Changes in the cervix during pregnancy
Anatomy of pregnancy and birth - cervix
Anatomy of pregnancy and birth - cervix | Pregnancy Birth and Baby beginning of content5-minute read
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Where is the cervix?
The cervix plays a critical role throughout a woman’s life, but never more so than during conception, pregnancy and childbirth. The cervix changes during these events, so it’s important to understand the role of this organ and what these changes mean for you and your baby.
The cervix is the muscular channel or opening that runs between the uterus (also known as the womb) and the vagina. The cervix is located in the pelvis and lies behind the bladder and near the front of the rectum. It is held in its position by tough, flexible ligaments.
Illustration showing the female reproductive system.What does the cervix do in women who are not pregnant?
In women who are not pregnant, the cervix is narrow and firm. Its size, shape and lining undergo subtle changes throughout a woman’s menstrual cycle.
For instance, the cervix has a smooth covering of mucus. When a woman is ovulating, the mucus becomes stretchy and elastic, which helps sperm move and survive following intercourse, and is known as ‘fertile mucus’. When a woman is not ovulating, the mucus takes on a more creamy texture and can be milky or yellow in colour. This change in consistency indicates that sperm are less likely to reach the uterus after intercourse at this time in the menstrual cycle.
The cervix contains a channel, referred to as the 'cervical canal', which also has an important role in women who are not pregnant. Sperm enters the uterus after intercourse and menstrual blood leaves the uterus during menstruation through this channel.
What is the function of the cervix during conception and pregnancy?
The cervix has several important functions during conception.
After a woman conceives, the mucus on the surface of the cervix becomes sticky and thick. This stops new sperm and microorganisms, such as bacteria and viruses, from entering the uterus and potentially harming the fetus.
The cervix also plays a crucial role during pregnancy. From conception until just before birth, the cervix protects the growing baby by increasing in size and strength, helping to keep the baby safe and secure in the uterus.
How does the cervix change during labour?
The cervix undergoes dramatic changes during labour in a process known as ‘effacement’ or ‘ripening’. It starts out long and firm, and as labour progresses, it softens, widens and becomes more elastic.
Changes to the cervix are partly triggered by contractions of the muscles of the uterus, which help open the cervix. As the cervix begins to open, you may see a clear, pink, or slightly bloody discharge (sometimes referred to as the 'show'). This is the release of the mucus plug, that sits over the cervical canal during pregnancy.
The first stage of labour begins when you feel contractions — your cervix will start to soften and to open. The time it takes for the cervix to open (or dilate) will vary from woman to woman and can range from several hours to days or even weeks. Once the cervix is dilated more than 3cm, and contractions are strong and regular, labour is said to be ‘established’.
Established labour is also known as the 'active phase'. This phase continues until the cervix dilates to approximately 7cm, with the contractions being strong, painful and around every 3 or 4 minutes.
This is followed by the ‘transition phase’, when the cervix continues to fully open. There is now less time to rest in between contractions.
First stage of labour is complete when the cervix is fully open (referred to as 'fully dilated'), the baby moves through the pelvis and the mother can begin pushing the baby out. Being fully dilated might not actually be a 10cm opening of the cervix. Rather it is when the doctor or midwife cannot feel any cervix when they perform a vaginal examination.
The second stage of labour is when your baby is being born and the third stage is when the placenta is delivered.
What problems can occur with the cervix during pregnancy, labour, or birth?
The cervix is monitored throughout pregnancy, labour and birth to identify any problems. For instance, if the cervix is weak, it might be difficult to keep the baby in the uterus for the whole pregnancy. This can lead to premature labour and birth.
During labour, contractions might not be regular or strong enough to fully open the cervix, which slows labour down. In these situations, the doctor or midwife might intervene by breaking the mother's waters or using a hormone to increase contractions and speed up the dilation of the cervix.
It is important that the mother does not begin pushing the baby out until the cervix is fully dilated. This is because pushing too soon might swell the cervix, which can slow down the birth.
Read more here about complications in labour, and how they are managed.
