The funny word "pessary" is currently called a device for vaginal use used in medicine: in urology, gynecology, obstetrics.

During pregnancy, a pessary is necessary in a situation where the expectant mother is not at all laughing: if the condition of her cervix makes it doubt that the current pregnancy will be full-term.

During pregnancy, a supporting pessary is used as a conservation measure, instead of, and, sometimes, in addition to this:

• due to incompetence of the cervix;
• to prevent premature opening of the cervix, if the patient has a history of "recurrent miscarriage";
• in later periods during gestation (according to indications).

The task of the pessary:

• keep the cervix closed and prevent it from opening;
• remove part of the load from the severity of the fetus from the cervix, redistributing it to the walls of the uterus.

An obstetric pessary externally is a flat ring-shaped, oval or volumetric cup-shaped object of a primitive design, made of hypoallergenic material.

The peculiarities of its structure exclude trauma to the tissues of the genital organs and the paths of a woman, both during its wearing and during manipulations with it in the vagina.

Although various modifications of pessaries can be found on sale: cubic, mushroom-shaped, etc., they serve several other purposes and have the prefix "gynecological", however, on an individual basis, they are also used at the risk of miscarriage.

The need to install a pessary is determined by the obstetrician-gynecologist leading the pregnancy, based on an examination of the cervix and determining its maturity, as well as on the results of ultrasound of the cervix.

When choosing the shape of the pessary, it is also better to trust the doctor, who, depending on the anatomical features of the structure of the pelvic organs of the patient, will recommend the best option.

An obstetric pessary is indicated for use already from the 13th - 16th week of pregnancy, but, in practice, it is most often installed from the 20th - 22nd week, preferring to use suturing at an earlier date for isthmic-cervical insufficiency.

In this case, a combined technique is often used: sutures + pessary, then the main function of the pessary is to unload the cervix in order to reduce the risk of opening the cervix under the pressure of the weight of the fetus.

The effectiveness of using a pessary according to various studies is from 87 to 92% of saved pregnancies among women who have had this obstetric device installed.

It is forbidden to use a pessary, as well as a surgical method of treatment with a threat of late miscarriage or:

• if there is a possibility of intrauterine death of the fetus;
• if incurable fetal malformations are diagnosed;
• if there are contraindications to carrying the current pregnancy;
• against the background of infectious and inflammatory diseases of the pelvic organs;
• on the background ;
• when expressed: the bottom of the fetal bladder protrudes into the vagina.

Specially, without other indications, the process of installing a pessary does not require hospitalization and can be performed by an obstetrician-gynecologist on an outpatient basis. This procedure is very simple and short.

However, during pregnancy, self-installation of a pessary is highly not recommended, since it is always preceded by special preparation of the vagina, and the procedure requires careful observance of sanitary conditions, which is difficult to achieve at home.

In addition, manipulations involving an incompetent cervix require special care and professional experience.

The mechanism for installing a pessary during pregnancy

On the eve of the procedure for installing a pessary, a woman must undergo a gynecological examination, the purpose of which is to take a sample for the degree of purity of the patient's vaginal microflora, as well as an external assessment of the condition of her genitals and tracts.

In addition, during the examination of the patient, the doctor determines the optimal shape and size of the obstetric pessary.

At the pessary appointment, the woman will be asked to come with an empty bladder. The patient is offered to sit on a gynecological chair and, if possible, relax the muscles of the vagina. After that, an antiseptic treatment of the female genital organs and tracts is performed, and the pessary is disinfected and injected according to the instructions.

The process of introducing a pessary depends on the shape and material from which it is made:

• Plastic flat pessary, type "Juno".

It is introduced into the perineum, placing it with the narrow side forward, turning the ribs parallel to the pharynx of the vagina.

It is advanced along the genital tract, unfolded and set in such a way that the cervix is ​​located in the central ring, the wide part rests on the back wall of the vagina, and the narrowed part rests on the pubic part. Thus, the pessary, as it were, props up the uterus, while simultaneously releasing the cervix from the pressure of the presenting part of the fetus.

• Cup-shaped silicone pessary type "Dr. Arabin.

Before introduction into the perineum, the sides of the wider lower ring are closed. The pessary is straightened under the cervix, placing it in the upper ring (smaller diameter), while the bottom of the pessary (larger diameter ring) is turned towards the sacrum, closing the uterus.

In order to facilitate the promotion of the obstetric pessary through the genital tract, its edges are lubricated with glycerin or vaseline (in some cases, clotrimazole) ointment.

Does it hurt to put in a pessary?

