Recommendations after installing a pessary. Why is an obstetric pessary installed during pregnancy?

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In some clinical situations, doctors have to place an obstetric pessary on the uterus during pregnancy so that the woman can carry a child. This special device helps extend the period of gestation until the due date of birth and prevents premature birth. With such methods of preserving pregnancy, all manipulations are performed by an obstetrician; unauthorized use of vaginal rings is prohibited, as it is dangerous for the child. Not all women know what a maternity pessary is, so when striving for motherhood, they should study this topic.

What is a pessary

Structurally, this is a plastic ring, which is considered a foreign body in the reproductive system of the expectant mother. The main function is to support the cervix, reduce attacks of high fetal pressure, and prevent premature and pathological birth. A pessary can be inserted only for medical reasons, which are voiced by a highly specialized specialist during a gynecological examination, vaginal ultrasound and other clinical examinations. Not all pregnant women are prescribed ring installation; the procedure is accompanied by internal discomfort.

Why is a pessary placed during pregnancy?

If the health and life of an unborn baby are at risk, the expectant mother needs to act immediately. In extensive obstetric practice, such a procedure as installing a pessary during pregnancy is known, which is necessary in the following clinical situations:

patients with isthmic-cervical insufficiency;
multiple pregnancies (twins or more);
women with a short cervix;
slightly open internal os of the cervical canal;
anatomical features of the cervix;
exacerbation of inflammatory processes;
previous surgical manipulations on the cervix (after suturing).

Types of obstetric pessaries

To protect against premature birth, upon examination by a gynecologist, a vaginal pessary corresponding to the diameter of the cervix is prescribed. Rings are available in several types; photos of each option can be found on thematic sites on the World Wide Web. Below is a conditional classification of pessaries that the expectant mother will have to wear for a single week:

Dount. Outwardly, it is a “doughnut” that is prescribed to the patient to maintain pregnancy. Disadvantage: stagnation of secretions from the pelvic organs.
Cube. An unloading obstetric element in the shape of a cube, which ensures normal outflow of secretions.
Ring. It has the shape of silicone rings that allow secretions to pass through and protect against sexually transmitted infections. Disadvantage - they can fall out, they are not securely attached to the size of the vagina.
Cellhorn. Such a ring on the cervix during pregnancy reliably protects against the threat of premature birth, allows natural discharge to pass through, and is tightly attached to the vagina. The disadvantage is that such structures cause internal discomfort after installation.

Until when should a pessary be inserted?

To avoid unwanted termination of pregnancy, doctors install an obstetric pessary. The ring is inserted deep into the vagina, and the gynecologist uses special materials and instruments, excluding transmission of infection to the fetus. A relief pessary can be installed for medical reasons in the 2nd or 3rd trimester of pregnancy. But in the absence of contraindications, the doctor removes the rings at the 38th obstetric week or immediately at the onset of labor. After completing the session, one of the specialist’s recommendations is vaginal sanitation.

Contraindications for use

If the uterus is in good shape, doctors approve a period of wearing a pessary to preserve the fetus. However, a ring for maintaining pregnancy is not appropriate in all clinical situations; there are medical contraindications. Among them:

the appearance of bloody discharge from the genital tract;
presence of severe somatic diseases;
prolapse of the membranes;
bladder problems;
inflammation of the mucous membranes of the cervix.

How to place a pessary

If the clinical picture threatens premature dilatation of the cervix, the gynecologist urgently prescribes the installation of a pessary in a hospital setting. The procedure is quick, but feels unpleasant, but there is no need to resort to local anesthesia or general anesthesia. Installation of a dense silicone ring takes a couple of minutes, the sequence of actions of the obstetrician-gynecologist is as follows:

the patient must first undergo examination for sexually transmitted infections (if any, they must be treated with conservative methods);
Before the session, a pregnant woman must empty the bladder and rectum, not eat food, and sanitize the vagina;
if the uterus is toned, a pregnant woman needs to take a safe antispasmodic 30 minutes before the procedure;
if the expectant mother has a high threshold for pain sensitivity, it is first necessary to use a local anesthetic;
Having correctly selected the size of the pessary, doctors first treat the ring with glycerin and then insert it into the vagina, carefully securing the device to the cervix.

What does it feel like if the pessary has moved?

Due to excessive stress during pregnancy and not only, the pessary may accidentally become dislodged, and the expectant mother may experience a sensation of a foreign body in the perineum. In this case, it is necessary to remove the ring, but heavy vaginal discharge, increased tone of the uterus, internal discomfort, and pain suggest an extremely undesirable displacement of this device.

Discharge after installation of a pessary

An increase in the amount of leucorrhoea is a normal phenomenon after the installation of a pessary, which does not indicate extensive pathologies and does not require a timely response to a health problem. If the discharge occurs with acute attacks of pain, and has a greenish, brown or bloody tint, to prolong pregnancy, you need to urgently consult a gynecologist for advice. The patient may have to remove the characteristic device. If brown or bloody discharge appears immediately after installation, there is no cause for alarm.