Sources:
MSD Manual (Female internal genital organs), Translational Research in Anatomy (March 2016) (The structure and function of the cervix during pregnancy), Women's Health (Understanding your menstrual cycle fact sheet), Mater Mother's Hospital (Labour and birth information), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Labour and birth), Royal Women's (Stages of labour), King Edward Memorial Hospital (Second stage of labour and birth), SA Health (Induction of labour techniques), Queensland Health (Vaginal examinations in labour)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: October 2020
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Related pages
- Anatomy of pregnancy and birth - uterus
- Anatomy of pregnancy and birth - perineum and pelvic floor
- Anatomy of pregnancy and birth - pelvis
- Anatomy of pregnancy and birth - abdominal muscles
- Anatomy of pregnancy and birth
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Uterus, cervix & ovaries - fact sheet | Jean Hailes
This fact sheet discusses some of the health conditions that may affect a woman's uterus, cervix and ovaries.
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A diaphragm is a shallow, cup-shape made of silicone inserted inside the cervix. In Australia there is one size diaphragm available sold as Caya®.
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Pap smear tests are currently used in Australia as a screening test for cervical cancer. A Pap smear test can detect changes in the cells of the cervix that may develop into cancer.
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Early labour signs include a show, waters breaking and pain.
During labour, your contractions increase and your cervix dilates, so you can birth your baby.
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Induction of labour
Inducing labour allows women to deliver their baby normally by stimulating labour contractions. There are several medical and surgical techniques which can be used.
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Placenta previa means the placenta has implanted at the bottom of the uterus, over the cervix or close by.
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Cervix in early pregnancy: What changes to expect
In early pregnancy, changes take place in the position and texture of the cervix and the consistency and color of cervical discharge. Tracking changes in the cervix can help a woman detect whether she is pregnant.
The cervix is a circular band of muscle that separates the uterus from the vagina. The cervix changes at different points in the menstrual cycle and throughout the stages of pregnancy.
In this article, we look at how the cervix and cervical discharge change in the early stages of pregnancy. We also discuss how women can check their cervix for changes.
The cervix undergoes various changes throughout the menstrual cycle and in early pregnancy, which we discuss in the following sections.
Position
Share on PinterestDuring the early stages of pregnancy, the cervix undergoes many changes.When a woman is not pregnant, the position of her cervix changes throughout the stages of the menstrual cycle:
- During ovulation, the cervix is higher in the vagina.
- After ovulation and before menstruation, if the woman has not become pregnant, the cervix drops lower in the vagina.
If a woman has conceived, the cervix will remain higher in the vagina, with its position being similar to that during ovulation.
Texture
The texture of the cervix also changes in early pregnancy due to increased blood flow. If the woman has not conceived, the cervix will feel firm to the touch, like the tip of a nose. If she has conceived, the cervix will feel softer, more closely resembling the lips.
Cervical discharge
The consistency and color of cervical discharge change in different stages of the menstrual cycle.
Some women use the consistency of their discharge, or cervical fluid, to track the stages of their menstrual cycle. This technique is one component of natural family planning.
Understanding the typical cervical mucus changes throughout the menstrual cycle can help women identify early pregnancy:
- Immediately after a period, women may notice reduced discharge or mild vaginal dryness.
- A few days after this but well before ovulation, discharge becomes sticky and may appear white or yellow.
- In the fertile window in the days before ovulation, discharge will increase and become creamy and opaque.
- At ovulation and a day or so before, the cervical mucus will be stretchy and resemble egg white.
- After ovulation, cervical mucus will begin to dry up and thicken if the woman is not pregnant.
A woman who has conceived during her cycle may notice cervical mucus increasing instead of drying up after ovulation.
According to the American College of Obstetricians and Gynecologists, light bleeding or spotting may occur around the time of implantation, which is generally 1–2 weeks after conception.
Feeling the cervix offers clues regarding early pregnancy, but it is not a sure way to detect pregnancy. Cervical changes may be subtle, and not all women will be familiar enough with their cervix to pick up on the changes. The only guaranteed way to check for pregnancy is with a pregnancy test.
However, women can check their cervix at home. To do this, they should clean the hands thoroughly before placing a finger into the vagina. The location of the cervix is in the top wall, nearest the stomach, and it should feel like a small bump.
Women who are trying to conceive may wish to become familiar with their cervical patterns. Doing this will make them better able to pick up on changes that occur during ovulation and early pregnancy.