The sensations of a woman during the procedure depend on her sensitivity, as well as on the professionalism of the doctor performing the manipulations. Basically, future mothers share, rather, about unpleasant, but quite tolerable than painful sensations during the introduction and installation of a pessary. There are a lot of those for whom the procedure turned out to be completely painless.

Almost all women who have been fitted with a pessary note immediate relief from discomfort from increased uterine tone.

With the correct size of the pessary and its correct installation, discomfort when wearing it should not be felt. The opposite situation indicates that the pessary has been displaced, or the size has been chosen incorrectly.

How to choose a pessary

The type of obstetric pessary corresponds to the size parameters of the upper part of the expectant mother's vagina (placement of the pessary) and the transverse diameter of the cervix, as well as the number of births in the woman's history.

Some manufacturers, when creating a standard line, also take into account the fertility of pregnancy and changes in the condition of the uterus after surgical procedures.

The most affordable and common flat plastic pessary "Juno" is produced in three sizes (see Table 1):

Table of sizes of obstetric pessaries

Cup-shaped pessaries Dr. Arabin have 10 sizes, and Portex rings - 16 options.

Types of pessaries by manufacturers

Specialty stores selling medical devices offer the following types of pessaries:

The selection of the type of pessary is carried out by the doctor, depending on the structural features of the genital organs and the paths of the patient, as well as their own experience with the device.

What about after installation?

The installation of a gynecological pessary significantly improves the quality of life of a pregnant woman with a threatened miscarriage and allows you to remove some restrictions on physical activity.

However, the pessary itself does not solve the problem of the risk of miscarriage, and therefore its wearing is accompanied by general recommendations for patients with a threat of termination of pregnancy, including:

• a ban on sexual contact;
• a ban on bathing in the bathroom, swimming in open water, swimming pools, etc.
• prohibition of heavy physical activity, weight lifting, etc.

When is the obstetric pessary removed?

If the period of application of the pessary proceeds without complications, then its removal is carried out at the 37th week of pregnancy, waiting for the development of labor, as a rule, during the next week.

However, removal of the pessary may become necessary early if:

• the patient was diagnosed with chorioamnionitis;
• premature delivery of a woman is necessary for medical reasons;
• labor activity has begun;
• leakage/outflow of amniotic fluid was detected.

After removing the pessary, the genital tract is sanitized.

Possible complications while wearing

Often, future mothers note the appearance of unusually abundant vaginal discharge after the installation of an obstetric support device. This may be a normal reaction of the body to the placed foreign object, an attempt to get rid of it. However, it is worth excluding, first of all, (for example, with the help of) and other complications of pregnancy.

Cervical insufficiency is often infectious in nature, a foreign body in the vagina (pessary) can provoke an exacerbation of the disease, and also cause a manifestation. This is evidenced by characteristic color and smell.

To prevent such troubles, once every 2 weeks, a patient with a pessary is shown an outpatient intravaginal lavage with antiseptic agents without removing the obstetric device, application, etc.

In order to timely detect during pregnancy while wearing a pessary, a woman should regularly, at the request of the doctor, take a test for the purity of the vaginal microflora (about once every 14 days).

In some cases, the treatment of colpitis requires the temporary removal of the pessary. In this case, the sanitation of the vagina is carried out in stationary conditions, since the patient, after removing the obstetric device, falls into the risk group for the development of premature labor.

If in the process of wearing a pessary a woman feels discomfort, constant or only in a certain position, when changing position, etc., it is quite possible that this indicates a displacement of the device in the genital tract. The same may be indicated by the appearance of abundant whitish discharge.

The displacement of the pessary will be easily detected by the doctor during a gynecological examination and will also easily put it in place.

In general, the method of prolonging pregnancy with the use of a pessary can be considered a panacea, especially in late pregnancy, when the use of surgical intervention for suturing is not possible.

Instructions for use

Single-use obstetric pessary type-1 instructions for use

Composition

harmless, ultrapure biologically inert plastic (825 grade polystyrene)

The product is sterile. Sterilization gas - ethylene oxide.

Description

The obstetric unloading pessary Juno (Simurg, Belarus) is intended for the prevention of premature birth in pregnant women with isthmic-cervical insufficiency (ICI) and for the prevention of the development of this pathology.

FIELD OF APPLICATION – obstetrics. Obstetric pessaries are used in specialized medical institutions by a specialist doctor.

The shape of the product corresponds to the anatomical structure of the female genital organs and provides a secure fixation of the product inside the vagina. The pessary resembles a trapezoid with concave sides and rounded corners. The narrow side of the trapezium of the product rests against the pubic joint, the wide part of the trapezoid "covers" the rectum, without creating problems during defecation. There are several functional openings: a large central opening for the cervix and side openings for unhindered outflow of vaginal secretions.

