INCOMPETENT CERVIX

Overview

An incompetent cervix, also called a cervical insufficiency, occurs when weak cervical tissue causes or
contributes to premature birth or the loss of an otherwise healthy pregnancy.

Before pregnancy, your cervix — the lower part of the uterus that opens to the vagina — is normally
closed and firm. As pregnancy progresses and you prepare to give birth, the cervix gradually softens,
decreases in length (effaces) and opens (dilates). If you have an incompetent cervix, your cervix might
begin to open too soon — causing you to give birth too early.

An incompetent cervix can be difficult to diagnose and treat. If your cervix begins to open early, or you
have a history of cervical insufficiency, your doctor might recommend preventive medication during
pregnancy, frequent ultrasounds or a procedure that closes the cervix with strong sutures (cervical
cerclage).

Symptoms

If you have an incompetent cervix, you may not have any signs or symptoms during early pregnancy.
Some women have mild discomfort or spotting over the course of several days or weeks starting
between 14 and 20 weeks of pregnancy.

Pathophysiology

1. When the fetus reaches its 20th week, it starts to become heavy and gain fats.
2. The mother’s cervix is weak, and it could not hold the fetus’ weight anymore as it slowly starts to
dilate.
3. This would cause the appearance of a show, a pink-tinged vaginal discharge.
4. Then, the membranes would rupture and amniotic fluid would be discharged.
5. Uterine contractions would start followed by a short labor, then the birth of the fetus.

Be on the lookout for:

 A sensation of pelvic pressure

 A new backache
 Mild abdominal cramps
 A change in vaginal discharge
  Light vaginal bleeding

Risk factors

Many women don't have a known risk factor. Risk factors for cervical insufficiency include:

 Cervical trauma. Some surgical procedures used to treat cervical abnormalities associated with
an abnormal Pap smear can result in cervical insufficiency. Other surgical procedures such as a
D&C could also be associated with cervical insufficiency. Rarely, a cervical tear during a previous
labor and delivery could be associated with an incompetent cervix.
 Race. Black women seem to have a higher risk of developing cervical insufficiency. It isn't clear
why.
 Congenital conditions. Uterine abnormalities and genetic disorders affecting a fibrous type of
protein that makes up your body's connective tissues (collagen) might cause an incompetent
cervix. Exposure to diethylstilbestrol (DES), a synthetic form of the hormone estrogen, before
birth also has been linked to cervical insufficiency.

Complications

An incompetent cervix poses risks for your pregnancy — particularly during the second trimester —
including:

 Premature birth
 Pregnancy loss

Prevention

You can't prevent an incompetent cervix — but there's much you can do to promote a healthy, full-term
pregnancy. For example:

 Seek regular prenatal care. Prenatal visits can help your doctor monitor your health and your
baby's health. Mention any signs or symptoms that concern you, even if they seem silly or
unimportant.
 Eat a healthy diet. During pregnancy, you'll need more folic acid, calcium, iron and other
essential nutrients. A daily prenatal vitamin — ideally starting a few months before conception
— can help fill any dietary gaps.
 Gain weight wisely. Gaining the right amount of weight can support your baby's health. A weight
gain of 25 to 35 pounds (about 11 to 16 kilograms) is often recommended for women who have
a healthy weight before pregnancy.
  Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. In
addition, get your doctor's OK before taking any medications or supplements — even those
available over-the-counter.
 If you've had an incompetent cervix during one pregnacy, you're at risk of premature birth or
pregnancy loss in later pregnancies. If you're considering getting pregnant again, talk with your
doctor to understand the risks and what you can do to promote a healthy pregnancy.

Diagnostic Tests

There are few diagnostic tests that could detect an incompetent cervix before it usually happens. It is
usually diagnosed after the pregnancy has already been lost.

 Ultrasound. This is the only test that the physician could order if an incompetent cervix is already
suspected.

Medical Management

Medical management by the physician would not include any medications that could hinder the dilation
of the cervix. Surgical procedures are immediately enforced to prevent compromising the pregnancy.

Surgical Management

There are two types of surgical management for incompetent cervix:

 McDonald’s Cervical Cerclage. Nylon sutures are placed horizontally and vertically across the
cervix. They are pulled back together until the cervical canal is only a few millimeters in
diameter.
 Shirodkar Cervical Cerclage. Sterile tape is used for this technique, where it is threaded in a
purse-string manner under the submucous layer of the cervix. Then, it is sutured in place so it
would close the cervix
 These sutures are removed on the 37th or 38th week of pregnancy for the fetus to be born
vaginally.

Nursing Management

As nurses, here is what we could do to help in our own way.

Nursing Assessment

 Ask the woman who is reporting for painless bleeding if she is feeling an intense pressure on her
pelvis.
 Inspect and save pads used by the woman during bleeding to determine any clots or tissues that
already passed out.
 Determine if the woman is experiencing true contractions to prepare for the birth of the fetus.

Nursing Diagnosis

Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix.

Nursing Interventions

 Determine any factors that further contribute to the anxiety of the woman so it could be
avoided.
 Monitor vital signs to determine any physical responses of the patient that could affect her
condition.
 Convey empathy and establish a therapeutic relationship to encourage client to express her
feelings.
 Provide accurate information about the situation to help client back into reality.

Evaluation

 Patient would appear relaxed and report that anxiety has been reduced.
 Verbalize awareness of feelings of anxiety.
 Enumerate ways to deal with anxiety.
 Use resources or support system effectively.
 Once a pregnancy is deemed dangerous, extra care is enforced to ensure the safety of your little
one. As health care providers, we have to collaborate with each other to preserve a life that is
sure to contribute a lot when he is already out in the world.

Source:

1998-2020. Incompetent Cervix. Mayo Foundation for Medical Education and Research (MFMER).
Retrieved url from https://www.mayoclinic.org/diseases-conditions/incompetent-cervix/symptoms-
causes/syc-20373836
Belleze, M. 2016. Incompetent Cervix. Notes on Maternal and Child Health Nursing. Nurselabs. Ut in
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