How to insert an obstetric pessary. When is the pessary removed during pregnancy?

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So, yesterday we started a conversation, and their types and indications for their use and contraindications for use. Due to the fact that these devices have come to obstetrics relatively recently, many questions and controversial issues arise around them, although they have already proven themselves well as a remedy for the threat of abortion due to premature opening of the cervix. Today we will talk further, discussing certain issues related to the setting of these pessaries and some of the nuances of their use.

Terms of setting pessaries

Always an important issue when deciding on the treatment of isthmic-cervical insufficiency or in the presence of other indications, will be the timing of the pessary. If it was possible to suture the cervix only from about twenty weeks of pregnancy due to the need for general anesthesia, then the installation of a pessary is possible according to the indications and earlier than this period, if such an action becomes a real need. But in such cases, only the ring of the first type will be used. But these indications are extremely rare, usually obstetric pessaries are mostly installed as a means for the prevention and treatment of this pathology in terms of more than 20 weeks, and often this happens in the period from 28 to 33 weeks of pregnancy. The most basic thing for setting up an obstetric pessary is the full preparation of a woman's genital area, and more specifically, a complete sanitation of the vagina. If there are signs of any infections, including such a common pathology during pregnancy as thrush, this problem in almost one hundred percent of cases will exacerbate when wearing a pessary. Therefore, advance preparation is needed.

In order to carry out the setting of an obstetric pessary, you must first take a course with special sanitizing vaginal suppositories to prevent infection or to eliminate it, and only after the full course has been completed, the vaginal ring will be set. By itself, the procedure for its setting does not have any physiological difficulties, it does not require much time and effort, for several minutes the vaginal ring can be quite easily installed inside the woman's body. Previously, the woman will be asked to completely empty the bladder, and then lie down in the gynecological chair, while the doctor, bending the pessary itself in a special way, will gently insert the ring through the vagina and install it in the right place. To facilitate insertion, the pessary is pre-lubricated with a moisturizing agent, for example, a solution of glycerin, in order to reduce the uncomfortable and unpleasant moments of its introduction into the body.

Is the placement of an obstetric pessary unpleasant?

Naturally, the setting of an obstetric pessary is not the most pleasant procedure, given the psychological state and different pain thresholds for different groups of women. Therefore, some of the expectant mothers, when placing a pessary, talk about feelings of pain, sometimes even very strong, in the process of putting it in place. But it is quite possible to endure these unpleasant sensations, they will not be long at all, although there is very little pleasant in the procedure. However, according to doctors, these sensations will be akin to severe discomfort due to tissue stretching, rather than real pain during the procedure. To withstand such sensations is quite possible, but it can be unpleasant. However, here it is worth making a reservation that if the uterus is especially sensitive or is in good shape, then about half an hour before the procedure it is recommended to take an antispasmodic on the advice of a doctor so that the procedure can be transferred much easier. Painkillers and anesthesia are not used when placing pessaries. After the pessary is installed, detailed instructions for intimate hygiene will be developed for the woman, what should be avoided when wearing a pessary and what will need to be done. The main recommendations will be the following:
- a ban on intimate life when setting a pessary;
- observance of physical rest;
- as prescribed by the doctor, special vaginal suppositories will be used to prevent the formation of genital infections;
- regular examinations with swabs for flora every 2-3 weeks;
- conducting a gynecological examination to determine whether the pessary is correctly located on the cervix and in the vagina, whether there are any complications as a result of wearing it.

If you think that something is wrong with the pessary, you should not try to correct or remove it yourself, immediately consult a doctor for advice and checking the correct installation.

Can there be problems with wearing a pessary?

In cases of correct setting of the pessary, the ring will be almost imperceptible, and will not cause any severe discomfort to its owner in wearing. A woman usually quickly gets used to its presence inside the body, which does not give any unpleasant and uncomfortable sensations. However, almost every one of them will worry about whether the pessary will somehow fall out of the vagina as the pregnancy progresses. This is not completely excluded, but such a phenomenon is extremely rare. The main reason for this may be an incorrectly selected type and size of a pessary or its inept establishment by a doctor. When the pessary is displaced from its proper place, the woman will immediately feel it, since the pessary will press on her in the wrong places. First of all, it will be uncomfortable to sit, or the presence of a pessary will be felt when changing the position of the body. However, if the pessary is chosen according to all sizes, and the woman follows all the instructions of the doctor and she is careful in wearing it, then you should not worry about the possible loss of the pessary, it will simply be impossible. Also, it sometimes seems to women that the pessary is placed too low, and it can even be felt when washing. It is important to remember that if there is no discomfort and pain, it is better not to touch the pessary and not to put your hands and fingers into the vagina and not to touch the pessary. Do not forget to visit a doctor, he will check the correct setting of the pessary.