When to remove a pessary during pregnancy

If no complications are observed, early removal of the pessary is not necessary. The optimal period for removing such a silicone ring is 38 obstetric weeks. There are cases when the pessary is removed during labor without consequences for natural delivery. The main thing is to properly care for the genitals and eliminate the risk of pathogenic infection. The need to remove the pessary may also arise at an earlier stage of pregnancy, the medical indications are as follows.

Maria Sokolova

Reading time: 8 minutes

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Pregnancy is an important event in the life of every female. But sometimes happiness can be overshadowed by a disappointing diagnosis: “Threat of premature birth.” Today, expectant mothers can protect themselves with several treatment methods, one of which is the installation of a pessary.

This procedure is safe and painless, although it has its drawbacks.

What is an obstetric pessary - types of pessaries

Not so long ago, the problem of the threat of miscarriage and premature birth could only be solved through surgical intervention. On the one hand, this helps to preserve the fetus, but the use of anesthesia and suturing has its negative sides.

Nowadays, it is possible to protect the fetus with the help of obstetric pessary (Meyer ring).

The structure in question is made of silicone or plastic.

Although such materials are considered safe for health, the body does not always respond positively to this foreign body. Sometimes allergic reactions may occur that require immediate removal of the structure and treatment.

Doctors often call a pessary a regular ring - but it is not. This device is a mixture of circles and semicircles connected to each other. The largest hole is intended to fix the cervix, the rest are needed for the outflow of secretions.

In some cases, a pessary is used, which is shaped like a donut, with many small holes along the edges.

Depending on the parameters of the cervix and vagina, there are several types of pessaries:

Type I Used if the dimensions of the upper third of the vagina do not exceed 65 mm, and the diameter of the cervix is limited to 30 mm. Often the design is installed for those who have a history of their first pregnancy.
II type. Relevant for those who are having their 2nd or 3rd pregnancy and who have different anatomical parameters: the upper third of the vagina reaches 75 mm, and the diameter of the cervix is up to 30 mm.
III type. Installed for pregnant women with a size of the upper third of the vagina from 76 mm, and a cervical diameter of up to 37 mm. Experts turn to similar designs when.

Indications and contraindications for installing a pessary during pregnancy

The design in question can be installed in the following cases:

Diagnosis. With this pathology, the cervix softens and begins to open under pressure from the fetus/amniotic fluid.
If present in medical history miscarriages, premature births.
If there are malfunctions of the ovaries, errors in the structure of the internal genital organs.

It is not mandatory, but it is recommended to install a uterine ring in the following situations:

If it happened C-section.
Pregnant woman exposed
If desired by the expectant mother. Sometimes partners try to conceive a child for a long time, and it takes them several months or years. In some cases, a couple undergoes treatment for infertility for a long time. When the long-awaited event finally arrives, a woman, in order to minimize the risk of miscarriage, may insist on installing a pessary.
If the ultrasound shows more than one fetus.

Meyer's ring alone is not always enough to maintain pregnancy. It is often used as an aid , in combination with medications, suturing.

Sometimes an obstetric pessary is generally contraindicated:

If the patient has an allergy to a foreign body, or there is regular discomfort.
The fetus has been diagnosed with abnormalities that require an abortion.
The diameter of the vaginal opening is less than 50 mm.
The integrity of the amniotic sac is compromised.
If infection of the mucous membrane of the uterus or vagina is detected.
With heavy discharge, or with discharge mixed with blood.

How and when to place an obstetric pessary, are there any risks?

This device is most often installed in the interval between 28 and 33 weeks. But according to indications, it can be used as early as the 13th week.

Before starting the procedure (or better yet, at the stage of pregnancy planning), you should test blood for infections, take smears.

When pathologies are identified, it is necessary to take measures to eliminate them, and only then carry out various manipulations with the pessary.

The technology for installing the structure is as follows:

A few days before the procedure, you should use vaginal suppositories.. This will ensure that the vagina is cleansed of various harmful bacteria.
No anesthesia is administered before the procedure. However, every woman has a different pain threshold. Those who are particularly susceptible to pain can take a pain reliever 30 minutes before insertion of the uterine ring.
The gynecologist pre-selects the design, which will fit in size. As mentioned above, there are several types of pessaries: the correct selection of the device is very important.
The pessary is lubricated with cream/gel before insertion. The introduction begins from the lower semi-ring of the wide base. In the vagina, the product must be unfolded so that the wide base is located in the posterior fornix of the vagina, and the small base is located under the pubic symphysis. The cervix is placed in the central opening.
After installation of the structure, the patient is sent home. During the first 3-4 days, you get used to the foreign body: frequent urge to urinate, pain in the lower abdomen, and discharge may bother you. If, after the specified period, the pain does not go away, and the secreted secretion has a greenish tint or contains blood impurities, you should immediately consult a doctor. If you have copious, liquid, transparent discharge that has no odor, you should immediately contact a gynecologist: this may be amniotic fluid leaking. In such a situation, the ring is removed and treatment is carried out. The urge to urinate may be bothersome throughout the entire period of wearing the ring if the pessary is set low.

