Angeles University Foundation College of Nursing Angeles City

Incompetent Cervix
REPORT
In partial fulfillment of the requirements in Related Learning Experience- Delivery Room

Submitted By: DE LEON, Karla Camille C. Group 14

Submitted To: Marisa Avila, RN, MAN

Cervical incompetence

 A medical condition in which a pregnant woman's cervix begins to dilate (widen)

and efface (thin) before her pregnancy has reached term.

It may cause miscarriage or preterm birth during the second and third trimesters. In a woman with cervical incompetence, dilation and effacement of the cervix may
occur without pain or uterine contractions. In a normal pregnancy, dilation and effacement occurs in response to uterine contractions. Cervical incompetence occurs because of weakness of the cervix, which is made to open by the growing pressure in the uterus as pregnancy progresses. If the responses are not halted, rupture of the membranes and birth of a premature baby can result. According to statistics provided by the Mayo Clinic, cervical incompetence is relatively rare in the United States, occurring in only 12% of all pregnancies, but it is thought to cause as many as 2025% of miscarriages in the second trimester. It is generally categorized as premature opening of the cervix without labor or contractions. Diagnosis can be made either manually or with ultrasonography. The use of ultrasonography has been very helpful with the diagnosis, and is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm. Sometimes funneling is also seen, this is where the internal portion of the cervix, internal os (portion of the cervix closer to the baby) has begun to efface. The external os will be unaffected if diagnosed in time. Risk factors for premature birth or stillbirth due to cervical incompetence include: Cervical Trauma Hormonal influences Congenitally short cervix Forced D & C Uterine anomalies Diagnosis of cervical incompetence Previous preterm premature Diethylstilbestrol exposure, which

can cause anatomical defects, and Uterine anomalies Repeated procedures (such as

mechanical dilation, especially during late pregnancy) appear to create a risk.

in a previous pregnancy, rupture of membranes,

Treatment Once incompetent cervix has been diagnosed, a woman undergoes treatment for future pregnancies, which involves a surgical procedure called a cerclage. The cerclage is a pursestring stitch (suture) that acts as an cinch to keep the cervix from dilating. It is often placed between 12-15 weeks in pregnancy. The stitch is inserted surgically while the patient is under spinal, epidural, or general anesthesia. Often times the procedure is an outpatient surgery, although there is a chance that the woman may still need to spend the night in the hospital if she begins to experience cramping or extensive bleeding. There are 5 types of cerclages that can be used: The McDonald stitch is the most common for it is the easiest to use and can allow for vaginal delivery. The stitch is weaved in and out of the cervix and pulled tightly and tied to keep the cervix closed. The Shirodkar stitch can be both permanent (requiring a cesarean section) or it can be removed near term. This stitch is started at a 12 o'clock position, worked through the cervix to a 6 o'clock position, ending back in the 12 o'clock position on the other side of the cervix. It is also pulled tightly and tied to keep the cervix closed. How the stitch is tied off determines whether it will be removed or if it is permanent. An abdominal stitch is used when there is too little cervix to work with. The upper and lower part of the cervix are stitched together. A cesarean section is required for delivery. The Hefner cerclage is commonly used when incompetent cervix is diagnosed later in pregnancy. It has an added benefit when there is little cervix to work with. This cerclage is removed closer to term as well. The Lash cerclage is the only type that is placed prior to pregnancy. In cases of extensive cervical trauma or an anatomical defect, this stitch can be used. It is permanent and requires a cesarean delivery. It is important to discuss risks with your doctor prior to undergoing surgery for a cerclage. They include infection, tearing of the cervix from excessive pressure, premature rupture of the members, chorioamnionitis (infection of the membranes), pre-term labor, uterine rupture, maternal hemorrhage, and rarely, injury to the bladder. Once the cerclage has been placed, you will be put on bedrest from a period of 24-72 hours. There could be a restriction of activity or possibly continued bedrest if complications occur. Intercourse is also restricted once the stitch is in place due to increase risk of infection and trauma to the cervix. Spotting can occur as well as cramping. It is important to look for signs of increased discharge with odor, heavy bleeding, and burning, itching, fever over 101, or heavy cramping. If you notice any of these symptoms, it is urgent you contact your physician.