Pessary at pregnancy

The word "pessary" comes from both fundamental languages of medicine. From Greek (pessos – a stone of an oval form for sports) and Latin (pessarium – "measuring gravity"). The pessary at pregnancy performs at the same time two functions:

• Deduction of internal body (uterus) in necessary (the correct situation);
• Prevention of loss of internals, owing to decrease in their gravity.

In medicine the pessary represents an oval or roundish plate from silicone or from plastic. The pessary at pregnancy is entered into a vagina for the purpose of prevention of premature births at istmiko-cervical insufficiency.

Out of pregnancy use of a pessary is used at an urine incontience, for conservative treatment of a cystocele. More rare, for the purpose of contraception.

Obstetric pessary

The treatment method is used by an obstetric pessary at pregnancy at istmiko-cervical insufficiency. This term designates insolvency of a uterine pharynx. The channel of a neck of uterus is expanded, the cover of fetal egg freely sags in patrimonial ways. There is a danger of the beginning of premature births. As indications for use of a pessary at pregnancy serve the following states:

• Incomplete smykaniye of a uterine pharynx in the field of an isthmus;
• Prevention of insolvency of seams after surgical correction of istmiko-cervical insolvency;
• Existence of polycarpous pregnancy.

The obstetric pessary is made of the material which is not causing allergic reactions then sterilized by means of gamma radiation. Selection of material and its sterilization interfere with development of reaction of rejection of a foreign body.

The pessary at pregnancy represents the truncated pyramid with the concave bases. The wide end is located from below to a rectum, the small basis adjoins to a pubic joint. The opening for a neck of uterus is made in the form of the channel on a perednezadny axis of a small pelvis. Additional openings are intended for outflow of a vulval secret. The network between openings is made by crossing points of rigid material which interferes with deformation of a pessary, at pregnancy it is in vagina polot rather long time, and removal of the proofreader of a neck of uterus is inadmissible.

The mechanism of action of a pessary at pregnancy

Corrective function of a pessary is provided by the following processes:

• Decrease in load of receptors of a neck of uterus the fetal membranes which are sticking out in a gleam of the channel;
• Redistribution of intrauterine pressure to a front wall of body of a fruit bed;
• Fixing of the cervical channel in situation to a back vault of the vagina;
• Achievement of a full smykaniye of an opening of a neck of uterus at the expense of the central opening of a pessary at pregnancy which without efforts squeezes its walls;
• Formation of the mucous stopper interfering spread of a pre-natal infection;
• Correction of an emotional spirit of the pregnant woman.

Pessaries at pregnancy are issued three sizes which size depends on the size of a neck of uterus in the diameter and capacity of a vagina.

Contraindications for use of a pessary at pregnancy

At some states installation of a pessary is prohibited as can cause additional, extremely undesirable complications. It is not necessary to use a pessary at pregnancy when:

• Inflammatory changes of vulval flora are defined;
• There are bloody allocations;
• At extreme degree of istmiko-cervical insufficiency – as a main type of correction.

If inflammatory processes arise at established pessaries at pregnancy, sanitation of patrimonial ways with obligatory bacteriological control is made.

Installation of a pessary

The procedure simple is also carried out on reception in clinic for women, that is, in out-patient conditions. In a hospital make installation of a pessary only when istmiko-cervical insufficiency is diagnosed during treatment in department.

Before entering a pessary at pregnancy, the patient empties a bladder that the front vault of the vagina did not interfere with manipulation. The pessary in position of the patient is put, lying on a chair. Installation of a pessary by the wide basis to a vagina exit is made. In the beginning the lower half of a ring, then, the second half ring – is entered into the back arch.

When the pessary is completely entered into a vagina, it is necessary to establish it correctly. For this purpose the ring is developed in the kosopoperechny plane of a small pelvis so that the wide basis was turned to a pubic joint, and the neck of uterus appeared in the central opening.

The dredging located on the parties of a pessary does not allow pressure upon an urethra and rectum a foreign body.

As a rule, installation of a pessary does not demand anesthesia. For simplification of the movement of a ring in a vagina use glyceric oil. When lability of muscles of a uterus, in order to avoid the beginning of sokratitelny activity is noted before entering a pessary at pregnancy, the patient appoint spasmolysants in preventive doses. Take them for half an hour prior to manipulation.

Pessary obstetric unloading

The pessary at pregnancy is called unloading not only because its installation reduces load of a uterus, but also unlike pessaries which is established out of pregnancy, they have absolutely other tasks: deduction of a uterus in a pelvic cavity or contraception.

Important! The pessary obstetric unloading is inefficient at omission and a prolapse of the uterus! Other design of a uterine ring is necessary for the women having pathology of the copular device absolutely.

Removal of a pessary at pregnancy

In a planned order the pessary is removed in 37-38 weeks of pregnancy, according to the emergency indications – immediately.