Cervical changes are among the many changes that the body undergoes during early pregnancy. Other symptoms of early pregnancy include:
- breast tenderness
- nausea
- food aversions
- food cravings
- headaches
- constipation
- slight cramping
- mood swings
- fatigue
- frequent urination
- bloating
- nasal congestion
These symptoms are not unique to a pregnancy and may be reasonably mild initially.
The same symptoms can also appear just before a menstrual period. It is not possible to tell whether a woman is pregnant without her taking a pregnancy test.
Share on PinterestIf a woman experiences cervical discharge that is foul smelling, green, or bloody, they should seek advice from a doctor.
Women who think that they might be pregnant should make an appointment with a doctor. They should also talk to a doctor if they miss their period for several months and are not pregnant or if they experience vaginal bleeding during pregnancy.
During early pregnancy, it is best to talk to a doctor if cervical discharge is:
- foul smelling
- green
- bloody due to a cause other than menstruation
Additionally, a person should let their doctor know if they are experiencing vaginal itching or pain. These symptoms can indicate other infections that may affect the cervix.
Women can expect their cervix to change throughout pregnancy. During early pregnancy, the cervix will change slightly in position and in how it feels to the touch.
Cervical discharge will also change in consistency and color.
During pregnancy, a woman should see her doctor if she has any doubts, questions, or concerns.
Changes in the cervix during pregnancy
Pregnancy is always pleasant, but sometimes not planned. And not all women have time to prepare for it, to be fully examined before its onset. And the detection of diseases of the cervix already during pregnancy can be an unpleasant discovery.
The cervix is the lower segment of the uterus in the form of a cylinder or cone. In the center is the cervical canal, one end of which opens into the uterine cavity, and the other into the vagina. On average, the length of the cervix is 3–4 cm, the diameter is about 2.5 cm, and the cervical canal is closed. The cervix has two parts: lower and upper. The lower part is called the vaginal, because it protrudes into the vaginal cavity, and the upper part is supravaginal, because it is located above the vagina. The cervix is connected to the vagina through the vaginal fornices.
There is an anterior arch - short, posterior - deeper and two lateral ones. Inside the cervix passes the cervical canal, which opens into the uterine cavity with an internal pharynx, and is clogged with mucus from the side of the vagina. Mucus is normally impervious to infections and microbes, or to spermatozoa. But in the middle of the menstrual cycle, the mucus thins and becomes permeable to sperm.
Outside, the surface of the cervix has a pinkish tint, it is smooth and shiny, durable, and from the inside it is bright pink, velvety and loose.
The cervix during pregnancy is an important organ, both in anatomical and functional terms. It must be remembered that it promotes the process of fertilization, prevents infection from entering the uterine cavity and appendages, helps to "endure" the baby and participates in childbirth. That is why regular monitoring of the condition of the cervix during pregnancy is simply necessary.
During pregnancy, a number of physiological changes occur in this organ.
For example, a short time after fertilization, its color changes: it becomes cyanotic. The reason for this is the extensive vascular network and its blood supply. Due to the action of estriol and progesterone, the tissue of the cervix becomes soft. During pregnancy, the cervical glands expand and become more branched.
Screening examination of the cervix during pregnancy includes: cytological examination, smears for flora and detection of infections. Cytological examination is often the first key step in the examination of the cervix, since it allows to detect very early pathological changes that occur at the cellular level, including in the absence of visible changes in the cervical epithelium. The examination is carried out to identify the pathology of the cervix and the selection of pregnant women who need a more in-depth examination and appropriate treatment in the postpartum period. When conducting a screening examination, in addition to a doctor's examination, a colposcopy may be recommended.
As you know, the cervix is covered with two types of epithelium: squamous stratified from the side of the vagina and single-layer cylindrical from the side of the cervical canal. Epithelial cells are constantly desquamated and end up in the lumen of the cervical canal and in the vagina. Their structural characteristics make it possible, when examined under a microscope, to distinguish healthy cells from atypical ones, including cancerous ones.
During pregnancy, in addition to physiological changes in the cervix, some borderline and pathological processes may occur.
