How far to insert pessary when pregnant

How and when to use clotrimazole for thrush

Dosage and strength

Clotrimazole for thrush comes as a pessary and cream that you use internally, or externally.

Clotrimazole pessaries contain 100mg, 200mg or 500mg.

The pessary dose to treat thrush is:

100mg – use 1 pessary every night for 6 nights in a row or 2 pessaries for 3 nights in a row.
200mg – use 1 pessary (or 2 100mg pessaries) every night for 3 nights in a row
500mg – use 1 pessary for 1 night only

Clotrimazole internal cream contains 500mg of clotrimazole in every 5g of cream. It comes as a single application that you use once.

Clotrimazole external cream is used 2 or 3 times a day for at least 2 weeks.

How to use it

Canesten sometimes comes as a pessary and external cream combined in 1 pack. This treats your thrush internally and your external symptoms.

How to use external cream

Wash your hands before you start.
Put a strip of cream onto your fingertip. A 1cm strip is enough to treat an area the size of the hand. Apply it in a thin layer to the affected area and rub it in gently.
Wash your hands when you’ve finished.

Do this 2 or 3 times a day for at least 2 weeks. The cream will work better if you can use it 3 times a day.

How to use pessaries

Pessaries are made to go into your vagina only. Do not swallow them.

Pessaries need moisture in the vagina to dissolve completely. If they do not dissolve, pieces of the pessary may crumble and fall out of the vagina. You may notice this if you have vaginal dryness.

To help the pessary dissolve, insert it as far as possible into your vagina at bedtime. Each pessary comes in a foil blister pack, together with an applicator to help you insert it. Make sure the foil is not broken before you use it.

Wash your hands before you start.
Remove the applicator from the packet.
Pull the plunger (the thinner end of the applicator) out as far as it will go.
Take the pessary out of the blister pack.
Gently squeeze the holder (the wider end of the applicator) to open it.
Push the pessary into the application following the instructions that come in the medicine packet.
Lie on your back, bend your knees then let your knees fall to each side.
Gently put the applicator into your vagina and push it in as far as you can comfortably.
Holding the applicator in place, slowly press the plunger in until it stops moving.
Remove the applicator.
Throw the applicator away safely, out of the reach of children. Do not flush it down the toilet.
Wash your hands thoroughly when you've finished.If you have a 100mg pessary, you can insert 2 pessaries at a time.

Do not use tampons or other vaginal products while you're using the pessary. Do not use pessaries during your period – wait until your period has finished.

How to use internal cream

Wash your hands before you start.
Remove the applicator from the packet.
The internal vaginal cream is already in the applicator. You will need to put the plunger into the applicator.
Carefully twist and pull off the cap following the instructions that come in the medicine packet.
Lie on your back, bend your knees then let your knees fall to each side.
Gently put the applicator into your vagina and push it in as far as you can comfortably.
Holding the applicator in place, slowly press the plunger in until it stops moving.
Remove the applicator. Throw the applicator away safely, out of the reach of children. Do not flush it down the toilet.
Wash your hands thoroughly when you've finished.

For some internal creams, you will also need to take a capsule of fluconazole to complete your treatment.

It's quite common to notice a slight discharge after using the cream so it may help to wear a panty liner. This does not mean that the treatment has not worked.

If you forget to use it

If you forget to use a pessary or internal cream at bedtime, use it during the night if you remember. If you only remember the next day, wait until bedtime for your next dose. Pessaries and internal cream work best at night.

If you’re using the external cream and you forget to put it on, use it as soon as possible and continue putting it on 2 to 3 times a day as usual.

If you have forgotten for more than 1 day, your infection may not be treated properly. If you still have symptoms after you finish your course, speak to a doctor.

If you use too much

If you use too much external clotrimazole cream or use it more often than you need to, it may make your skin irritated, or red. Use less cream the next time if this happens.

If you insert too many pessaries at the same time, you may feel discomfort or irritation. Stop using the pessaries and see a doctor if the discomfort or irritation does not go away.

Page last reviewed: 2 November 2022
Next review due: 2 November 2025

Thrush cream, pessary, gel or pill - which is safe in pregnancy

In a nutshell

Canesten thrush cream is safe if you’re pregnant, but oral thrush pills are not. Pessaries are also safe but be aware you'll need to insert them carefully.

