Cicatricial deformation of a neck of a uterus
The Cicatricial Deformation of a Neck of an Uterus (CDNU) — post-traumatic or congenital violation of an anatomic shape of a neck of a uterus with insolvency of its tservikalny channel. In most cases the clinical symptomatology is expressed slightly. Pathology can be shown by existence of cervical is more white, a dispareuniya, pelvic pains, increase in duration of periods. At diagnosis consider data of the anamnesis, survey in mirrors, a kolposkopiya, cytomorphological and laboratory researches. For treatment use surgical methods: ablyation, trakheloplastika, konization, trakhelektomiya, imposing of a circular seam.
Cicatricial deformation of a neck of a uterus
According to various researches in the sphere of gynecology, the frequency of post-traumatic and congenital cicatricial changes of a neck of a uterus makes from 15,3 to 54,9%, at the same time at reproductive age it can reach 70%. The disease is revealed more often at the women who for the first time gave birth to the child aged 30 years are more senior. At patients from tservitsita the probability of post-traumatic replacement of a normal epithelium with cicatricial fabric increases. The high importance of prevention, timely diagnostics and treatment of RDShM is caused by significant influence of a disease on increase in risk of development of infertility, inflammatory and oncological processes.
Usually lead processes and interventions at which the epithelium with the subject muscles and connecting fabric is damaged to formation of the hems breaking normal anatomical structure of a neck of a uterus. Are the most common causes of cicatricial deformation:
- Pathological childbirth. Ruptures of a neck arise at rapid childbirth with insufficient disclosure of the tservikalny channel, imposing of obstetric nippers, a large fruit or its wrong situation. The probability of damages is twice higher at primipara 30 years are more senior.
- Invasive manipulations. During abortions, medical and diagnostic procedures and endoscopic operations and on its appendages the doctor enters tools via the tservikalny channel into cavities of a uterus. At the same time integrity of an epithelium is broken.
- Mistakes at suture. Process of regeneration suffers at an insufficient or wrong ushivaniye of the gaps which arose at the time of delivery or at rough carrying out invasive manipulations.
Extremely seldom deformation of a neck of cicatricial type is congenital. In such cases the disease usually is followed by pathology from other bodies of a female genital.
When forming cicatricial deformation process of the physiological restoration of sites damaged ekzo-and an endotserviksa is broken. Instead of epitelialny cages in a zone of a gap connecting fabric proliferirut. In the beginning it is rather elastic, but in process of formation of a hem is condensed, loses ability to stretching and reduction. As a result the tservikalny channel becomes isolated not completely and loses the protective function. In repeated labor the uterus neck with cicatricial changes cannot reveal completely that complicates their current. At deep ruptures of edge can heal in the form of rags. Insolvency of the tservikalny channel is followed by development of an ektropion.
When determining degree of RDShM consider such criteria as a solvency of an external pharynx, quantity and the sizes of hems, a state endo-and an ekzotserviksa, surrounding fabrics. Distinguish four extents of cicatricial deformation changes:
- I degree. The external pharynx passes a tip or all finger of the doctor. The Tservikalny channel has the form of a cone which top is the internal uterine pharynx. Depth of single or multiple old gaps does not exceed 2 cm. Signs of an ektropion of the lower departments of the tservikalny channel come to light.
- II degree. The external uterine pharynx cannot be identified. The neck of a uterus "is split" on the certain forward and back bay with distribution of old gaps to the arches. it is completely turned out.
- III degree. Old gaps reach the vaginal arches. The external pharynx is not defined. One of lips of a neck is hypertrophied. The dysplasia of an epithelium and signs of inflammatory process is noted.
- IV degree. It is shown by a combination of old gaps which extend to the vagina arches, with insufficiency of muscles of a pelvic bottom.
At the I degree of RDMSh the only symptom of a disease often is the increased number of mucous cervical allocations. At cicatricial deformation of the II-IV degree some patients complain of the pulling or aching pains in the bottom of a stomach and in lumbar and sacral area. Accession of an infection is followed by change of color is more white which become muddy, whitish or yellow. Recurrence of periods usually is not broken, but their duration can increase for 1-2 days. In 13-15% of cases of the woman note morbidity during sexual intercourse. One of signs of cicatricial deformation process in a neck is the impossibility to conceive or take out the child.
Cicatricial deformation often is complicated by accession of a secondary infection with development of a chronic tservitsit. Insufficiency of protective function of the tservikalny channel leads to distribution of inflammatory process on endometrium, uterine tubes and ovaries. As constantly is affected by acidic environment of a vagina, the probability of development of an erosion, dysplasia, leukoplakia, polyps, malignant tumors sharply increases. The cicatricial changed uterus neck in labor shows functional insolvency – natural childbirth drags on or become impossible. The disease is one of the reasons of cervical infertility.
Cicatricial changes in the tservikalny channel and neck of a uterus can be assumed on existence in the anamnesis of the complicated childbirth or invasive procedures. For confirmation of the diagnosis include in the plan of inspection:
- Gynecologic survey on a chair. At survey in mirrors expansion of an external pharynx, old ruptures, signs of an ektropion comes to light. During the vaginal research the external pharynx is passable for the gynecologist's finger.
- To Kolposkopy. Under a microscope the nature of cicatricial changes of a surface of a neck of a uterus and the tservikalny channel is in more detail studied.
- Cytomorphological research. The cytology of dabs and histology of a bioptat allow to estimate a condition of cells of a neck, and also in time to find regeneration of fabrics.
- Laboratory diagnostics. In the presence of inflammatory process apply serological analyses, PTsR and crops on flora to identification of specific and nonspecific infectious agents.
Treatment of RDShM
As the disease is followed by anatomic changes, for its treatment surgical methods are most effective. The choice of a concrete technique is defined by extent of deformation, reproductive plans of the woman and existence of complications. The following types of operations are recommended:
- Ablative methods. For removal of the cicatricial changed fabrics, an ektropion, sites of an endotserviks with polyps, a dysplasia or a leukoplakia apply radio wave and argonoplazmenny treatment, laser vaporization, cryodestruction, a diatermokoagulyation. Ablyation is effective at deformation of the I degree at the patients of reproductive age planning pregnancy.
- Trakheloplastika. During reconstructive operations by method of partial or full stratification cicatricial fabrics at preservation of a muscular layer are removed and mucous, the tservikalny channel is restored. The method is shown to women of childbearing age with the II-III extent of cicatricial deformation.
- Konization and trakhelektomiya. Excision of affected areas or amputation are carried out at a deformation combination to intraepitelialny neoplaziya or insolvency of muscles of a pelvic bottom. Radical operations are performed more often at patients who were above reproductive age.
- Imposing of kisetny seams. At emergence of signs of istmiko-tservikalny insufficiency during pregnancy the locking function of a neck of a uterus is restored mechanically. Installation obstetric a pessariya can become an alternative to carrying out operation in that case.
Auxiliary medicamentous methods of treatment are directed to knocking over of inflammatory process. After sanitation of a vagina sick appoint medicines for restoration of its normal microflora.
Forecast and prevention
Performing reconstructive plastic surgeries in 90-93% of cases allows to restore a normal form and functions of a neck of a uterus. Efficiency of imposing of kisetny seams to pregnant patients with the cicatricial deformation which was complicated by istmiko-tservikalny insufficiency makes from 70 to 94% (depending on the chosen technique). For prevention of a disease reasonable purpose of invasive procedures, timely registration at pregnancy, the correct preparation for childbirth and their competent maintaining is recommended. In the presence of traumatic gaps their timely ushivaniye with the subsequent control at the gynecologist is important.