Discharge while wearing a pessary

When wearing a pessary, you need to be careful about vaginal discharge. It is important to consult a doctor earlier than the time scheduled by the plan in cases where the nature of the discharge has changed dramatically, there are discharges that disturb you, which were not detected earlier in the process of wearing the pessary. These include the presence of bloody or brown discharge, ichor immediately after the pessary is placed, but they should be completely sparse and disappear quickly. If they continue, you should immediately inform the doctor about it. Also alert should be the presence of yellow or green discharge, which are signs of bacterial infections, such conditions will require immediate treatment and it may be necessary to remove the pessary for some time if there are no positive results when the doctor prescribes therapy. Liquid and copious discharge, similar to water, practically odorless and colorless, should be no less alert, they indicate leakage of amniotic fluid and require immediate admission to the hospital.

However, it is also worth remembering that when wearing a pessary, the amount of vaginal discharge will physiologically increase - this is a completely natural phenomenon. Many of the women will complain about the fact that some time after the pessary was placed, the amount of clear vaginal discharge increased. Thus, the body resists the presence of a foreign body in it and possible infection from it. This is no cause for concern. If in doubt, you should once again visit a doctor or test for amniotic fluid leakage with a special gasket from a pharmacy. After removing the pessary, the accumulated cervical mucus may also stand out somewhat more abundantly for some time. One of the drawbacks in wearing a pessary is the possibility of developing colpitis, an inflammatory process in the vagina, when it is displaced. In this case, the main suspicions for it will be discharge with unpleasant sensations of itching and irritation in the vagina.

The pessary is removed during a successful pregnancy at 38 weeks, childbirth can be expected after its removal in the next few days. Removing the pessary is as simple as putting it on before. After its removal, the birth canal is sanitized and the woman is prepared for childbirth. Sometimes the pessary needs to be removed ahead of time - at the onset of labor or outflow of amniotic fluid, in the presence of an infection of the fetal bladder, in infectious processes of the genital tract and the need for urgent delivery.

More articles on the topic "Treatment of pregnant women":

The pessary appeared in medical practice not so long ago, but it has already proven itself well and is actively used in gynecology. It is installed by pregnant women in order to maintain and prolong pregnancy until the due date. It is effective in 85-90% of cases.

The obstetric pessary was created in accordance with the anatomical features of the structure of the female body. The classic version is silicone or plastic rings that are interconnected. This is not the only possible form. There are also cup, oval, round, mushroom-shaped, cubic, etc. The cup-shaped pessary is designed to support the cervix and prevent the opening of the uterine os. When diagnosing isthmic-cervical insufficiency (ICI), a device is installed in the form of a thick PVC ring, which, due to thermoplasticity, becomes soft inside the body and adapts to the organ in which it is located. All devices are sterilized by means of gamma radiation.

Pessary during pregnancy. Indications for installation

The installation of a pessary is required during pregnancy:

when detecting or as a prevention of the occurrence of CCI;
to keep the uterus and nearby organs in the correct position;
with divergence of sutures after surgical treatment of ICI;
in multiple pregnancies.

The obstetric ring makes it possible to save a threatened pregnancy and avoid it. It prevents the opening of the cervix, its premature softening and relieves stress from the organ. It is installed until 37-38 weeks and removed about a week before delivery.

There are cases when early removal of a pessary is required:

emergency delivery,
infection.

Pessaries of various types are also successfully used in the treatment of non-pregnant women, for example, to prevent uterine prolapse or incontinence.

Contraindications to the use of a pessary:

the appearance in the 2-3 trimester of pregnancy of spotting;
the presence of various serious pathologies in the mother or fetus, when it is necessary to have an abortion;
protrusion of the fetal bladder;
inflammation of the vagina or cervix.

How to put a pessary

In case of urgent need, the pessary can be inserted already at the 20th week of pregnancy. But most often it is installed in the period of 28-33 weeks.

The first step is to sanitize the genital tract. If any infection is present (), then it will aggravate while wearing the pessary. The doctor will take preventive measures by prescribing vaginal suppositories, and after completing the full course of treatment, he will install the ring. The procedure for installing a gynecological pessary is simple, it takes only a few minutes.

An hour before the procedure, a pregnant woman is given an antispasmodic because of this. It relieves contractions and reduces soreness.

Steps for installing a pessary ring:

Emptying the bladder.
The location of the woman in the gynecological chair.
Lubrication of the pessary with a moisturizing agent (medical glycerin), which facilitates its insertion into the vagina.
The curved ring is gently inserted through the vagina and placed in the desired position.

The procedure is not the most pleasant, but is carried out without anesthesia. Women note discomfort.