The selection of the size of the obstetric pessary is carried out by the doctor individually for each woman - they must correspond to the anatomical features of the structure of the genital organs.

Simurg produces products in three sizes:

Pessary obstetric unloading type 1 (smallest)

Pessary obstetric unloading type 2 (medium)

Pessary obstetric unloading type 3 (large)

WARNINGS

When using an obstetric pessary, it is possible to increase vaginal secretion.

The obstetric pessary is not intended for the correction of genital prolapse.

It is unacceptable to use an obstetric pessary if the integrity of the final package is broken or if the expiration date indicated on the package is exceeded.

When using an obstetric pessary that does not correspond to the anatomical features of the patient, the development of a pain syndrome is possible. In this case, the removal of the pessary and replacement with a correctly sized obstetric pessary is required.

MECHANISM OF ACTION

The mechanism of action of the obstetric unloading pessary is based on a decrease in the load on the cervix due to a decrease in the pressure of the fetal egg.

Isthmic-cervical insufficiency: the external and internal os gapes, the fetal membranes prolapse into the cervical canal.

An obstetric pessary was installed: the cervix is ​​in the central opening of the pessary, the large base is located in the posterior fornix of the vagina, and the small one is in the anterior fornix. The lateral surface of the pessary is in contact with the walls of the vagina, which cover and hold it. The pressure on the cervix is ​​reduced.

When using an obstetric unloading pessary, regular monitoring by an obstetrician-gynecologist is necessary, it is advisable to observe sexual rest, it is possible to increase discharge from the genital tract (it is necessary to exclude inflammation).

Obstetric unloading pessary of single use "Yunona" Type-1 - in the form of a trapezoid with smoothed half-ring corners.

The size of the upper third of the vagina (mm) - 55-65

Cervical diameter (mm) - 25-30

The presence of childbirth in history - less than 2

The color of the marker on the package is green

Selling Features

Without a license

Indications

- functional and organic isthmic-cervical insufficiency;

- prevention of isthmic-cervical insufficiency in pregnant women;

– prevention of suture failure during surgical correction of CI.

Contraindications

Absolute:

- this method should not be used in clinical situations where prolongation of pregnancy is impractical;

- the anatomical features of the patient, preventing the correct location of the pessary.

Relative:

- inflammatory diseases of the vagina, cervix, external genitalia (preliminary sanitation is required followed by bacteriological control).

Mode of application

Dosage

The optimal time for the installation of an obstetric pessary is 13-25 weeks of pregnancy.

Attention! Inserting and removing the pessary on your own is not recommended. This can provoke an abortion.

The introduction and removal of an obstetric unloading pessary is a medical manipulation.

The procedure can be performed in stationary conditions.

The insertion and removal of the pessary does not require anesthesia.

Conditions for the introduction of a pessary:

- no contraindications for use;

- normal uterine tone;

- Consent of the patient.

INTRODUCTION

The introduction of the pessary is carried out in compliance with the generally accepted rules of asepsis.

After examining a woman with an empty bladder, position the obstetric pessary so that the wide base is located at the entrance to the vagina. Insert the lower half ring of the wide base into the vagina.

Then, pressing on the back wall of the vagina, enter the upper half ring of the wide base. After that, fully insert the obstetric pessary.

Turn the obstetric pessary so that the wide base is located in the posterior fornix of the vagina, and the cervix is ​​in the central opening of the obstetric pessary

REMOVAL OF THE OBSPHERIC PESSARY

In a planned manner, the obstetric pessary is removed upon reaching 37-38 weeks of pregnancy in a hospital.

Extraction technique is reverse to insertion.

After removing the obstetric pessary, it is advisable to sanitize the genital tract, depending on the nature of the vaginal microflora.

Few of us think how lucky we are: we no longer live in those days when the best option for a pessary was half a pomegranate or, in a more advanced era, a sponge soaked in oil and wax. Now, fortunately, pomegranates are used exclusively for food, and oil and wax have been replaced from the scene by medical silicone, from which modern gynecological pessaries are made in all their diversity. Let's get to know them better.

Scope of application of gynecological pessaries

A pessary is a medical grade silicone product that is used to solve problems. with pelvic floor dysfunction: omission pelvic organs and urinary incontinence.

Gynecological pessaries do not allow the uterus to fall and fall out, providing it with support. Urogynecological pessaries with a thickening on the arc of the ring prevent involuntary urination when coughing, sneezing, laughing, etc., since the thickening on the pessary presses on the urethral neck.