The process of installing the Meyer ring is painless and safe. This design rarely causes negative reactions from the body.

However, here a lot depends on the professionalism of the doctor: an incorrectly installed design will not correct the situation, but will only cause discomfort. Therefore, it is better to contact trusted specialists in reliable clinics.

After introducing a pessary, pregnant women should adhere to certain recommendations:

Vaginal sex should be avoided. In general, if there is a threat of miscarriage, any type of sex should be forgotten until the baby is born.
Bed rest should be observed: any physical activity is unacceptable.
Visits to the local gynecologist should be at least once every 2 weeks after installation of the product. The doctor on the gynecological chair will perform an examination to make sure that the structure has not moved out of place.
In order to prevent the development of vaginal dysbiosis in pregnant women, smears are taken every 14-21 days to determine the microflora. For prevention, vaginal suppositories and capsules can be prescribed.
It is prohibited to remove/adjust the pessary yourself. Only a doctor can do this!

How to remove a pessary - how does childbirth go after a pessary?

Closer to the 38th week of pregnancy, the Meyer ring is removed. The procedure takes place quickly in a gynecological chair and does not require the use of painkillers.

The structure can be removed earlier in case of the following complications:

The amniotic sac is inflamed or leaking. This phenomenon can be determined using a test that is sold in city pharmacies.
Infection of the genital organs.
The beginning of labor activity.

After removing the pessary, heavy discharge may occur. There is no need to worry about this: sometimes the ichor accumulates under the rings and comes out only when the foreign body is removed.

To ensure vaginal sanitation, the gynecologist prescribes candles or special capsules which are inserted into the vagina. Such prophylaxis is carried out for 5-7 days.

Many people associate the removal of the vaginal ring with the onset of labor. But that's not true. Childbirth occurs differently for each patient.

In some cases, a happy event may occur in just a few days . Others are safe last 40 weeks .

The Сolady.ru website reminds you that all information in the article is provided for educational purposes only, it may not correspond to the specific circumstances of your health, and does not constitute medical advice.

The birth of a child prematurely is a very alarming signal and can lead to the death of the baby. When there is a threat of premature delivery, a woman is often hospitalized and kept in the hospital until the birth itself. However, in some cases, an obstetric pessary can help carry a pregnancy to term.

What awaits a pregnant woman who has been prescribed such a procedure? Isn’t it painful? Is such an intervention dangerous for a pregnant woman or her unborn baby? We suggest you understand all the nuances of installing an obstetric pessary during pregnancy.

If we analyze the causes of premature birth in women, then in almost half of the cases the culprit of the tragedy will be a pathology called “ICI” (isthmic-cervical insufficiency). Often women do not think about the structure of the cervical canal and its role in pregnancy. The cervical canal (uterine os) is the internal part of the cervix that connects it to the vagina. Normally, the cervix and cervical canal should be compressed into a ring until just before childbirth. In some cases, the cervical canal opens slightly, and the cervix shortens at the same time. Under the influence of such factors, the fertilized egg ceases to be retained normally. As pregnancy increases intrauterine pressure, this causes the membranes to be pushed toward the cervical canal, causing the risk of preterm labor.

Preparation for childbirth includes gradual expansion of the cervical canal. If, long before the due date, the gynecologist, along with the dilatation of the cervix, notices a slit-like cervical canal in the pregnant woman, this indicates that the woman may begin labor at any moment.

Complicating the situation is the fact that with ICI, the path is open for infection to penetrate from the vagina into the uterus, leading to inflammation that destroys the membranes and contributes to spontaneous abortion or premature birth.

Types and causes of ICN

With ICI, the tone of the muscle fibers that affect the tone of the uterus is reduced - therefore, this disorder is also called “cervical incompetence.” What are the causes of isthmic-cervical insufficiency? Most often, this diagnosis is associated with various injuries to the cervix in the past.

The causes of this disease may be related to:

congenital anomalies of the genital organs (including congenital ICN);
complicated childbirth (with ruptures, the application of obstetric forceps, with breech presentation, polyhydramnios, large fetus);
long-term abortions;
surgical interventions on the cervix, fetal destruction operations;
pregnancy in very young or elderly women;
hormonal disorders (with increased levels of female hormones and progesterone deficiency, ovarian dysfunction, genital infantilism, etc.);
heavy physical activity during pregnancy;
bad habits of a woman;
expressed anxiety and suspiciousness of women who are confident in the poor prognosis of their pregnancy.

Due to various causes of the disease, there are two types of isthmic-cervical insufficiency

functional;
traumatic.

