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function of the cervix plays a primary role during pregnancy keeping the fetus
in the uterus until it is mature enough to be delivered and preventing it from
vaginal infections that can enter the uterus via the cervix. Cervical
incompetence and vaginal infections are main contributors to preterm births. By controlling the cervix, the embryo will be
safe and healthy inside the uterus until the end of gravidity which is the goal
of every pregnancy. Because the preterm birth is the main cause of perinatal
morbidity and mortality worldwide prevention of preterm birth is probably the
most important challenge in modern obstetrics.
only does the cervix keeps the fetus in the uterus during pregnancy but it can
prevent form other risk factors such as infection. The cervix acts as a barrier
between the fetus and vaginal infections that can lead to early labor since some
infections are very risky if they pass the barrier and enter the uterus.
Considering that, vaginal infections are very common in pregnant women however
the amniotic fluid is sterile and the uterus likewise growing fetus is protected from all infections such as bacteria
and viruses by the cervix. Thus, the cervix is considered as a controller and
limits all microbial access by producing the mucus, which plays a role as an
anti-microbial. If this blockage is compromised, bacteria may go into the
uterine cavity leading to preterm birth (Racicot).
be considered normal, the cervical length should be at least 30 mm, if cervix
measures less than 25 mm then is considered as a risk for the gravidity (Dawes). As the pregnancy continues
in the second trimester, weeks 14 to 27, the pressure will rise in the cervix
due to its position with the fetus. As a result, the cervix may shorten due to
this pressure risking the fetus to be delivered before maturity. This can be
called also as an incompetent cervix when the cervix is shortened, or weakened
cervix, when the cervix is not firm as much as it should be. Both these
conditions can lead to miscarriage or preterm delivery, even though based on the
statistics this can happen only 1 in 100 pregnant women (americanpregnancy.org). Not only weakened
cervix due to the softness of the muscles can be open and risks the fetus from
reaching full term but also can lead to premature rupture of the membrane,
condition in which the bag of water breaks before the 37th week of pregnancy and before
the onset of contractions. Incompetent cervix usually does not have any symptoms;
this is the reason that the risk for miscarriage or preterm birth may be higher
than in other problems that can be identified before is too late (americanpregnancy.org)
In the second trimester of pregnancy, in addition to
supplemental screening for anatomic anomalies of the fetus, it is necessary to
carry out an adequate overview of the cervical segment. In the world, nowadays,
the importance of ultrasound diagnostics in assessing the cervical segment is
much more important than a clinical examination. In this way, an endovaginal
probe, as well as transabdominally, is more precisely estimating the length (in
millimeters), as opposed to the manual examination, in which the vaginal part
of the cervix is assessed.
The cervical measurements in the first trimester are
closely related to preterm birth even though between 11th and 14th
week of gestation prediction for preterm birth is not well defined yet.
Importance of cervical length in the previous studies did not appear to have
any relations to preterm birth and only limited number of
data showed the association between preterm births and cervical length. Two
studies were done to compare the length of the cervix in the first and second
trimester of pregnancy which they did not show that cervical length and preterm
birth to have been linked between 10 and 14 weeks of pregnancy. If we take to account difficulties to measure
the cervical length before 14 weeks as it cannot be distinguished from the
uterine segment because the gestational sac did not reach the size to expand
lover part lead us to an explanation why the data did no show the close
relation between cervical length and preterm birth. (P. Antsaklis). But how cervix can be measured then?
The new method was proposed to measured cervix length by distinguishing
endocervix and isthmus, moreover, look for the myometrial thickening between
endocervix and the gestational sac. This method suggests that first should be
measured the linear
distance between the two ends of the glandular area around the endocervical
canal and second the shortest distance between the glandular area and the
gestational sac (isthmic length), distinguishing between the endocervix and the
Using this method to measure the cervix, one study done to show that when the
cervix is shorter in the first trimester chances for spontaneous delivery
before 34 week is high than in women with normal cervix length. However limited
are the studies that suggest further examinations which can provide more
information about the importance of the cervix length at this stage of
pregnancy (P. Antsaklis).
As the most important parameter, which is controlled
throughout the entire period of pregnancy is the size of the cervix, or rather,
its length. In many ways, this figure depends on the possibility of a
successful pregnancy. One of the most important checkups in pregnancy is a
cervical examination – the opening in the vagina. The cervix is the one responsible
for the safety of the fetus to the very birth that is why it is controlled
throughout the entire period of pregnancy. Otherwise, the cervix is always open
in women, for sperm entry and swelling of menstrual blood, but in pregnancy,
the cervix closes and becomes a special protective barrier. In a normal
pregnancy, the cervix is ??firm, long and closed until before giving birth,
however, a week or two before delivery it softens, becomes shorter and opens.
Before the act of giving birth, the cervix is usually open about 10 cm. Nevertheless,
in some women, the cervix is ??not so “reliable”. In pregnant women
with cervical insufficiency, the cervix sometimes opens and widens well before
the term itself even in the first trimester.
modern postpartum, where premature birth is still predominantly responsible for
perinatal mortality and morbidity; any method of screening to more precisely
define a risk group of pregnant women would be welcome. According to “Miscarriage:
Signs, Symptoms, Treatment, and Prevention”, in childbearing years 10-25% of
clinically recognized pregnancies will end with miscarriage (American
Pregnancy Association). Pregnancy is a special condition of the female body when it shifts to a new
mode of operation and what is happening in it, it is aimed at the preservation
and development of an unborn child. This applies to all internal organs being
closely linked, including the cervical canal which
contributes the pregnancy by keeping the fetus in the uterus and controlling
and limiting bacteria that can enter the uterus through the cervix.
Role of the Cervix in Pregnancy.
December 6, 2017
Professor: C. Seibert
December 6, 2017
Professor: C. Seibert
The Role of the Cervix in Pregnancy
Bunker Hill Community College