The mechanism of action of all these pessaries is similar: they support and fix the pelvic organs in the correct anatomical position. Due to this, the discomfort experienced by the patient disappears. Thus, pessaries can perform 3 functions:

1. therapeutic, i.e. prevent deterioration in the position of the pelvic organs in the early stages,
2. supportive, i.e. to ensure the normal course of the patient's life until the problem is solved, for example, surgically or conservatively with the help.
3. preventive - in the modern world, gynecologists recommend that women wear pessaries after childbirth to prevent dysfunction of the pelvic floor muscles.

Gynecology and pessaries: why complicate things?

Of course, at first glance it may seem that doctors recommend the installation of a pessary in 1 case out of 10, but in general, women after pregnancy do fine without them. But is it true?

Indeed, pronounced prolapse of the uterus during pregnancy rarely occurs (and this is good!). But 14-38% of women after childbirth begin to complain of urinary incontinence, and up to 35% of women suffer from prolapse of the walls of the vagina and (or) uterus. Moreover, this problem can occur after natural childbirth, and after a caesarean section.

The fact is that from the 20th week of pregnancy, the strength of the pelvic floor muscles drops by 22-35%. This condition lasts up to 6 weeks after childbirth, but then muscle strength should be restored, which, unfortunately, does not happen in all women. If, due to childbirth, there is a rupture of the muscles of the pelvic diaphragm, a strong stretching of the ligaments that support the uterus, damage to the pelvic nerve, then the pelvic floor can no longer hold the organs in the correct position.

But you can not use a pessary? Alas, if you abandon the pessary, then pelvic floor dysfunction will slowly progress. A year after childbirth, the frequency of urinary incontinence and prolapse will increase by 7-10%, after 10 years - already by 25%, and by the age of 45-50 it will reach 50-77%. The frequency of sexual dysfunction with such problems increases from 20% after the birth of a child and can reach 50-80% during later life.

So the timely use of pessaries will help prevent all these unpleasant consequences and eventually return to your usual way of life. However, for this, it is important to choose the right pessary - this must be done with the help of a doctor, preferably after childbirth, when lochia ceases to stand out. How are pessaries chosen?

Cube Dr. Arabin - a pessary is used for prolapse of the genital organs of 3-4 degrees with concomitant urinary incontinence

Choosing a pessary: ​​types, forms, use

When choosing a urogynecological or gynecological pessary, it is important not so much to carefully study the brands and manufacturers, but to take into account the anatomical features, the diagnosis made and the severity of the symptoms. Depending on the severity of prolapse and urinary incontinence, the doctor can choose one of eight types of pessaries.

• Used for severe urinary incontinence (especially during exercise) with little or no symptoms of pelvic prolapse.
• It looks like a ring with an oval thickening and a steel spring inside to maintain elasticity. The thickening maintains a bridge between the bladder and urethra, thereby preventing urinary incontinence. The size of the pessary is selected so that, having eliminated incontinence, it does not interfere with normal urination and does not cause discomfort. After 1-2 months of wearing, it is recommended to choose a larger size due to the relaxation of the vaginal tissue.

1. Pessary

• Used to correct grade 1 prolapse without concomitant urinary incontinence. The product is equipped with a metal spring that retains its shape. After selecting and installing a pessary in the gynecologist's office, the patient can do this manipulation herself, at home.

1. Pessary

• Unlike the previous product, the thick ring keeps its shape due to the thickness of the walls. It is intended for the correction of prolapse of 2-3 degrees, provided that there is no urinary incontinence. More often used by patients of age, necessarily - in the absence of damage to the pelvic floor.

• Used to correct grade 2-3 prolapse with mild or no urinary incontinence. It looks like a saucer with perforation and thickening along the wide edge. The absence of damage to the pelvic floor is a prerequisite for its use.
• When choosing a size, the gynecologist will choose the smallest size that is held in the correct position and does not cause discomfort during movement.

• Chosen to correct grade 3-4 prolapse with little or no symptoms of urinary incontinence. This is a cone with a thickening at the top and a wide perforated base. The head rod is needed so that the base does not slip and is held in the correct position. If the size is chosen correctly, then the prolapsed organs will be returned to their original anatomical position, and the product itself will not cause discomfort.
• After inserting the mushroom pessary, the patient should feel the position of the rod in order to return the pessary to its place if it is dislodged after a bowel movement. It is recommended to remove the product daily, before going to bed at night, and install it again in the morning; for this, the gynecologist must instruct during the first installation of the pessary.

