25.08.2023
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4 min. reading Ring for pregnant women or obstetric pessary: indications for use
A special device made of silicone or plastic, the purpose of which is to prevent miscarriage and premature birth, is called an obstetric pessary (pregnant ring). The ego's main function is to support the internal organs of the pelvis.
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A ring for pregnant women can be recommended if the mother-to-be is at risk of not carrying the baby for various reasons. This is a kind of alternative to sutures that are applied to the cervix to preserve pregnancy.
This method has been used since ancient times. The first mentions of obstetric pessaries date back to the Middle Ages, but scientists claim that they were also used in Ancient Rome. Then they were made of wool, wood and even precious metals. And the first ring for pregnant women, which had a modern shape and appearance, was made of rubber in the 19th century. Then plastic pessaries appeared, and later, in the middle of the 20th century, they began to be made of silicone.
Doctors use an obstetric pessary in the following cases:
- shortening of the cervix;
- isthmic-cervical insufficiency;
- heavy physical exertion during pregnancy;
- increased internal pressure in the uterus;
- inability of the cervix to function normally;
- small intervals between pregnancies in women;
- with a painful feeling of pressure in the lower abdomen when a woman stands or when walking.
Oleksandra Zagorodnia
Associate Professor of the Department of Obstetrics and Gynecology #1, Bogomolets National Medical University, Doctor of Medical Sciences
One of the indications for the use of a pessary is isthmic-cervical insufficiency, which was first detected after the 22nd week of pregnancy. Isthmic-cervical insufficiency — painless shortening and opening of the cervix in premature pregnancy. When establishing this diagnosis before the 22nd week, preference is given to a circular suture on the cervix, after this period the suture carries more risks than advantages. Occasionally, situations arise when, after applying a circular suture to the cervix, its shortening progresses, in such cases, they also resort to the installation of an obstetric pessary.
How does an obstetric pessary work?
The main task of the obstetric pessary is to reduce the load on the cervix by reducing the pressure of the presenting part of the fetus. The mechanism by which the necessary result is achieved is as follows: the cervix moves in the direction of the sacrum, closes, and the pressure inside the uterus is redistributed. Also, the pessary does not allow the mucous plug to exit, which reduces the risk of infection of the amniotic membranes and the fetus itself.
Source: Burda Media
Oleksandra Zagorodnia
Associate Professor of the Department of Obstetrics and Gynecology #1, Bogomolets National Medical University, Doctor of Medical Sciences
The principle of operation of the pessary consists in fixing the cervix in a certain position, which prevents its further shortening and opening. The use of an obstetric pessary is not associated with tissue puncture, like applying a suture to the cervix. Neutral materials from which pessaries are made do not have a negative effect on the tissues of the vagina and cervix. As a rule, the obstetric pessary is combined with progesterone preparations, which significantly increases the effectiveness of the treatment. Obstetrical pessary does not cause discomfort and has no side effects, and the procedure for its installation is simple and painless.
When an obstetric pessary is applied
An obstetric pessary is installed starting from the second trimester of pregnancy after 16 obstetric weeks and up to the 34th week of pregnancy. Installing the ring is considered a simple procedure that can be performed by an obstetrician-gynecologist right in the office of a woman's consultation. Unlike suturing, anesthesia is not required for this procedure. The decision to install a pessary, as well as its shape and size, as well as the period for which it is installed, is determined exclusively by the doctor.
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It's important. There are three types of obstetric pessaries:
- Dome-shaped. This type of pessary is used most often. Its shape resembles a bowl without a bottom. Such a form is necessary for reliable fixation of the pessary on the cervix. A feature of this type is the presence of a special perforation on the walls of the cup, which facilitates the outflow of vaginal secretions.
- Ring-shaped. There are two types of pessaries of this type: for women who have given birth and for those who will do it for the first time. Due to the fact that the ring is made of medical silicone, it is absolutely non-toxic and does not cause allergic reactions. On the ring there are four notches located one opposite the other. Thanks to them, the ring is easily installed and fixed, and it is also easy to remove afterwards.
- Unloading. The shape of such a pessary resembles a trapezium with holes and rounded corners. It is very ergonomic and easily fixed. But when using such obstetric pessaries there is a risk of their displacement. In this case, it is simply necessary to consult a doctor immediately.
When the obstetric pessary is removed
On average, an obstetric pessary is installed from 15 to 22 weeks. For the entire period of using the pessary, you will have to give up sexual relations, and wash very carefully, without touching or displacing the ego. Also, during the entire period, every 2-3 weeks, a woman needs to take swabs from the vagina and at least once a month conduct ultrasound of the cervix. It is necessary to be prepared for the fact that once every 14 days the pessary together with the vagina (without extraction) must be treated with antiseptics. Only a doctor can do this.
The pessary is removed, as a rule, after the 37th week, this is the period of full-term pregnancy, when the child has already matured and is ready to meet the mother.
Oleksandra Zagorodnia
Associate Professor of the Department of Obstetrics and Gynecology #1, Bogomolets National Medical University, Doctor of Medical Sciences
It is necessary to remove the pessary as scheduled at 37 weeks of pregnancy, but this does not provoke the beginning of labor and does not mean that you will go to the delivery room the next day. Until this period is reached, pessary removal is carried out exclusively in the case of regular labor, which could not be stopped by medical means, in case of rupture of the amniotic membrane or uterine bleeding.
The attitude of specialists to this method of pregnancy preservation is ambiguous. Here is the opinion of obstetrician-gynecologist Elena Petrovna Berezovskaya, who lives and works in Canada.
Elena Berezovskaya
Doctor-researcher, obstetrician-gynecologist, author of the book "Tabletop guide for pregnant women", founder and head of the International Academy of Healthy Life in Toronto, Canada doctorberezovska.com, facebook.com/dr.olena.berezovska, instagram.com @dr_olena_berezovska
Pessaries are practically not used abroad, because their ineffectiveness has been proven. In addition, this is a foreign body that is constantly in the vagina and irritates the cervix, which is not desirable for ITC. Most often, only our post-Soviet doctors choose a pessary, because skills and conditions are necessary for applying a suture. And he will hand the woman a pessary and assure her that exactly this will help her, simple as that. Moreover, many doctors receive remuneration for selling pessaries, so in the former USSR countries pessaries are now recommended to almost all pregnant women, even with normal cervical length indicators. Abroad, the choice is only in the suture technique, but usually the doctor knows only one type of such technique.
The opinion of the editors may not coincide with the opinion of the author of the article.
Use of photo: P.4, Article 21 of the ZU "On copyright and related rights - "Reproduction for the purpose of covering current events by means of photography or cinematography, public communication or communication of works seen or heard during such events, to the extent justified by the informational purpose."
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