What causes uterine relaxation?

Relaxation of the cervix means relaxation of the uterus. Relaxation of the ligaments of the uterus can lead to uterine prolapse and may even make the body more susceptible to gynecological diseases. There are many reasons for uterine relaxation, such as frequent childbirths, abortions, or frequent gynecological examinations of the uterus. Treatment can only be started after the cause is found.

Overview of Uterine Relaxation

Causes

Risk factors: Conditions that lead to uterine overdistension (multiple pregnancy, polyhydramnios), uterine fragility (post-term pregnancy or chorioamnionitis), and extrinsic restriction of uterine contractility (use of uterine relaxants or general anesthesia).

It is generally believed that most of them are related to cervical injuries caused by curettage, delivery or surgical delivery, especially forceps curettage during artificial abortion in late pregnancy, which can easily damage the internal cervical os. A small number of patients have congenital developmental abnormalities.

Diagnosis

It is usually diagnosed by palpation of the abdomen and is marked by a soft uterus. About 75% of postpartum hemorrhage is caused by uterine atony, which is the main cause of postpartum hemorrhage and often leads to unstable vital signs.

The diagnosis of uterine insufficiency can be based on the following:

1. Have a history of cervical surgery such as cervical dilation and curettage, or a history of emergency delivery or forceps delivery.

2. It is easier to conceive, but also more prone to miscarriage or premature birth, and most women have a history of more than two spontaneous abortions in mid-pregnancy. The characteristics of miscarriage are that there is no obvious paroxysmal abdominal pain before miscarriage, sudden rupture of the fetal membrane, and rapid delivery of the fetus, which is mostly fresh and has no congenital developmental abnormalities.

3. During the non-pregnancy period, if the cervix is ​​shorter than 1.5 cm or a size 8 cervical dilator can easily pass through the internal os of the uterus without resistance or pain. During pregnancy, the cervical canal is short and the internal and external openings of the uterus are relaxed, allowing fingers to pass through.

4. Hysteroiodized oil angiography shows that the cervical canal is pathologically dilated and the diameter is greater than 6 mm. B-ultrasound examination shows that the internal os of the uterus is wide. If it is larger than 19 mm and there is a history of miscarriage, the diagnosis will be confirmed.

Treatment and care

The treatment methods for endometrial relaxation can be summarized as surgical and non-surgical treatments. Surgical treatments are divided into two types: pregnancy surgery and non-pregnancy surgery.

1. Surgery during pregnancy: Surgery is mainly performed in the second trimester of pregnancy (16-22 weeks). Ultrasound examination is routinely performed before the operation to rule out stillbirth and other possibilities. Salbutamol sulfate is taken before and after the operation to reduce the sensitivity of the uterus. Surgical methods include cervical suture and cerclage, the latter of which is divided into buried and pocket suture. Regular follow-up is performed after the operation. If suture slippage is found, a second suture can be performed. Hospitalize half a month before the due date or in advance and remove the sutures when delivery is imminent.

2. Surgery during non-pregnancy period: It is usually performed 3-5 days after the menstruation ends. The surgical methods include internal cervical os constriction and internal cervical os circular tightening. Currently, surgery during pregnancy is often used clinically. Non-surgical treatment mainly uses vaginal pessaries to prevent miscarriage or premature birth through mechanical blocking.