• Used to correct grade 2-4 prolapse with mild symptoms of urinary incontinence. It looks like a cup pessary, but without perforation and with an oval thickening on the upper part of the wall. To use this pessary, you need to make sure that there is no damage to the pelvic floor.
• When installing a pessary, the ring is moved up through the vaginal fornix so that the thickening raises the bridge between the bladder and urethra. Checking the correct position and replacing the product is the same as in the case of a urethral pessary. It is recommended to remove the pessary daily to avoid ulcers or infections.

• It is used to correct grade 3-4 prolapse with mild or absent symptoms of urinary incontinence, and is also recommended after surgery to remove the uterus and appendages. The product has the form of a cube with perforations and recesses on each side, and is also equipped with a thread for easy extraction.
• The vacuum effect allows this type of device to be used even if the pelvic floor is not strong enough to hold the ring pessary. The cube helps to relax scars, suitable for wearing before operations to eliminate organ prolapse.
• Choosing the size of the pessary, the doctor focuses on the fact that during installation it does not squeeze the bladder and intestines, but at the same time does not fall out during movement, coughing and straining. After a few days or weeks, the doctor may adjust the selection of the device.
• With isolated prolapse of the uterus, a smaller model should be chosen and placed in the upper third of the vagina; if there is additional prolapse of the bladder and intestines, then a larger pessary is placed in the middle third of the vagina.
• The cube must be taken out in the evening and returned to its place in the morning. To remove the pessary, pull on the thread until the patient feels the pelvic floor muscles resist. Then, with the index and middle fingers, loosen the edges of the pessary and remove it.

When installing gynecological pessaries on your own, do not forget to lubricate it with a lubricant so as not to damage the mucous membrane during insertion. Important! Only water-based lubricants should be used.

When choosing a thin or thick ring, pay attention to the inner diameter, because. with the same outer diameter (basic size), the inner diameter of the thick ring is 10 mm smaller.

If you have been diagnosed with pelvic organ prolapse, start using the Kegel machine, because. the pessary performs only a supporting function, and the simulator strengthens the muscles. Subsequently, you can do without a pessary.

Even at the time of Hippocrates, healers used various devices to reduce the tone of the pelvic muscles and prolapse of the genitals. They used metal rings, round objects, lumps of wool, linen, twisted fabric. A modern obstetric pessary, which is installed when the uterus is prolapsed or prolapsed, is made of plastic or silicone and gives it the most anatomical shape.

Features and types of structures

In obstetric and gynecological practice, two main types of pessaries are used, which have a different design and indications for use:

• obstetric, at;
• urogynecological, which is used for pelvic organ prolapse.

Types of Pregnancy Devices

Obstetric rings are used during the period of bearing a child. They have different designs depending on the manufacturer.

Juno's ring looks like several semi-rings of different sizes connected together. It has a large central hole designed to hold the neck, and side holes. They provide structural rigidity and outflow of vaginal secretions. The Juno gynecological pessary is made of plastic, produced in three sizes. Each one is different in color.

The perforated obstetric pessary is produced by Simurg and Arabin. It is a cup-shaped silicone device with small holes along the contour for the outflow of vaginal contents. They self-retain in the vagina and provide support for the fetus and cervix. Models differ in the following parameters:

• external diameter;
• bowl height.

The greater the height of the curvature, the more pronounced isthmic-cervical insufficiency in a pregnant woman.

There is a ring obstetric pessary, which is made of silicone. The composition includes silver ions, and a film of miramistin or chlorhexidine is applied to the surface, which prevents the development of infection. It is produced in two sizes - for giving birth and nulliparous women.

For gynecological patients

The choice of devices for women with pelvic organ prolapse is much wider. The type is selected depending on the degree of omission. The best well-retaining gynecological pessaries are made in Germany by Arabin. It is a family owned company that has been treating genital prolapse for over 100 years.

Juno obstetric ring (left) and Arabin urethral pessary used for urinary incontinence (right)

Devices differ in shape and size, each has its own purpose:

1. Urethral is used in patients with severe urinary incontinence but minimal signs of pelvic organ prolapse. Fixture diameter 45-100 mm.
2. Ring and cup - with prolapse of 1-2 degrees and slight signs of incontinence. Ring diameter 50-100 mm.
3. Mushroom - if there is prolapse of 3-4 degrees, urinary incontinence is absent or pronounced. Size from 50 to 90 mm.
4. Gynecological cubic and urethral cups are used to correct grade 3-4 prolapse with significant symptoms of urinary incontinence, after.
5. Hodge pessary - used in patients with congenital anomalies of the genital organs, violation of the topography as a result of trauma or surgery. Ring diameter 55-95 mm.
6. Tandem - corrects the condition after removal of the uterus and appendages, if the cubic pessary does not cope with the task. The size is determined by the length of the edge of one element, it can be from 25 to 45 mm.