Symptoms and treatment of ICI

Isthmic-cervical insufficiency may not manifest itself at all. Many women do not pay attention to minor symptoms in the form of painless bleeding or minor discomfort. And only in later stages (after 18-20 weeks) can a pregnant woman feel pain in the lower abdomen and lower back. This occurs at the moment of fetal death and the beginning of abortion.

Gynecologists may also miss the symptoms of ICI, since it is undesirable to look at pregnant women on the chair one more time. Such examinations can lead to infection of the genital organs and provoke premature birth. And a gynecological examination itself cannot always help in identifying this pathology. Only ultrasound cervicometry (ultrasound of the cervix) can accurately diagnose ICI.

Treatment methods for ICN are selected by a gynecologist. However, they can be conservative or operative.

A pessary for isthmic-cervical insufficiency often becomes the only alternative to surgical treatment - suturing the cervix.

What is an obstetric pessary and why is it needed?

A pessary (Meyer ring) reduces the degree of pressure on the cervix and allows you to carry the pregnancy to timely birth.

When talking about a pessary (obstetric ring), we mean a device made of biologically pure material - flexible plastic or silicone. A pessary is often simply called a ring. For complete sterility, the device is treated with gamma rays. There are also urological pessaries used for prolapse (prolapse or prolapse) of the pelvic organs, urinary incontinence or dysfunction of the pelvic muscles.

The obstetric pessary has been used in Russia for about 20 years (in Europe even longer) with very high efficiency (in almost 85% -90% of cases). The main indications for installing a pessary during pregnancy are the following situations:

isthmic-cervical insufficiency;
threats of miscarriage;
previous premature termination of pregnancy;
pregnancy after long-term infertility;
multiple pregnancy;
heavy physical activity after uterine rupture.

An obstetric pessary is also called an unloading pessary. They look like a concave pyramid consisting of several rings of different diameters. These rings can be of various shapes (oval, round, mushroom-shaped, cubic, cup-shaped). All edges of the ring are perfectly adjusted and smoothed so as not to damage the fabric. The wide part of the device is located in the direction of the rectum, and the narrow end is directed towards the womb.

Thanks to its special concave shape, the pessary not only does not compress the organs, but also relieves pressure on the bladder and the base of the rectum.

In the center of the ring there is a hole for the cervix, and on the sides there are smaller holes for the release of vaginal secretions. There are bridges between the holes of the pessary that ensure the strength of the device.

A pessary is installed not only for the purpose of treatment, but also to prevent pregnancy complications for medical reasons.

Obstetric pessaries come in three sizes:

for nulliparous women (with a cervical diameter of up to 30 mm and an upper part of the vagina up to 65 mm) – type 1;
for those who have given birth (with a cervical diameter of 25 to 30 mm and the upper part of the vagina up to 75 mm) - type 2;
for those who have given birth repeatedly (with a cervical diameter of up to 37 mm and an upper part of the vagina up to 85 mm) - type 3.

Obstetric rings are inserted through the vagina and placed in the uterus, preventing the cervix from dilating. Subsequently, the pessary reduces pressure on the fetus and allows you to properly redistribute the load.

Installation of a pessary

The pessary is selected and installed only by a gynecologist. This can happen on an outpatient basis (in a antenatal clinic) or in a hospital. The patient is first examined and a pessary is selected for her, taking into account her anatomy.

Acceptable periods for installing a pessary are gestational age from 12 to 25 weeks. The optimal time for manipulation is considered to be after the 20th week of pregnancy. Once installed, the ring will not cause the woman any discomfort.

Installation of the pessary is painless and quick.

There is a strict rule for installing a ring: the absence of any infections or inflammations in the genitals.

Therefore, before installing an obstetric ring, it is necessary to take a bacterial smear from the vagina. If any infections are discovered, they must be treated immediately.

A prerequisite for installing the ring is the I-II degree of vaginal cleanliness (after the results of a smear on the microflora).

Installation of a pessary includes the following points:

Half an hour before installation, patients with increased uterine tone are usually recommended to drink no-shpu or papaverine (antispasmodics).
The ring installation procedure takes several minutes and can be a little unpleasant. First, the woman empties her bladder.
The pregnant woman is seated on a gynecological chair and examined. The pessary is pre-lubricated with glycerin for more comfortable insertion. No anesthesia is required for administration.
The ring is placed at the entrance to the vagina with the wide end down. First, the lower part of the pessary is inserted, and then the upper. The inserted ring is unfolded to a functional “oblique” position and secured to the cervix. The cervix should be in the central opening of the ring.

A properly placed pessary supports (but does not cover) the cervix, pushing it toward the sacrum.

The effect of the obstetric ring

A woman should discuss the choice of an obstetric pessary, the manufacturer’s company and its size with her gynecologist.

