Incompetent Cervix as one of the Antenatal complications

7/30/2019 Incompetent Cervix as one of the Antenatal complications

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INCOMPETENT

CERVIX

Reported by:

Agripo, Kenje Kate T.Oja, Grezzly


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INCOMPETENT CERVIX

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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INCOMPETENT CERVIX

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


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INCOMPETENT CERVIXDiagnostic Test:

1. Pelvic Exam

-Also called as internal or

vaginal exam

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 thesize of the uterus and ovaries

2. Transvaginal

Ultrasound

-Monitor the cervical length

and to see if the cervix is

opening

Procedure done:

A slender transducer is placed in thevagina to send out sound waves

Gather pictures of the uterus, ovaries,

or cervix are seen on a TV- like screen


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INCOMPETENT CERVIX

Cervical Cerclage

Surgical Management:

-Suturing of the cervix early in the pregnancyto 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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INCOMPETENT CERVIX

Types of Cervical Cerclage:

1. Mcdonalds Stitch

(Not permanent and houldbe 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 placesas it comes out of and goes

back into the cervical skin all

around the cervix


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INCOMPETENT CERVIX

Types of Cervical Cerclage:2. Shirodkar Stitch

(Either be permanent or taken

out during near term)

A purse string stitch around

the cervix underneath the

skin of the cervix to help

cinch it together

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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INCOMPETENT CERVIX

Types of Cervical Cerclage:

3. Abdominal Stitch

(Permanent)

A stitch around the lower part

of the uterus through an

abdominal incision to cinchthe lower part of the uterus

and upper cervix together.

Stitch is done at the very topof the cervix inside the

abdomen


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INCOMPETENT CERVIX

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 ofpreterm delivery is inversely related to the length of

the cervical canal, which contains mucus with

antibacterial properties.


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INCOMPETENT CERVIX

Pathophysiology:

-If the mechanical or antibacterial properties of the

cervix are functionally impaired, by surgery, trauma

to the cervix , the remaining strength of the cervixmay be insufficient to retain the pregnancy.


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INCOMPETENT CERVIX

NURSING PROCESS

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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INCOMPETENT CERVIX

NURSING PROCESS

PLANNINGAfter 8 hours of student-nurse

interaction, the client will be able

to :

INTERVENTION

Measures to promote:

Prepare the patient for cervical

cerclage under regionalanesthesia as indicated;

monitor maternal vital signs

and FHR patterns closely


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INCOMPETENT CERVIX NURSING PROCESS

INTERVENTION


Instruct her in signs and

symptoms of labor with the

needs to notify health careprovider if any occur

Maintain bed rest after surgery

as ordered; if necessary, place

the patient in a slight ormodified Trendelenburg

position to alleviate pressure of

the uterus on the sutured area


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INCOMPETENT CERVIX NURSING PROCESS

INTERVENTION


Encourage follow-up to

evaluate progress of

pregnancy

EVALUATION

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Incompetent Cervix as one of the Antenatal complications