Not all rings are designed for permanent use. Mushroom must be removed at night. Cubic and tandem are inserted for a short time, no more than 8-12 hours.

Hodge pessary (left) and mushroom pessary used in patients with grade 3-4 prolapse

Dr. Arabin's gynecological pessaries are available in all types. They are made from high quality silicone. It does not cause inflammation and an allergic reaction in the tissues of the vagina, takes shape well and can be installed and removed by the patient herself.

Indications for use

in obstetrics

Obstetric rings are used for diagnosed isthmic-cervical insufficiency. This is a condition in which the cervix shortens prematurely. Gradually, the internal pharynx begins to open slightly, the fetal bladder prolapses into the cervical canal. It can become infected with bacteria that live on the vaginal mucosa, which leads to premature rupture of amniotic fluid and premature birth.

The diagnosis of CI is most often made between the 15th and 20th weeks of pregnancy. You can use a gynecological pessary during pregnancy up to 34-36 weeks. After this period, the child is considered full-term, the pregnancy does not need to be prolonged.

Indications for installation are organic or functional ICI, including after surgical treatment. The device can be used as a prevention of the development of CI in women at risk. These include:

• pregnant women with habitual miscarriage who had premature births in the late term;
• women with genital infantilism;
• primigravida at a young or late age;
• pregnancy after a long period of infertility;
• patients with a progressive threat of interruption, engaged in heavy physical labor;
• pregnant women with a deformed cervix;
• multiple pregnancy.

In gynecology

In gynecology, rings and cups are installed in women during menopause in the presence of prolapse (prolapse) of the pelvic floor. This pathology is a consequence of estrogen deficiency (what is the cause and danger of a lack of a hormone, we wrote earlier about this). Receptors for them are found in muscle tissue. The lack of estrogen leads to a decrease in the tone of the muscles and ligamentous apparatus of the uterus. Gradually, it shifts, signs of urinary incontinence appear.

The gynecological ring is installed:

• when only signs appear;
• a combination of incontinence and prolapse of varying severity;
• if it is impossible to perform an operation to strengthen the pelvic floor due to the patient's condition;
• in the postoperative period, to support the organs and prevent them from moving down.

Sometimes the device is prescribed even in the preoperative period. This allows us to assume and evaluate the position of the organs after plastic surgery on the pelvic floor.

Risks of not receiving treatment

For a pregnant woman, a pessary is the key to carrying a child to a state of maturity or the period in which resuscitation and nursing in the neonatology department will help minimize the development of complications.

At an older age, when diagnosing pelvic organ prolapse, refusing surgery and installing a ring is fraught with the following consequences:

1. The prolapse of the uterus leads to the gaping of the genital slit, the penetration of pathogens of infectious diseases and the development, and with ascending infection - endometritis, oophoritis.
2. Constant leakage of urine when straining during exercise, lifting weights, laughing and coughing.
3. Violation of urination and the development of cystitis, pyelonephritis.
4. Due to the constant irritation of the skin of the genital organs with leaking urine, pyoderma, eczema develops.
5. Violation of blood circulation in the node leads to necrosis of the pelvic organs.

A serious consequence is prolapse of the uterus.

In what cases is it contraindicated

A gynecological silicone or plastic pessary is not always suitable as a treatment method for CCI. It is not installed in cases where the bearing of a child is contraindicated due to the serious condition of the mother. Other contraindications are:

• frequent recurrent bloody discharge from the genital tract in the 2nd-3rd trimester;
• a pronounced degree of ICI, when the fetal bladder already sags into the cervix.

A gynecological pessary cannot be installed in the presence of an inflammatory process in the vagina. Preliminary it is necessary to carry out treatment and a control study or sowing on the flora. Only after confirming the absence of infection can the device be installed.

To facilitate installation in women with atrophic processes in the vagina, the device is lubricated with an ointment with estrogens. The ointment evenly covers the surface of the ring and for some time is a source of estrogen for the mucosa. This reduces the appearance of dryness, improves the wearing of the device.

A contraindication for the use of a cream with estrogen is any bleeding of unknown origin, the presence of a malignant tumor in history.

Installation technique

Before buying a ring or bowl, you must select the appropriate diameter of the device. How to choose a gynecological pessary by size is determined by the attending physician individually. It focuses on ultrasound data, gynecological examination and vaginal measurements. The dimensions of the pessary should be minimal so that it stays in the vagina on its own.