The first 4 days may be disturbed by frequent visits to the toilet, discharge and cramps in the lower abdomen. The presence of a pessary leads to some increase in vaginal secretion. The discharge itself becomes more watery.

The device is absolutely safe for mother and child. It is impossible to insert a pessary on your own. This procedure can only be performed by a qualified specialist in a medical institution.

Where to buy a pessary and what is the price of a pessary

The most popular is the Yunona pessary. It is made of hypoallergenic and completely safe materials. The cost varies between 300-800 rubles.

Analogues of foreign manufacturers are more expensive - from 1000 rubles. In principle, there is not much difference between them, but some women find them more comfortable.

Important nuances in the presence of a uterine pessary

Heavy physical activity is prohibited.
impossible without removing the pessary.
Sex life after the procedure is strictly prohibited.
Even the installation of the ring will not guarantee that the pregnancy will be successful.
It is necessary to observe bed rest, avoid stressful situations and give up long trips.
A cervical ultrasound is required every four weeks.
Mandatory periodic (every two weeks) check bacteriological microflora.
Over time, the unloading pessary may shift. The doctor should check the position of the ring.
It is forbidden to use the same pessary repeatedly. It's disposable. You can buy it at a pharmacy.
It is forbidden to remove or correct the pessary on your own. Only a doctor can do such manipulations.

Comment on the article "Who is shown and how to put a pessary"

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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, 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 preserve 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 the inflammatory process, which will be to one degree or another remain in the vagina for the entire time that 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.

There is a topic that women pass over in silence - it is too painful, especially for those who have learned the hard way what it means to be unable to bear a child. Desperate throwing from doctors to healers, crying into a pillow, family discord and even divorces are derivatives of this ailment. Putting a pessary during pregnancy is a lifesaver for some women, a way to get away from this sentence of fate.

To ring means to keep

For many couples dreaming of a child, pregnancy becomes a long-awaited gift. The woman's body begins to rebuild, adapting to the "interesting situation." The expectant mother and baby are getting closer and closer to each other. But she should not forget about the main thing - love must be reasonable, and for this you need to take care of your health.

In some women, the further course of pregnancy can be overshadowed by the fact that the uterus begins to open much earlier than the due date. To save a risky pregnancy and the birth of a baby, doctors in such cases decide to put a pessary on the expectant mother - a uterine ring.

A pessary is a plastic device that is placed over the cervix in case of early dilatation. Made of elastic biologically pure material and with perfectly smoothed edges, the device does not injure women's tissues.

Opening the cervix can cause miscarriage, and if a similar incident has already been observed in a previous pregnancy, such women are especially recommended to install this obstetric invention. And often, thanks to him, a pregnant woman manages to avoid a miscarriage or childbirth that is premature.

Information on the topic

A pessary is usually placed in the fourth month of pregnancy, but there are situations when the doctor deems it necessary to place it earlier. All the representatives of the weaker sex, who have the prospect of setting up a ring, are upset and alarmed by this news. But if a married couple really wants to have a child, and the woman is responsible for future childbearing, then she will agree to this step. Moreover, the chances of a future mother for a successful pregnancy outcome thanks to this simple device are greatly increased.

The procedure for setting a pessary is not very pleasant, it causes little pain in women, but it is fast in time. The introduction of the ring, however, like any medical procedure, requires preliminary preparation, such as: curing existing infections if they become aggravated during pregnancy.

Pregnant women with a particularly sensitive and excitable uterus should take an antispasmodic half an hour before the introduction of the pessary to avoid contractions. Before the introduction of the ring, the patient must empty the bladder. The doctor selects the required size of the device, treats it with glycerin ointment or gel and inserts it into the pregnant woman's vagina.

The correct size of the pessary allows you to install it as accurately as possible. The whole procedure lasts a few minutes and a pregnant woman can return home immediately after the introduction of the device.

Life after the introduction of a pessary

But! There is also a certain “fly in the ointment” in this “honey barrel” - the minus of this procedure is that the installation of an obstetric pessary excludes vaginal sex before childbirth. Other than that, there won't be any major changes in your life. Women, when wearing this device, practically do not feel any discomfort.

The expectant mother will take a smear 2 times a month for bacteriological tests, and during her visits to the doctor, he will observe the condition of the cervix. But ladies "in an interesting position" should in no case relax, deciding that the installation of a pessary fully guarantees a successful pregnancy.

Yes, a useful device can help, but rest, lack of physical activity and proper nutrition should become the rules in the behavior of a pregnant woman. As they say, saving a pregnant woman is the work of the pregnant woman herself.

At a period of 36-38 weeks, the expectant mother will visit a gynecologist, and the doctor will remove the obstetric device on an outpatient basis or in a hospital. The procedure for extracting the ring takes place as quickly as when it was installed.