The expert view

Thrush is very common in pregnancy and although it won’t harm your growing baby, it can be very uncomfortable for you. The good news is that most thrush medicine is safe to use when you’re pregnant – but not all.

While the chemicals in pessaries and thrush creams are safe, research in January 2016 suggests a link between Fluconazole - the main ingredient in anti-thrush pills that you take by mouth (oral) – and a 50% increased risk of miscarriage in early pregnancy.

In the UK, the best-selling anti-thrush oral pills are Canesten Oral Capsule and Canesten Oral and Cream Duo – so avoid these. You used to also be able to buy Diflucan, but this is no longer available at pharmacies.

“Oral fluconazole use in pregnancy was associated with a significantly increased risk of spontaneous abortion,” explain the authors of the study, who looked at 1.4 million pregnancies in Denmark.

The researchers are calling for more research to be done to understand the link, and in the meantime are urging caution. “Until more data on the association is available, cautious prescribing of fluconazole in pregnancy may be advisable.”

What is safe?

Thrush creams and pessaries, such as:

Canesten Combi
Canesten Pessary
Canesten Soft Gel Pessary
Canesten Cream

These all contain a different active ingredient – Clotrimazole – which has not been found to have any harmful effects during pregnancy.

What is not safe?

Anti-thrush pills you swallow, which contain Fluconazole, such as:

Canesten Oral Capsule
Canesten Oral and Cream Duo

And if you're unsure...

Always buy from a pharmacist and explain that you’re pregnant, so they can choose the safest product for you. If you’re worried, talk to your doctor or midwife.

Our MFM mums on our forum say:

"I am 34 weeks +4 days pregnant and have had thrush for about 13 weeks now," explains Rach_and_Harry. "I started just using the cream and it went but came back. So I went to my midwife who got my GP to prescribe me Canesten cream as it's rather expensive."

"I've had thrush a few times," says Sah83. "Once at about 10 or 11 weeks and once at about 15 weeks (I'm now just over 23). I was treated by my GP with Canesten pessary and cream both times, and this cleared it up for me."

"I had the same [thrush] problem and left it thinking it would just go away like it has done in the past," adds ButterflyBride123. "But when it didn't go away, I went to the doctors and they give me the pessary/cream (I was 8 weeks then). They said it would be safe although it said on the leaflet advise doctor if you're pregnant. Mine cleared up the next day and hasn't returned since."

Read more...

Which over-the-counter medication is safe to take in pregnancy?
Is it safe to use a hot water bottle when you're pregnant?
What's the safest sleeping position in pregnancy?

what is it, why and how is a ring placed on the cervix during pregnancy?

The threat of miscarriage is a diagnosis that is made to a large number of women. But modern medicine is finding more and more new ways to eliminate the risks of fetal loss. One of these methods is the installation of a pessary. It is carried out according to certain indications and allows you to save the child. The pessary should only be installed by an experienced clinician. In this case, the design will give the desired effect and will not cause pronounced discomfort to the expectant mother. Information about the price of the ring for the uterus during pregnancy, the conditions for its setting and all the features will be provided by the gynecologist. nine0003

What is a pessary?

An obstetric pessary is a product made of a soft but elastic material (silicone or plastic) that easily adapts to the anatomical features of the uterus and does not cause an allergic reaction or rejection. The design is traditionally made in the form of a ring, but there are also models in the form of a cube, bowl, mushroom and cone. An obstetric (unloading) pessary is used to support the cervix to reduce fetal pressure on it. The design effectively and evenly distributes the load and reduces the risk of preterm birth. nine0003

Indications for cervical ring insertion

The introduction of an obstetric pessary is carried out with ICI (isthmic-cervical insufficiency), which causes:

Weakening of the walls of the uterus
Neck shorteners
Opening of the uterine os

The need for a special design usually arises after complicated previous births, abortions, and various gynecological pathologies. nine0003

Also, an obstetric pessary is installed when:

Multiple pregnancy
Exacerbation of inflammatory processes
Cervical sutures
Individual features of the structure of the genital organs

In most cases, a special design allows you to carry the fetus.