Installation in pregnant women

Before installing a gynecological pessary, an informed consent is taken from a woman, which describes the consequences and possible complications of manipulation. The mechanism of action is associated with the following processes:

• displacement of the uterus deep into and reduce the pressure of the fetal head on the bladder and other pelvic organs;
• redistribution of pressure inside;
• closure of the walls of the cervical canal;
• preservation of the mucous plug in the cervical canal, which reduces the risk of infection of the fetus.

The installation of a pessary is carried out both in a hospital and in a clinic. The process is painless, but it is recommended that a woman drink 30 minutes before the Drotaverine or No-shpu procedure to avoid the appearance of uterine hypertonicity. Some pregnant women characterize the process as unpleasant.

Pessary for multiple pregnancy

Before the procedure itself, it is necessary to empty the bladder. Manipulation takes place in the supine position.

The gynecologist examines the vagina. The pessary is lubricated with glycerin or an antibiotic cream to facilitate insertion. First, a wide base is inserted, pressing it against the posterior commissure of the perineum. Then enter a narrow semicircle. The device is displaced in the vagina so that the neck falls into the widest part. It is corrected and left a little at an angle.

The patient is asked to rise to her feet. If the manipulation is performed correctly, then the pregnant woman will report relief from the symptoms of prolapse. Discomfort after installation should be absent.

Administration in gynecological patients

The introduction of a gynecological pessary occurs depending on its type, but has common similarities. Previously, manufacturers recommend lubricating them with estrogen-containing ointments.

Installed pessaries of various types

The device is immersed in the vagina in accordance with the anatomical features. If this is a Hodge pessary, then it is slightly bent for ease of insertion. It is necessary to control that the urological protrusion is directed to the urethra.

Installation or replacement of the pessary can occur independently. To do this, the patient needs to put one foot on the bed. Insert two fingers into the vagina, clasp the edge of the ring with them and gently pull outward. If necessary, you can tie a thread to the pessary, with which you can then remove the ring.

Lifestyle

After installing a pessary, a pregnant woman needs special supervision by an obstetrician-gynecologist. A pregnant woman is examined vaginally every 2-3 weeks. Once every 3-4 weeks, an ultrasound is prescribed, which can be performed without removing the device. In some cases, the presence of a silicone cup complicates the diagnosis of the length of the cervix, so it is removed for the duration of the study.

During a regular examination, they must be taken in order to notice signs of incipient colpitis in time. Observation of a woman and the doctor's tactics depend on the progression of the disease. If up to 20 weeks, according to the results of ultrasound, the neck is shortened, then the pregnant woman is sent to the hospital. The obstetric ring is removed from her, a purse-string suture is applied to the neck, and then the device is reinstalled.

If an infection is detected, it is necessary to sanitize the vagina for 10-14 days. The ring or bowl is not removed.

Women of late reproductive age also need periodic examinations. If symptoms of inflammation, bacterial flora are detected in the smear, it is recommended to sanitize the vagina.

The doctor teaches you to independently remove the device and install it back. Preliminary processing of the pessary is necessary. It is washed in warm water without using disinfectants. In a hospital environment, sterilization is carried out using hot steam, air and aldehyde-containing substances for disinfection.

Sexual life in patients with prolapse is limited. Pregnant women are prescribed a ring or cup when signs of ICI appear. Sex in this state is prohibited. This can stimulate uterine contractions. The pressure of the pessary on the fetus can provoke an increase in the signs of a threatened miscarriage.

In the late reproductive period, the possibility of having sex depends on the type of device. Only a pessary in the form of a ring has no contraindications. Other types of devices have a large volume, fill a significant part of the vagina, so sex in this position becomes impossible. For some, this is manifested by pain after the insertion of the penis.

Deadlines for deletion

In the absence of symptoms of complications, all pregnant women at week 37 undergo ring removal. You can remove the device throughout the pregnancy, if it becomes necessary to wash it. After hygiene procedures, it can be independently introduced into place. But most doctors are of the opinion that this manipulation is best avoided.

Prematurely remove the unloading ring in the following cases:

• premature rupture of membranes;
• vaginal bleeding;
• severe painful contractions.

If the pessary is incorrectly placed and causes discomfort, its position can be adjusted during the gynecological examination.

For gynecological patients, the cuboid, tandem or mushroom type is removed overnight. This manipulation can be performed at home on your own or seek help from a nurse.

Complications of constant wearing of the device are:

1. The appearance of bedsores on the walls of the vagina, which is the result of prolonged compression of the vaginal ring or cup.
2. Infectious complications with insufficient sanitation of the vagina before installing the gynecological ring.