The obstetric ring has a number of important positive aspects when using it. The main ones are the possibilities:

changing the direction of pressure on the fetus and reducing the load on the cervix;
fixation of the cervix with the walls of the central opening of the ring;
redistribution of pressure in the uterus;
reducing the risk of infection of the fetal membranes (due to the preservation of a reliable mucus plug in the cervical canal of the cervix).

Installing a pessary is not only physical, but also psychological support for many women during pregnancy.

Woman's behavior after installation of a pessary

The materials for making the pessary are of very high quality and prevent the development of allergies.

A slight increase in vaginal discharge is natural after insertion of the ring.

It is prohibited to be sexually active after the ring is installed. Although during a normal pregnancy, sexual relations are allowed and even encouraged.

After installing the ring, the woman does not need any special regime. All restrictions are related to the needs in the form of:

Taking vaginal smears every 2-3 weeks for the earliest possible diagnosis of vaginal inflammation (colpitis).
Regular ultrasound of the cervix (every 3-4 weeks) to assess the condition of the cervix.
Treatment of the vagina and pessary in it with antiseptic solutions (chlorhexidine, furatsilin) every two weeks.

Removal of the ring is carried out as planned at 37-38 weeks or urgently if there are urgent indications for this (bloody discharge, premature rupture of water, beginning labor).

If a woman is at risk of premature birth, the ring is removed only at 38 weeks of pregnancy. Removal of the obstetric pessary usually results in relaxation of the cervical muscles and the onset of labor (within a week).

After installing a pessary, a pregnant woman should especially carefully monitor her health and consult a doctor immediately if:

there was a suspicion of the development of inflammation of the genital organs;
water broke;
signs of early premature labor appeared.

Contraindications for installing a pessary

The pessary extremely rarely causes complications. However, these obstetric devices are not installed without indications. After all, any unnecessary manipulation of a pregnant woman’s genitals is an additional source of danger and a risk of contracting an infection.

An obstetric pessary is installed only in cases of absence of inflammatory diseases, bleeding and when there is confidence that the pregnancy will be carried to term.

Contraindications for installing a ring are the following situations:

degree of vaginal cleanliness above I-II;
gynecological bleeding in the 2nd and 3rd trimesters;
possible frozen pregnancy;
presence of myometrial tone (muscular uterine layer);
inflammatory diseases of the genital area (cervix or vagina) requiring treatment;
diseases of the mother that do not allow the fetus to bear and require termination of pregnancy;
gross malformations in the development of the fetus with the need for artificial delivery;
high degree of ICI with prolapse (protrusion into the vagina) of the amniotic sac.

An obstetric ring should not be placed on women with a pathologically excitable uterus. With such characteristics of a pregnant woman’s body, a pessary can almost immediately provoke labor at a time when the baby is not yet viable. However, this complication is rare.

What are the complications after ring installation?

Complications after insertion of an obstetric ring are extremely rare. But sometimes after installing it, side effects are possible in the form of:

displacement of the ring into the vagina with the development of colpitis or inflammation of the cervix;
development of inflammation of the membranes (chorioamnionitis) with subsequent infection of the amniotic (amniotic) fluid;
discomfort when sitting for long periods of time;
a significant increase in vaginal discharge.

Often, the installation of a pessary provokes the development of inflammation, as evidenced by the vagina. Then patients have to use various vaginal suppositories with an anti-inflammatory effect. However, such complications usually respond well to treatment.

If it was not possible to eliminate the inflammation of the cervix or vagina within 10 days, then this is an indication for removing the obstetric pessary.

Increased vaginal discharge is sometimes confused by women with the breaking of water. To determine the nature of the discharge in this case, special pharmacy tests are used.

Summarizing all of the above, we can say that a pregnant woman should not be scared at all if she is prescribed to wear an obstetric pessary. It’s okay if the pessary makes life somewhat more difficult for the expectant mother, requires closer monitoring of her health and makes additional visits to the doctor necessary. But this simple but reliable device, in most cases, will give her the opportunity to carry the baby to term and give him a chance to be born healthy. However, such obstetric manipulation must be carried out professionally and taking into account all contraindications.

The doctor's conclusion that it is necessary to install a pessary frightens many women. Of course, there is little pleasant in this, but still, a pessary is more good than evil, and the negativity towards it is unfair: it is often thanks to it that it is possible to successfully endure a pregnancy and give birth on time.

This device came to us relatively recently, but has already completely justified itself. Thanks to the installation and wearing of obstetric pessaries by pregnant women, pregnancy can be maintained and extended to its due date in 85-90% of all such cases. But not so long ago, in conditions that today require the installation of a vaginal ring, the algorithm of action was the only possible one: suturing the cervix - with the use of anesthesia and all the ensuing consequences.

What does an obstetric pessary look like: types and types

Translated from Latin, “pessarium” literally means “vaginal,” but experts are still more inclined to believe that the name of this device was borrowed from the Greeks: in some games they used a round or oval-shaped stone called “pessos.” By the way, it is precisely because of its shape that the pessary is often simply called a ring. Meanwhile, modern pessaries are diverse in appearance, shape, and purpose.

