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

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.

1. Associated findings

- History of cervical trauma

- History of repeated, spontaneous, second trimester terminations

- 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

• 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.

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 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.
 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