Indications for the use of a pessary are also urinary incontinence and hernia of the bladder. nine0003

Contraindications for cervical ring insertion

The obstetric pessary is not used for:

Bloody discharge
Protrusion of the amniotic sac
Chronic inflammatory processes in the genitals
Severe somatic pathologies
Suspected miscarriage
Bladder dysfunctions

Important! If the mucous membranes of the genital organs become inflamed after the installation of the product, a thorough antiseptic treatment of the birth canal is carried out. It also provides constant monitoring of the state of the microflora of the vagina. nine0003

The ring is not placed on the cervix and at the last stage of the ICI due to the inappropriateness of the procedure.

Varieties of obstetric pessaries

Special obstetric designs are always selected individually. This is due to the specifics of the structure of the female genital organs.

In obstetrics, the following types of pessaries are used:

Ring. Such products are ring-shaped and made of silicone. The disadvantages of such pessaries include low reliability of fastening and the risk of falling out
Cube. These products are in the shape of a cube. They, like rings, ensure the outflow of all secretions and cope with the main task. The risk of their falling out is minimal
Dount. Similar designs are shaped like donuts. They cope with the main task, but have the disadvantage of congestion of the vaginal secretion
Cellhorn. Such pessaries are the most reliable, but not very convenient to use. They are firm but do not retain vaginal discharge

When choosing the right product, important factors are the diameter of the cervix and the upper third of the vagina, as well as the number of deliveries of the patient.

Pessaries are available in three sizes:

For the cervix with a diameter not exceeding 30 mm and for the vagina, the length of the upper third of which does not exceed 65 mm. The smallest structures are installed for nulliparous women and those who have become mothers no more than two times
For the vagina with an upper third not exceeding 66-75 mm. Such products are also installed for women who have given birth to no more than two children
For the cervix with a diameter of 37 mm and a third of the vagina longer than 76 mm. Such designs are placed on women who have given birth to more than two children

What are the terms?

The pessary is installed for a period of 16 to 34 weeks after conception. The exact time of placement of the structure largely depends on the nature of the course of pregnancy. As a rule, products are introduced after the 20th week of pregnancy. In some cases, the installation of a pessary is necessary as early as 12-14 weeks. nine0003

Important! The exact date is determined only by the doctor. The installed pessary is worn throughout the rest of the gestation period. Preliminarily, the necessary preventive measures are taken to prevent the development of infectious processes.

Installation process

The introduction of the pessary does not take much time and does not cause severe discomfort. An experienced doctor copes with the task in just 15 minutes.

Installation is carried out in stages:

The patient is placed in a chair (the bladder and bowels are emptied beforehand)
The pessary is treated with glycerine oil for ease of insertion
The device is placed so that its narrow part is located under the pubic bones, and the wide part is located deep in the vagina

Important! In the presence of uterine hypertonicity, the patient takes an antispasmodic 30 minutes before installation. If necessary, anesthesia is given before the procedure. nine0003

Wearing features and restrictions

When wearing a pessary, a woman does not have to radically change her lifestyle.

There are only a few restrictions regarding:

Termination of intimate contacts
Physical activity restrictions
Prevention of constipation
Refusal to bathe and swim

After installing the structure, the woman will need to visit the gynecologist regularly (every 2 weeks). The doctor will conduct examinations and make sure that the pessary has not fallen out and is positioned correctly. Also, the gynecologist will take a smear for infections. nine0003

Possible complications

Possible complications include:

Change in the nature (abundance and frequency) of vaginal discharge
Discomfort while sitting
Inflammation of the amniotic sac
Development of colpitis (when changing the location of the pessary)
Wear of the vaginal walls
Bleeding

Regular visits to the gynecologist and the correct, professional installation of the structure allow you to prevent all complications. That is why it should be observed by experienced professionals. They will correctly install the pessary and follow the process of wearing it. nine0003

How does a pregnant woman feel if the pessary has moved?

Usually women do not experience any discomfort when wearing the product. This is due to the fact that the design has rounded edges and is characterized by sufficient softness and flexibility. It does not injure the soft tissues of the vagina.

The product cannot fall out. It is only possible to change the position of the pessary. In this case, the pregnant woman will feel discomfort and complain about the feeling of a foreign body in the vagina. Often the ring presses, which is especially acute when bending over and in a sitting position. Also, when the patient is displaced, they notice the appearance of white discharge. If the pessary has changed position due to an incorrectly selected size, the product is replaced. If the cause of the displacement was a violation of the doctor's recommendations for wearing the structure, it simply returns to its place. nine0003

Important! If you experience any discomfort, you should immediately consult a doctor. If this is not done, inflammation of the vagina is possible.