First of all, you should know that such drugs are used not only in obstetrics and gynecology, but also in other branches of medicine. So, for example, there are urological pessaries.

Today we will talk about medical devices that are used to treat and prevent some complications that develop during pregnancy. It's called an obstetric relief pessary.

So, in form, obstetric pessaries are as follows:

oval;
round (ring);
cubic;
strip pessaries;
cup;
mushroom-shaped;
donut type, etc.

In addition, obstetric “rings” are divided into types, each of which corresponds to a different size. There are three types in total:

obstetric pessary type 1 - intended, as a rule, for nulliparous women and those who have had no more than two births in the past; the first type ring is installed when the diameter of the cervix is 25-30 mm, the size of the upper third of the vagina is 55-65 mm;
obstetric pessary type 2 - intended for the same category of women, but with different anatomical parameters: cervical diameter - 25-30 mm, size of the upper third of the vagina - 66-75 mm;
obstetric pessary type 3 - indicated for women who have become pregnant for the third time or more and have the following physical characteristics: cervical diameter - 30-37 mm, size of the upper third of the vagina - 76-85 mm.

In each individual case, the “ring” is certainly selected in size and shape - it must correspond to the anatomical features and size of the internal genital organs of the woman who will be installed.

The unloading obstetric pessary is made of biologically pure, hypoallergenic, safe material. Most often it is silicone or special plastic - it is flexible and elastic (easily adapts to the female anatomy), but at the same time quite dense. The vaginal ring is disposable and has its own expiration date, during which it remains sterile.

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 this device surrounds the cervix, preventing it from opening. Other openings serve to allow vaginal secretions to pass through them.

All edges of the ring are rounded and smoothed, and therefore it is practically not felt when worn and is not capable of injuring the mucous membrane of the genital tract.

Obstetric unloading pessary: questions and answers

Any of us, preparing for pregnancy or learning about it, hopes that it will be a special, unclouded period. But the reality of life is that expectant mothers have to face many difficulties. The news about the need to install an obstetric ring immediately raises a number of questions: why, how and when a pessary is placed, what it is and is it necessary, what are the pros and cons, what is involved with it... We will try to answer the most important questions.

Why a pessary is placed during pregnancy: indications

Not even all pregnant women whose doctor recommends installing such a device fully understand what it is for. But in reality he doesn’t have much evidence:

isthmic-cervical insufficiency (ICI);
the need to prevent isthmic-cervical insufficiency;
suture failure due to surgical treatment of ICI.

That is, these are conditions in which the cervix dilates prematurely (it is very short or soft), which becomes the beginning of labor or miscarriage. An obstetric ring allows you to preserve and prolong a pregnancy that is in danger of failure. Quite often, a pessary is installed for twins or triplets. This gynecological remedy prevents premature birth in women with ICI and those carrying multiple pregnancies.

An unloading obstetric pessary keeps the cervix closed, preventing its premature softening, and relieves tension from it. It also redistributes fetal pressure and reduces the load on the cervix. And also, women admit, it’s somehow calmer with the “ring”: nevertheless, the guarantee of a safe pregnancy when wearing such an obstetric device is very high!

However, there are contraindications to installing a pessary. These are mainly conditions in which it is impossible to prolong pregnancy (for example, suspected missed abortion). You should also not place a ring if an inflammatory process is detected in the genitals or if there is bleeding during pregnancy.

At what stage and how to place an obstetric pessary

If suturing the cervix was possible only starting from the 20th week of pregnancy (due to the need for anesthesia), then a pessary can be installed according to indications earlier, if an urgent need arises. In this case, only the first type of ring is used. However, in most cases, the remedy is installed after 20 weeks, most often between 28 and 33 weeks.

The main thing is to prepare the genital tract, that is, to sanitize it: if there is any infection (for example, thrush during pregnancy, as often happens), then it will certainly worsen while wearing the pessary.

So, the doctor will most likely prescribe vaginal suppositories - for prevention or treatment, and after completing the course, he will place a vaginal ring. The procedure does not present any difficulties and does not require much time: the device will be installed within a few minutes.

The woman, having previously emptied her bladder, lies down on the gynecological chair, and the doctor, bending the ring in a certain way, carefully inserts it through the vagina and places it in its proper place. The pessary is pre-lubricated with a moisturizer, for example, glycerin, to increase the sliding of its surface and facilitate insertion into the vagina.

Is it painful to put on an obstetric pessary?

We all have different thresholds for sensitivity, which is why some women report feeling pain (sometimes even severe) during pessary insertion. Meanwhile, doctors believe that this is more discomfort than real pain. It is quite possible to withstand it, although it is certainly unpleasant. But if the uterus is very sensitive or is in good shape, then 30 minutes before the procedure you should drink an antispasmodic to make it easier to endure this manipulation. Anesthesia is not used when inserting the ring: pain may occur, but it is tolerable.

