When a gynecologist tells a pregnant woman that she has a prolapse of the fetal bladder, this indicates a direct threat of miscarriage, especially in the absence of appropriate treatment.
The period of expectation of the baby is not easy for the female body, because all its forces are concentrated on preserving and carrying out a full-fledged healthy child.
A large load falls on the cervix: fetal retention inside the mother’s body depends on the density of its compression.
What is prolapse of the fetal bladder?
By this term, doctors mean isthmic-cervical insufficiency (ICI). In this condition, weakness of the cervix and isthmus of the uterus is observed, as a result of which a miscarriage can occur, starting from the second trimester of pregnancy.
The cervical canal is not able to be in good shape and be tightly compressed, so its walls relax, and the fetal bladder under the weight of the child sags in the cervix, which leads to its infection and opening. Such actions lead to rupture of the membranes and termination of pregnancy.
Causes
When prolapse of the fetal bladder, the isthmus and cervix do not cope with their main task – to tightly close the path to the uterine cavity and reliably hold the growing baby in the mother’s womb.
There are certain reasons for lowering the fetal bladder, observed with isthmic-cervical insufficiency :
- congenital malformations of the female reproductive system;
- hormonal imbalance in the body of a pregnant woman (insufficient production of progesterone and excessive production of male sex hormones);
- multiple pregnancy;
- cicatricial changes in the uterus resulting from previous surgical interventions, as well as due to traumatic injuries.
Pathology can be identified only in the second trimester of pregnancy, when the baby begins to grow intensely, which leads to increased pressure on the cervix, which cannot reliably hold the fetus in the woman’s body.
Symptoms
The danger of isthmic-cervical insufficiency lies in the fact that it does not have precursors that would indicate the likelihood of developing pathology. Therefore, prolapse of the fetal bladder always occurs unexpectedly. If you are careful about your health, you can notice the initial symptoms of this condition and take measures to preserve the pregnancy.
The expectant mother should urgently seek medical help if she has found the following symptoms:
- amniotic fluid flow;
- atypical urination;
- discomfort in the vagina.
It is impossible to predict in advance that a woman will have bladder prolapse, since there are no subjective sensations until conception and in the first three months of pregnancy.
Diagnosis of isthmic-cervical insufficiency is performed with instrumental gynecological examination using mirrors, as well as with palpation of the vagina. At the initial stages, softening and shortening of the neck occurs, later a slight opening of the neck, about 2 cm, and prolapse of the fetal bladder are detected.
Treatment
The choice of treatment for ICI depends on several factors:
- the period of detection of insufficiency of the cervix and isthmus of the uterus;
- whether there is a history of self-abortion due to shortening and expansion of the cervical canal;
- reasons leading to the CPI.
When a woman has already experienced miscarriage for this reason, it is possible to have neck plastics at the stage of pregnancy planning. The effectiveness of the performed medical manipulations can be assessed no earlier than six months later – it is during this period that doctors recommend that they refrain from subsequent conception.
Conservative treatment is prescribed to the patient with early detection of prolapse of the fetal bladder caused by hormonal imbalance, in particular, an overabundance of male hormones. Medicines make it possible to correct endocrine disorders. If after 10-14 days the neck has stabilized, and there are no prerequisites for its further expansion, then therapy is limited only to medicines.
With ICI, they resort to installing a pessary, which tightly closes the cervix and does not allow it to open. The product is a strong wide ring, which is fixed at the entrance to the uterus. The pessary helps redistribute the load exerted on the cervical canal by the growing fetus, supports the muscles of the perineum and prevents the prolapse of the fetal bladder. If the prolapse has already occurred, then you can not put the ring.
In comparison with the surgical method of treatment, this technique has several advantages:
- ease of insertion and extraction;
- installation can be done both in a hospital setting and on an outpatient basis;
- no need to do anesthesia;
- pessary fixation after 25 weeks of pregnancy is allowed.
When taking medications does not help stop the opening of the cervix, or there is an ICI caused by a previous traumatic factor, surgical intervention is required to maintain pregnancy.
Suture on the neck is carried out between 13 and 26 weeks of pregnancy, and they are removed no earlier than 38 weeks. After this, the uterus opens on its own, shortens, opening the birth canal.
Suturing the cervix is the best option to prevent the threat of miscarriage during prolapse of the fetal bladder. This method is less traumatic, simple to implement, and also does not harm the health of the mother and child.
The operation is carried out only in a hospital. Before the procedure, a full examination of the pregnant woman is performed, sanitation of the external genital organs and vagina is carried out using antiseptic solutions. After the procedure, the expectant mother will have to visit the doctor weekly for follow-up examinations.
If the fetal bladder descends into the cervical canal, additional correction of the sutures is required. After reconstruction, a woman should follow the doctor’s prescription, observe bed rest and take prescribed medications.
Flat fetal bladder
This pathology is also called oligohydramnios.
Flat fetal bladder is observed due to some complications of pregnancy, which is caused by various reasons:
- infection of the mother or baby;
- deficiency of nutrients, as well as water;
- vitamin deficiency.
In the natural course of pregnancy, there is a free space between the baby’s head and the fetal membranes, filled with amniotic fluid. If there is a dense tension on the upper body of the baby, then the doctors establish the diagnosis of “flat fetal bladder”.
Puncture
Amniotomy is performed in situations where cervical dilatation is observed, and an independent discharge of amniotic waters has not occurred. The task of the procedure is to stimulate the onset of natural labor, if a woman feels the onset of labor, but they do not lead to a shortening and expansion of the cervical canal.
There are four varieties of amniotomy:
- premature – before the onset of labor;
- early – from the moment of the start of contractions until the neck is opened by 3 fingers;
- timely – performed in the interval at 7-10 cm of disclosure;
- belated – produced after full disclosure, when the bubble did not burst on its own.
Peeling
This procedure is performed when a woman is postponing pregnancy. Exfoliation allows you to stimulate the onset of labor. The gynecologist manually produces a separation of the bladder from the cervix, which contributes to the synthesis of prostaglandins, which act relaxing on the cervical canal.
When performing the procedure, the doctor must carefully exercise his actions so as not to damage the membranes.
Prevention of pathologies of the fetal bladder
It is impossible to completely prevent the prolapse of the fetal bladder, however, it is possible to reduce the risk of developing ischemic-cervical insufficiency by following simple recommendations:
- to make timely treatment of hormonal dysfunctions;
- during pregnancy, exclude weight lifting and difficult physical work.
When diagnosed with ICI, timely detection of the problem will prevent the prolapse and rupture of the fetal bladder, and the use of modern methods of treatment increases the chances of a successful pregnancy outcome by 2-3 times.
