GROUP 4: PREMATURE CERVICAL DILITATION

Assignment in Maternal & Child Health Nursing

Group Members:

Ayad, Nathan Scott

Orden, Deborah

Madarazo, Alyanna Jessea

Mata, Reygie

1. Brief Description of the Disease Prevalence and Statistics Anatomy and Physiology

Cervical insufficiency is the inability of the cervix to retain fetus, in the absence

of uterine contractions or labor (painless cervical dilatation), owing to a functional or

structural defect. It is cervical ripening that occurs far from the term. Cervical

insufficiency is rarely a distinct and well-defined clinical entity but only part of a large

and more complex spontaneous preterm birth syndrome.

Epidemiologic studies suggest an approximate incidence of 0.5% in the general

obstetric population and 8% in women with a history of previous mid-trimester

miscarriages. Wide variation in the incidence of cervical incompetence has been reported,

which is likely due to real biologic differences among the study population.

The competent human cervix is a complex organ that undergoes extensive changes

throughout gestation and parturition. A complex remodeling process of the cervix occurs during

gestation, involving timed biochemical cascades, interactions between the extracellular and

cellular compartments, and cervical stromal infiltration by inflammatory cells. Any disarray in

this timed interaction could result in early cervical ripening, cervical insufficiency, and preterm

birth or miscarriage. Current evidence suggests that cervical incompetence functions along with a
 continuum that is influenced by both endogenous and exogenous factors, such as uterine

contraction and decidual/membrane activation

2. Pathophysiology

 Cervical insufficiency (also called incompetent cervix) means your cervix opens

(dilates) too early during pregnancy, usually without pain or contractions.

 Cervical insuffiency can cause premature birth and miscarriage. Premature birth is

when your baby is born too early, before 37 weeks of pregnancy.

Associated findings

o History of cervical trauma

o History of repeated, spontaneous, second trimester terminations

o Possibly spontaneous rupture of the membranes

A common clinical manifestation is appreciable cervical dilation with prolapsed of the

membranes through the cervix without contractions.

3. Assessment and Management

Assessment

A. Clinical manifestations

Be on the lookout for:

1. A sensation of pelvic pressure

2. A new backache

3. Mild abdominal cramps

4. A change in vaginal discharge

5. Light vaginal bleeding

B. Diagnostic findings

An incompetent cervix can only be detected during pregnancy. Even then diagnosis can be

difficult — particularly during a first pregnancy.

Tests and procedures to help diagnose an incompetent cervix during the second trimester

include:

 Transvaginal ultrasound. Your doctor may use transvaginal ultrasound to evaluate

the length of your cervix and to check if membranes are protruding through the

cervix.

 Pelvic exam. Your doctor will examine your cervix to see if the amniotic sac has

begun to protrude through the opening (prolapsed fetal membranes).

 Lab tests. Your doctor might test a sample of amniotic fluid (amniocentesis) to

diagnose or rule out an infection of the amniotic sac and fluid (chorioamnionitis).

There aren't any tests that can be done before pregnancy to reliably predict an incompetent

cervix.

Management

A. Pharmacologic therapy

1. Progesterone supplementation. If you have a history of premature birth, your doctor

might suggest weekly shots of a form of the hormone progesterone called

hydroxyprogesterone caproate (Makena) during your second and third trimester.

2. Repeated ultrasounds. If you have a history of early premature birth, or you have a

history that may increase your risk of cervical insufficiency, your doctor might begin

carefully monitoring the length of your cervix by giving you ultrasounds every two

weeks from week 16 through week 24 of pregnancy.

 3. Cervical cerclage. If you are less than 24 weeks pregnant or have a history of early

premature birth and an ultrasound shows that your cervix is opening, a surgical

procedure known as cervical cerclage might help prevent premature birth.

B. 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 sub-mucous 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.

C. Prevention

 Seek regular prenatal care. Prenatal visits can help your doctor monitor your health

and your baby's health.

 Eat a healthy diet. During pregnancy, you'll need more folic acid, calcium, iron and

other essential nutrients.

 Gain weight wisely. Gaining the right amount of weight can support your baby's

health.

 Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits,

too.
 If you've had an incompetent cervix during one pregnancy, you're at risk of premature

birth or pregnancy loss in later pregnancies.

4. Nursing Process

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.

 Determine level of client’s knowledge. (rationale: Provide opportunity to clarify what has

been learned previously, to identify cultural myths, and to correct misconceptions)

DIAGNOSIS

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

cervix.

 Knowledge deficit related to lack of exposure/ recall or misinterpretation of information

 Risk for maternal injury related to premature cervical dilation as manifested by

threatened abortion

PLANNING

After the 8 hours shift, the patient will:

 Appear relaxed and report that anxiety has been reduced.

 Demonstrate self-care behavior to maintain the pregnancy.

  Experience no vaginal bleeding

INTERVENTION

 Determine any factors that further contribute to the anxiety of the woman so it could be

avoided.[1]

 Monitor vital signs to determine any physical responses of the patient that could affect

her condition. [1]

 Convey empathy and establish a therapeutic relationship to encourage client to express

her feelings.[1]

 Provide information about the future expectations.[2]

 Involve significant others in discussion [2]

 Note presence of vaginal bleeding, leaking amniotic fluid or uterine contraction. [3]

*vaginal bleeding may be a sign of cervical dilation and leaking membrane can herald

impending delivery and place client for greater risk of infection*.

 Notify physician of abnormal findings or signs of labor. [3]

*prompt intervention lessens likelihood of complication*.

EVALUATION

After the shift of nurse-client interaction, the client will be able to:

 GOAL MET- The patient appeared relax and report that anxiety has been reduced

 GOAL MET- The patient verbalized understanding of her own circumstances and

treatment

 GOAL MET- The patient has no vaginal bleeding

REFERENCES:

Incompetent cervix. (2019, July 25). Retrieved from https://www.mayoclinic.org/diseases-

conditions/incompetent-cervix/symptoms-causes/syc-20373836

Momof1. (2019, May 30). Incompetent cervix- Signs, Diagnosis and Effects: Parenting

healthy babies. Retrieved from https://parentinghealthybabies.com/incompetent-

cervix/

Cervical Insufficiency. (n.d.). Retrieved from

https://www.glowm.com/section_view/heading/The Incompetent Cervix/item/190

Thakur, M. (2019, December 9). Cervical Incompetence. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK525954/