After installing the product, the woman will be given detailed instructions on how to perform intimate hygiene, what to avoid, and what must be done without fail. The main recommendations are as follows:

You cannot have sex with the ring installed.
It is necessary to maintain physical rest.
According to medical prescription, you will have to use vaginal suppositories to prevent the development of sexually transmitted infections.
Every 2-3 weeks it is necessary to take a smear to monitor the condition of the vaginal microflora.
A gynecological examination is periodically required to ensure the correct placement of the device and the absence of complications due to its wearing.
It is best not to touch the pessary or try to adjust or remove it yourself.

Can a pessary fall off during pregnancy?

As a rule, a vaginal ring is almost imperceptible and does not cause severe discomfort when worn - women quickly get used to its presence and do not experience any particular trouble. But they often worry about whether the pessary might fall out during pregnancy.

This happens extremely rarely, but it is still possible. The main cause is usually an incorrectly selected or ineptly installed pessary. When he moves from his place, the woman will immediately feel that he has begun to “press.” First of all, it will become uncomfortable for her to sit; the device will be felt when changing body position.

But if the ring is the right size, and the woman follows all the doctor’s instructions and precautions, then there is no need to worry about the pessary falling off. Very often it seems that the pessary is located low enough that you can even feel it when washing. But if you don’t have the sensations described above, then it’s better not to climb there again and not touch anything. Be calm, but don’t forget about follow-up examinations with a gynecologist.

Pessary during pregnancy and discharge

You should consult a doctor ahead of schedule if, while wearing a relief pessary, you notice the appearance of vaginal discharge that was not there before:

brown, bloody discharge and ichor may occur immediately after the ring is inserted, but in very small quantities. If they appear while wearing the device, then you need to tell your doctor about it;
yellow or greenish discharge accompanies the development of a bacterial infection - this condition requires treatment, and the pessary may even have to be removed for a while if the therapy prescribed by the doctor is ineffective;
discharge like water, abundant, liquid, colorless and odorless (or with a slight sweetish aroma) indicates a violation of the integrity of the amniotic sac and requires urgent medical attention!

Meanwhile, you should know that an increase in the amount of leucorrhoea after installing a pessary is a completely natural phenomenon. Many women complain that some time after insertion of the ring, the liquid transparent discharge intensifies. This is how the body tries to get rid of the foreign body - don’t worry. If in doubt, buy a water leak test.

A lot of mucous discharge may appear after removing the pessary - this is cervical mucus that has accumulated while wearing it.

The disadvantage of the pessary is that its displacement often leads to the development of colpitis - inflammation of the vaginal mucosa. Suspicion should be caused by discharge accompanied by unpleasant sensations: irritation, itching in the vagina.

When to remove an obstetric pessary

If the pregnancy with the pessary proceeds well and no complications arise, then the unloading obstetric pessary is removed at 38 weeks - and labor can begin in the coming days (although not necessarily). This is done as simply and quickly as installation, after which sanitization of the birth canal also follows.

However, in some cases it may be necessary to remove the device earlier. Indications for this may include:

the beginning of labor;
rupture of amniotic fluid;
infection of the membranes (chorioamnionitis);
development of an infectious gynecological disease;
the need for urgent delivery.

In addition, the vaginal ring cannot be used as the only treatment for ICI during pregnancy.

All pregnant women want the pregnancy to go well, and then they give birth to a healthy, strong baby. However, not all expectant mothers succeed in this. Some people are prescribed a pessary during pregnancy, and women are scared, not knowing what it is. An obstetric pessary is a ring-shaped device with which the uterus is fixed during pregnancy. Any expectant mother who has been prescribed this device will be interested in learning about the consequences of using a pessary, side effects and contraindications for its use.

What is an obstetric pessary

Doctors call a small ring for pregnant women on the cervix a pessary. The most common device actually looks like a ring, but there are a lot of variations in the shape of this instrument - there are obstetric cup-shaped, cubic, cone-shaped, mushroom-shaped devices that perform the same function - reliable fixation of the uterus so that the fetal pressure is distributed evenly over it. An alternative to installing the device is an operation to suture the cervix, which is fraught with negative consequences.

In what cases is it installed

A terrible diagnosis - “threat of premature miscarriage” - is heard today by every fifth pregnant woman during an obstetric examination. However, not everyone gets a special ring that will protect the expectant mother from spontaneous early birth and miscarriage. Installation of an obstetric pessary is prescribed for isthmic-cervical insufficiency. This pathology is characterized by the following symptoms:

too soft and weak walls of the uterus;
constant opening of the uterine pharynx due to its damage;
short cervix.

This condition occurs after suffering gynecological diseases, abortions, constant curettage, difficult previous births, may be a consequence of diseases of the internal organs, or have a congenital form. Insufficient functioning of the uterus can lead to the fact that the membranes begin to penetrate the pharynx as the fetus grows, which can lead to infection, early rupture, and miscarriage. The use of a pessary in 85% of cases of obstetric practice helps to safely carry the fetus to term.