Benefits of placing pessaries at MEDSI

A team of international doctors. MEDSI clinics employ specialists with impressive experience in medical practice. All doctors have a second specialty "ultrasound diagnostics", patients undergo 24/7 ultrasound examinations
Delicate and careful individual approach. Installation of the product is carried out competently, quickly and with minimal discomfort for the patient
Precise selection of the required pessary. This reduces the risk of displacement, discomfort or complications

To make an appointment with a gynecologist, call the MEDSI clinic, call +7 (495) 7-800-500.

Do not delay treatment, see a doctor now:

Obstetrician-gynecologist appointment
Planning and management of pregnancy

Pregnancy pessary - placement on the cervix, how and when to use it

The most common cause of death in newborns is prematurity. Inadequate development does not allow the child to adapt to the external environment, the organs cannot function normally. Placement of an obstetric pessary on the cervix helps reduce the chance of preterm delivery.

ICN

In 30-40% of cases, early labor is caused by isthmic-cervical insufficiency. So in medicine are called pathological processes occurring in the reproductive system. In this case, the length of the cervix decreases, there is a partial opening of the cervical canal. With the development of pregnancy and the growth of the fetus, intrauterine pressure increases. The fetal egg does not create the necessary support in the lower part of the uterus. The fetal membrane protrudes, its part is located in the cervical canal. As a result, isthmic-cervical insufficiency progresses. nine0003

With the development of ICI, a high probability of penetration of bacteria, microbes to the walls of the fetal egg is created. An inflammatory focus appears that destroys the membrane, the amniotic fluid flows out, the premature labor process begins .

There are many reasons why ICI develops. Pathology may be the result of gaps formed during previous births. It occurs with a deficiency of the necessary hormones, a congenital anomaly in the structure of the cervix. nine0003

An obstetrician easily detects in pregnant women the presence of pathologies of the cervix, CI. The correction technique is selected taking into account the factor that provoked the pathology. Surgical cerclage is used in extreme cases due to the increased risk of infection and trauma. During the operation, a suture is created on the cervix. More often, a conservative correction is prescribed - the installation of a pessary.

Obstetric pessary specific

This device is made of polymers or medical silicone. It is established during the bearing of the child. The optimal shape, corresponding to the anatomical features of the female genital organs, the high flexibility of the materials facilitates the adaptation of the pessary after installation. It ensures uniform distribution of the load created by the fetus, transfers it from the cervix to the walls of the uterus. nine0003

Timely correction of cervical insufficiency by installing a pessary significantly reduces the likelihood of preterm birth, miscarriage .

Varieties of obstetric pessaries

Several types of pessaries are used in obstetrics:

Cup-shaped. Outwardly similar to a cup with a round hole in the center. Perforated walls in the product are provided for the outflow of secretions.
Ring. It has a rounded shape with small notches along the edges. nine0014
Trapezoidal. Reminiscent of a butterfly in shape and more than other obstetric pessaries corresponds to the female anatomy. Due to its design, the product is securely fixed during installation, supporting the rectum and resting with its narrowed part against the pubic bones.

Obstetric pessaries in the form of a ring or bowl are made of elastic silicone. "Butterfly" is made of plastic and has a more rigid design. According to women's reviews, the installation of a silicone device on the cervix is not as painful as the introduction of a plastic pessary in the form of a trapezoid. nine0003

Reasons for inserting a pessary during pregnancy

The main reason for inserting an appliance is the presence of CCI in a pregnant patient. In the presence of pathology, the cervix becomes shorter, the tissues of the uterine walls lose strength. Under such conditions, the opening of the uterine pharynx begins before the due date.

The installation of a pessary is also indicated in other cases. It must be worn if:

the cervix has been surgically sutured; nine0014
the patient is pregnant with two or more babies;
placenta or fetus too low;
identified polyhydramnios;
there is a congenital anomaly in the structure of the uterus.

The doctor also prescribes the installation of a device for patients who had medical abortions before this pregnancy, complicated birth processes, miscarriages, and gynecological anomalies.

Timely installation of a pessary reduces the load on the cervix, allows you to endure the baby, give birth on time .