Under the influence of hormonal changes that occur in a woman's body during the menstrual cycle, cyclic changes also occur in the cells of the epithelium of the cervical canal. During the period of ovulation, the secretion of mucus by the glands of the cervical canal increases, and its qualitative characteristics change. With injuries or inflammatory lesions, sometimes the glands of the cervix can become clogged, a secret accumulates in them and cysts form - Naboth follicles or Naboth gland cysts that have been asymptomatic for many years.
Small cysts do not require any treatment. And pregnancy, as a rule, is not affected. Only large cysts that strongly deform the cervix and continue to grow may require opening and evacuation of the contents. However, this is very rare and usually requires monitoring during pregnancy.
Quite often, in pregnant women, during a mirror examination of the vaginal part, polyps cervix. The occurrence of polyps is most often associated with a chronic inflammatory process. As a result, a focal proliferation of the mucosa is formed, sometimes with the involvement of muscle tissue and the formation of a pedicle. They are mostly asymptomatic. Sometimes they are a source of blood discharge from the genital tract, more often of contact origin (after sexual intercourse or defecation). The size of the polyp is different - from millet grain rarely to the size of a walnut, their shape also varies. Polyps are single and multiple, their stalk is located either at the edge of the external pharynx, or goes deep into the cervical canal.
Sometimes during pregnancy there is an increase in the size of the polyp, in some cases quite fast. Rarely, polyps first appear during pregnancy. The presence of a polyp is always a potential threat of miscarriage, primarily because it creates favorable conditions for ascending infection. Therefore, as a rule, more frequent monitoring of the cervix follows. The tendency to trauma, bleeding, the presence of signs of tissue necrosis and decay, as well as questionable secretions require special attention and control. Treatment of cervical polyps is only surgical and during pregnancy, in most cases, treatment is postponed until the postpartum period, since even large polyps do not interfere with childbirth.
The most common pathology of the cervix in women is erosion . Erosion is a defect in the mucous membrane. True erosion is not very common. The most common pseudo-erosion (ectopia) is a pathological lesion of the cervical mucosa, in which the usual flat stratified epithelium of the outer part of the cervix is replaced by cylindrical cells from the cervical canal.
Often this happens as a result of mechanical action: with frequent and rough sexual intercourse, desquamation of the stratified squamous epithelium occurs. Erosion is a multifactorial disease. The reasons may be:
- genital infections, vaginal dysbacteriosis and inflammatory diseases of the female genital area;
- is an early onset of sexual activity and a frequent change of sexual partners. The mucous membrane of the female genital organs finally matures by the age of 20-23. If an infection interferes with this delicate process, erosion is practically unavoidable;
- is an injury to the cervix. The main cause of such injuries is, of course, childbirth and abortion;
- hormonal disorders;
- , cervical pathology may also occur with a decrease in the protective functions of immunity.
The presence of erosion does not affect pregnancy in any way, as well as pregnancy on erosion. Treatment during pregnancy consists in the use of general and local anti-inflammatory drugs for inflammatory diseases of the vagina and cervix.
And in most cases, just dynamic observation is enough. Surgical treatment is not carried out throughout the entire pregnancy, since the excess of risks and benefits is significant, and after treatment during childbirth, there may be problems with opening the cervix.
Almost all women with various diseases of the cervix safely bear and happily give birth to beautiful babies!
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Cervix: general information, structure
Consultation with a specialist:
The structure of the cervix and its functions
The organ has a cylindrical shape, and its inner part is a hollow “tube” lined with epithelial tissue.
The cervix is divided into two regions:
- Vaginal. Enters the vaginal cavity. It has a convex shape. Lined with stratified squamous epithelium.
- Supravaginal. Lies above the vagina. Lined with columnar epithelium.
The area where the squamous epithelium of the vaginal part changes to the cylindrical epithelium of the cervical canal is called the transformation zone.
The cervical canal is the central part of the cervix. It has an internal pharynx that goes to the body of the uterus, as well as an external one facing the vagina - it is seen by the gynecologist when examining the patient. In nulliparous women, the external os has a round or oval shape, in those who have given birth, it is slit-like. The channel always contains a certain amount of mucus.
Cervical mucus is a biological fluid, the importance of which in a woman's reproductive health can hardly be overestimated.