Types of obstetric pessaries

Each woman is individual, has her own dimensions of the vagina and cervix. Depending on these indicators, the following options for obstetric pessaries are distinguished:

1 type. Used during the first pregnancy, when the diameter of the cervix is no more than 30 mm, and the length of the upper third part of the vagina is 60-65 mm.
2nd view. The use of such obstetric rings is justified during the second or third pregnancy, when the upper third part of the vagina is 65-75 mm, and the diameter of the cervix is 30 mm.
3rd view. Such rings are relevant for women who are carrying more than one child, whose upper third of the vagina is more than 76 mm, and whose cervical diameter exceeds 37 mm.

Until when should a pessary be inserted?

Diagnosis of the functioning of the uterus, its possible weakness and insufficiency of work - all this is done by obstetricians at the end of the first trimester. However, sometimes at these times it is not possible to establish the presence of pathology, and the final diagnosis confirming isthmic-cervical insufficiency is made in the second trimester. The pessary is installed between the 1st and 2nd trimester, at 13-23 weeks of gestation. The expectant mother should be prepared to wear this obstetric device for a long time, almost the entire period of bearing the baby.

How to choose

The correct selection of an obstetric pessary is very important, because this instrument helps save the life of the fetus and relieves pressure on the uterus, so you cannot try to choose the right device yourself. The need for installation should be recommended by a qualified gynecologist or obstetrician, based on ultrasound data and visual examination of the uterus, during which its diameter and vaginal dimensions are determined.

The material for the manufacture of this obstetric instrument is silicone or special soft plastic. A gynecologist helps a pregnant woman choose the required product, pointing out the specific manufacturer, type and type. It has been noted that when using imported pessaries, fewer side effects occur, and these devices are better tolerated by the body.

How to place a pessary

Before placing the ring, you have to take smears to check the vaginal microflora. In addition, the necessary indications for the installation of this obstetric device are normal uterine tone and the absence of protrusion of the membranes into the pharynx, the diameter of the cervix is at least 30 mm, and the upper third of the vagina is at least 60 mm. Obstetricians claim that the procedure for installing the ring is atraumatic and painless, however, if you have a low pain threshold, you can ask for local anesthesia. The pre-selected structure is installed as follows:

The woman lies on her back with her legs spread wide.
The gynecologist generously lubricates the obstetric pessary with a special cream or gel and begins to insert it into the vagina with a wide base.
After insertion, the ring is unfolded so that the base is deep in the vagina, and the narrow part is under the pubic bones of the pelvis. Installation takes 15-20 minutes, after which you can get up and go home.

Do's and don'ts after inserting a pessary

You should not think that all problems are over after installing the obstetric ring, and you can relax without visiting doctors. In order for the embryo to develop normally, certain medical requirements must be observed when installing a pessary:

Vaginal intercourse should be stopped.
You should avoid heavy physical activity and try not to bend over or squat.
See a gynecologist at least 2 times a month so that the doctor, during the examination, makes sure that the device is in place and has not moved anywhere.
You will have to regularly take a smear to check the health of the microflora, since wearing an obstetric ring can provoke the occurrence of vaginal infections, which are treated on an outpatient basis.
Under no circumstances should you try to remove the pessary yourself.

Possible complications while wearing

Since the device is a foreign body inserted into the body for a long period, the following complications are possible when wearing an obstetric pessary:

Constant vaginal discharge. If this is not leakage of amniotic fluid (to rule out this option, buy the appropriate test at the pharmacy), and the discharge is clear and odorless, then you can calm down - everything is going fine.
The occurrence of candidiasis and other fungal diseases.
Inflammation of the walls of the vagina and cervix, colpitis, vaginitis.

Discharge after installation of a pessary

Immediately after installing the device, you may notice brownish bloody discharge. Normally, they should be scanty and stop 3-4 days after installing the pessary. However, if the discharge becomes more and more abundant, you should consult a doctor. Greenish discharge, as well as itching and burning of the vagina, indicate the development of a fungal or bacterial infection. This situation should also be the reason for an unscheduled visit to the gynecologist.

What does it feel like if the pessary has moved?

If the device is installed correctly, the woman should not feel any discomfort. However, if when changing position, bending, changing position, she feels discomfort and inconvenience in the uterine area, then there is a possibility that the device does not occupy the desired position. This may be evidenced by simultaneous abundant discharge of a whitish hue. If such symptoms occur, you should immediately consult a doctor so that he can correct the position of the instrument and return it to its place.

When to remove the pessary

In a normal pregnancy, the obstetric device is removed at approximately 38 weeks, before the woman is about to give birth. If swelling of the cervix is diagnosed, then extraction may be accompanied by painful sensations. Early removal of the instrument is carried out in a hospital under such circumstances.