which can result in premature birth and the loss of a child.

A woman has no right to be negligent in maintaining a pregnancy and neglect methods that allow her to carry a child to term. The life and health of the unborn child depends on this. And it's worth it to endure discomfort, go for washings, monitor the norm of microflora, and refuse sex.

Note: a prerequisite when a pessary is on the cervix is ​​to take smears for bacteriological flora every 2-3 weeks.

Conclusion:

Timely diagnosis and correctly chosen method of treatment of isthmicocervical insufficiency, taking into account all possible pathogenetic factors of miscarriage, allows you to carry the pregnancy to the term of physiological childbirth, and the woman to have a healthy child.

Thanks to this device, it is highly likely that miscarriage or premature birth can be avoided. At the same time, one should not forget that no one canceled the exclusion of physical activity and proper rest, and wearing a pessary does not give a 100% guarantee for the high results of its use.

My miracle has recently turned 4 years old :) and if another pregnancy occurs, then the help of a pessary will probably be needed again and I will put the "ring".

Thank you for your attention, health to all future mothers and babies!

Thank you for your attention and see you soon!