It has antibacterial properties and prevents penetration into the uterine cavity infections.
When a woman becomes pregnant, the cervical canal is closed with a dense mucous plug, which reliably protects the fetus from pathogenic microorganisms.
The rheological characteristics of cervical mucus change depending on the woman's monthly cycle. During ovulation and menstruation, it becomes more fluid. In the first case, it helps the sperm to move through the canal, which means it promotes conception. In the second, it facilitates the outflow of menstrual blood.
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Cervix during pregnancy
The task of the cervix during this period is to protect the fetus from infection and prevent abortion or premature birth.
Shortly after conception, the following changes occur in it:
- The pink surface of the channel takes on a bluish tint due to the increased pattern of blood vessels. This is facilitated by intensive blood circulation in the uterus.
- The mucous membrane becomes softer. This is also due to increased blood circulation and mucus secretion.
- The cervix descends lower, and the lumen of the canal narrows and is tightly “sealed” with a cork.
According to these changes, the gynecologist can visually determine pregnancy a few weeks after conception.
As the fetus develops in the womb, the length of the cervix gradually decreases. It is very important that it matches the gestational age, since a too short neck can threaten miscarriage or premature birth.
In the third trimester, the cervix becomes shorter, softer, and closer to childbirth, it begins to open slightly. The mucus plug may come off within a few weeks of labor.
Cervix and childbirth
Before the onset of active labor activity, the organ shortens to 1 cm and its anatomical position changes. The neck, previously directed slightly backward, moves to the center and is located under the head of the child.
As labor proceeds, the cervix shortens and smoothes, and its lumen gradually opens so that the baby's head can pass through it. Full dilatation of the cervix - about 10 cm.
At the first birth, the internal os opens first, and then the external one. With subsequent disclosure occurs at the same time, so childbirth is faster.
Diseases of the cervix
Diseases of this organ are divided into the following types:
- Background - not associated with malignant processes.
- Precancerous (dysplasia) - there are areas with damaged cell structure (atypical cells), but without malignant changes.
- Cancer - malignant changes in the cellular structure.
Most of the diseases of the cervix occur without symptoms. In some cases, they may be accompanied by increased discharge, discomfort during sexual contact, bloody discharge. But even cervical cancer can give severe symptoms only at a late stage, when the disease is difficult to cure.
Cervical pathology can only be detected by specialized methods during a gynecological examination.
These methods include:
- Pap smear. Allows you to suspect the presence of atypical cells and the degree of their damage, to identify the inflammatory process in the cervix. Based on the results of the Pap test, further examination of the patient is performed.
- Colposcopy. Visual examination of the mucous membrane of an organ using an optical device - a colposcope. During colposcopy, various tests can be performed to identify damaged areas, as well as a tissue fragment (biopsy) is taken to perform a histological examination.
- Histological analysis. The study of the cellular structure of the selected biomaterial under a microscope. The diagnosis of "dysplasia" and "cervical cancer" can only be made based on the results of histology.
- Flora smear. It is performed to identify pathogenic flora and determine its sensitivity to antibiotics and antimycotics (antifungal drugs).
The analysis is necessary for organizing the treatment of inflammatory processes.
Your doctor may also order blood tests for sexually transmitted diseases (STDs) and human papillomavirus (HPV). Some strains of HPV are oncogenic and provoke dysplasia and cervical cancer.
Oncological processes of the cervix are formed rather slowly, passing through three stages of dysplasia - mild, moderate and severe. And even the third degree of dysplasia can be treated with full preservation of the reproductive function of a woman.
Early stage cervical cancer also has a favorable prognosis for the patient if treatment was started on time. Whether the organ will be preserved at the same time, the doctor decides according to indications.
At later stages, a radical hysterectomy is practiced - removal of the uterus with appendages, pelvic lymph nodes and the upper region of the vagina.
We repeat that dysplasia and subsequently cervical cancer develop slowly, almost asymptomatically, but are easily diagnosed during a medical examination.
Whether a woman gets this type of cancer or not is largely a matter of her personal responsibility. An annual visit to a gynecologist for preventive examinations will protect you from this serious illness and preserve your reproductive health.
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