List of contraindications for installation

An obstetric pessary is not used in the following cases:

acute inflammation of the uterus and vagina;
after 34 weeks of pregnancy;
infectious diseases of the genital tract;
if there is bleeding;
with protrusion of the amniotic sac at the last stage of ICI.

If the patient has complications such as colpitis or inflammation of the membranes after the ring is placed on the cervix, the vaginal discharge becomes more abundant, their smell and color change, then you need to contact your doctor. The product may have shifted or an infection may have entered the vagina. nine0003

The use of a pessary in the detection of CCI

Experts consider the installation of a supporting device in the presence of cervical incompetence the best way to maintain pregnancy and prevent early birth. This is an affordable, simple technique that guarantees the safety of mother and child.

The need to install a pessary can only be determined by a doctor, taking into account the condition of the patient, the period of pregnancy .

Conservative cervical correction is usually performed at 20-22 weeks. If there are pronounced defects, the ring is installed earlier, used as an additional device after surgical cerclage. nine0003

Insertion and removal procedures are pain-free and no anesthetics are required. To eliminate discomfort allows the correct psychological attitude of the patient, a trusting attitude towards the doctor.

Prevention of preterm birth

The use of an obstetric pessary during pregnancy is not only a treatment for CCI. It is indicated for the prevention of preterm birth in women at risk of miscarriage, in those who have a history of early termination of pregnancy, who have cervical ruptures and are forced to do physical labor. It is also recommended for those who have suffered from infertility and have finally become pregnant, or who are carrying twins or triplets. nine0003

Placement of an obstetric pessary during pregnancy – is not only a physical support for the uterus and an obstacle to preterm labor, it is a psychological support for a woman who is uncertain about the safe bearing of a child.

Planned removal of the obstetric ring is performed at 37-38 weeks of gestation, its use does not affect the course of labor and does not affect the development of the fetus.

Peculiarities of inserting the pessary during pregnancy

According to the obstetrician's prescription, the device can be inserted at different stages of pregnancy. Basically, the introduction is carried out after twenty weeks, later than 34-35 weeks the device is not used. In difficult cases, if there is a threat of miscarriage, a ring on the cervix can be installed for a period of 12 weeks. nine0003

The optimal insertion period is determined by the physician based on the results of a complete examination .

Place a support ring on the cervix in an outpatient setting. If hypertonicity is observed, the patient takes an antispasmodic 30 minutes before the installation. The design, size is selected by the doctor based on data on the number of births, the diameter of the neck. The procedure takes about 15 minutes. The use of a special gel preparation eliminates discomfort and speeds up the insertion of the device. nine0003

There may be mild pain in the lower abdomen after insertion. You can remove them with candles "Papaverine", tablets "No-shpa".

At thirty-seven to thirty-eight weeks, the pessary is scheduled to be removed. The procedure does not affect the development of the fetus, the course of childbirth .

The doctor determines the optimal time for removing the ring. Usually this procedure is scheduled for the last week of the third trimester, but the pessary is sometimes removed before this date. The onset of the birth process after the procedure is impossible to predict. The period can take from a day to 2 weeks. nine0003

Rules for wearing a pessary

After installation, the doctor gives recommendations, explains the rules that must be observed to maintain pregnancy, eliminate the risk of introducing pathogenic microorganisms into the uterus. To do this, exclude:

sexual contacts;
bathing;
physical activity;
swimming in open water areas, swimming pools;
heavy, hard to digest food.

A pregnant woman should visit a doctor regularly. Every 14 days, a smear is examined for microflora, an examination is carried out. nine0003

Where can I buy an obstetric pessary?

It is better to buy the device in specialized places - pharmacies or medical equipment suppliers. You can order an obstetric ring in the online store with home delivery. If you are about to install a pessary during pregnancy, ask your doctor, perhaps a specialist will help in ordering the right product.

As for the cost, two brands of obstetric pessaries are in great demand on the Russian market - "Doctor Arabin" (Germany) and "Yunona" (Belarus). German devices have a higher price, but, unlike Belarusian models, they are made of soft silicone, which means they are more comfortable to wear. nine0003

Before buying a uterine ring, be sure to visit a gynecologist, as the correct size of the product depends on its effectiveness and comfort when using. Obstetric pessaries "Yunona" are manufactured in three sizes, the line of supporting devices "Doctor Arabin" has been expanded to 13 sizes.

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