For many older women, the use of a gynecological ring or cup is the only way to improve the quality of life, get rid of urinary incontinence, especially when surgery is contraindicated for health reasons.

It would seem that the device of the pessary is so simple that you can safely take goods from any manufacturer from the shelf. But do not rush to conclusions! In fact, a lot depends on how accurately the size of the product is calculated, what the material from which it is made, and how serious the scientific basis underlies the production of a pessary. A product of inadequate quality can injure the mucous membrane, and therefore it is best to choose a reliable manufacturer.

1. Arabin pessaries from Dr. Arabin (Germany)

• The first advantage of pessaries is a huge choice of sizes in all product lines. Due to this, discomfort during their use is completely eliminated. You can always choose the most convenient option.
• The second plus is a very wide range of clinical cases in which pessaries from Dr. Arabin, whether it is the threat of preterm labor, miscarriage or pelvic organ prolapse.
• The third plus is the hypoallergenic flexible silicone from which the pessaries are made. While wearing the product, the patient does not feel it, which is very important in cases where pessaries are not installed for a long time.
• Fourth plus - the price justifies the quality

1. Pessaries from Simurg (Belarus)

• The manufacturer produces 14 varieties of pessaries. 12 models are made from medical silicone, manufactured according to German technologies, and 2 products from medical plastic.
• All silicone pessaries have their own size range, which allows you to accurately select the right size for each patient. Elastic and soft products do not cause any pain during the introduction and are not felt throughout the entire course of treatment.
• Plastic pessaries are inserted with little discomfort, but are also worn without any discomfort. The main advantage of plastic pessaries is the price, which is several times less than that of silicone counterparts.

Which pessary to choose?

• In fact, the most important thing for which the patient is selected pessary. Diagnosis and the severity of the problem are two of the most important characteristics when choosing a product.
• To correctly determine the type and size of a pessary, you should consult a doctor who is experienced with pessaries. After all, only during a personal examination, taking into account all the features of the anatomical structure of the pelvic floor organs, the doctor will be able to choose the appropriate type and size of the product.
• All products presented in Russia are accompanied by quality certificates, which makes the purchase of goods from a particular manufacturer affordable for everyone.

Installing and maintaining an obstetric pessary

An obstetric pessary is selected and installed by an obstetrician-gynecologist. He can do this both at the patient's home and in the hospital, i.e. in the hospital. The pessary is installed most often at 13-25 weeks of pregnancy. The procedure itself should be painless (although discomfort is possible), and a properly selected and installed pessary should not cause discomfort.

In order to avoid uterine hypertonicity, the doctor may prescribe antispasmodics 30 minutes before installing the pessary. Be sure to empty your bladder first. The actual installation takes only a few minutes and takes place without anesthesia.

After examining the patient on the gynecological chair, the doctor treats the pessary with a lubricant to facilitate insertion. If this is an unloading pessary, then the doctor places it at the entrance to the vagina with a wide base down. The procedure goes like this:

1. First - the introduction of the lower half ring into the posterior fornix of the vagina.
2. With a slight pressure on it and on the back wall of the vagina, the doctor inserts the upper half ring.
3. Then the doctor inserts the entire pessary and turns it so that it is in an oblique plane with respect to the longitudinal axis of the pregnant woman's body. Those. the wide base is located in the posterior fornix of the vagina, and the narrow base is located under pubic articulation. The cervix should be in the central opening of the pessary.

Installing a domed pessary is easier: the doctor inserts it into the vagina, squeezing so that when the pessary unfolds, its convex surface of the pessary faces the cervix.

When using a pessary, it is necessary to take smears from the vagina every 2-3 weeks to prevent colpitis and every 3-4 weeks to undergo an ultrasound of the cervix. Once every 2 weeks, the vagina and pessary are treated with antiseptic solutions. It is not necessary to remove the pessary.

The doctor will remove the pessary at 37-38 weeks or in case of emergency indications (bleeding, prematurely broken water, etc.).

Installing and maintaining a gynecological pessary

The size of the pessary is selected using adaptive rings:

• After introducing the approximate size of the try-on ring, the doctor will ask the patient to stand up and walk for 10-15 minutes, as well as to strain and cough, if the pessary has shifted or causes discomfort, then the product is removed and a larger / smaller size is introduced, depending on the sensations described.
• If the patient does not feel any discomfort when moving, straining and coughing, then the size is correct. The rings are removed and the necessary pessary is installed.
• During the installation of the pessary, the attending physician teaches the patient how to independently insert and remove the device at home, because. there are filling models that are worn during wakefulness and removed at night.