INCOMPETENT CERVIX

Reported by: Agripo, Kenje Kate T. Oja, Grezzly

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Definition: - Also called premature cervical dilation or cervical insufficiency - Refers to a painless premature dilation of the cervix without contractions therefore cannot hold a fetus until term

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Risk Factors: 1. Congenital conditions -Uterine abnormalities and genetic disorders - Exposure to diethylstilbestrol (DES) 2. Obstetric trauma 3. Dilation and curettage 4. Certain cervical procedures -Cone Biopsy 5. Unusually short cervix 6. Spontaneous abortion

 INCOMPETENT Diagnostic Test: 1. Pelvic Exam

-Also called as internal or vaginal exam

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Procedure done: Caregiver gently puts a warmed speculum into the vagina. This let the caregiver see the cervix(bottom part of the uterus) With gloved hands, the cargiver check the size of the uterus and ovaries

Procedure done: A slender transducer is placed in the vagina to send out sound waves -Monitor the cervical length Gather pictures of the uterus, ovaries, or cervix are seen on a TV- like screen and to see if the cervix is opening

2. Transvaginal Ultrasound

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Surgical Management: Cervical Cerclage

-Suturing of the cervix early in the pregnancy to reinforce its opening and prevent premature dilation and effacement - The stitch is inserted surgically while the patient isunder spinal, epidural, or general anesthesia

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Types of Cervical Cerclage:

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1. Mcdonalds Stitch
(Not permanent and hould be taken out)

A purse string stitch around the cervix to cinch it together

Stitch goes in & out of the skin covering the cervix until it is all the way around, the string is seen in several places as it comes out of and goes back into the cervical skin all around the cervix

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Types of Cervical Cerclage:

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A purse string stitch around the cervix underneath the skin of the cervix to help cinch it together

2. Shirodkar Stitch
(Either be permanent or taken out during near term)

The stitch is underneath the skin of the cervix and sutures are made through the walls of the cervix so theyre not exposed

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Types of Cervical Cerclage:

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3. Abdominal Stitch
(Permanent)

A stitch around the lower part of the uterus through an abdominal incision to cinch the lower part of the uterus and upper cervix together.
Stitch is done at the very top of the cervix inside the abdomen

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Pathophysiology:
-During that time it is a firm structure that predominantly consist of collagen , but in the prelude to parturition the collagen is degraded and the cervix becomes soft and pliable enough to dilate -Infection and inflammation are causally related to preterm labor and cervical ripening -This relates to the cervical properties as the chance of preterm delivery is inversely related to the length of the cervical canal, which contains mucus with antibacterial properties.

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Pathophysiology:
-If the mechanical or antibacterial properties of the cervix are functionally impaired, by surgery, trauma to the cervix , the remaining strength of the cervix may be insufficient to retain the pregnancy.

 INCOMPETENT NURSING PROCESS

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ASSESSMENT

Cervical dilation in the absence of contractions or pain Pink-stained vaginal discharge Increased pelvic pressure w/ possible ruptured membranes and release of amniotic fluid

DIAGNOSIS

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NURSING PROCESS

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After 8 hours of student-nurse interaction, the client will be able to :
Measures to promote:

PLANNING

INTERVENTION

Prepare the patient for cervical cerclage under regional anesthesia as indicated; monitor maternal vital signs and FHR patterns closely

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Measures to promote:

INTERVENTION

Instruct her in signs and symptoms of labor with the needs to notify health care provider if any occur Maintain bed rest after surgery as ordered; if necessary, place the patient in a slight or modified Trendelenburg position to alleviate pressure of the uterus on the sutured area

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NURSING PROCESS

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Measures to promote:

INTERVENTION

Encourage follow-up to evaluate progress of pregnancy

EVALUATION