Incompetent Cervix

Introduction
Cervical Incompetence is a management dilemma for today’s
obstetricians, as well as a source of anxiety for couples who
experience recurrent pregnancy wastage. It is thought to be
responsible for approximately 15% of habitual immature deliver is
in the 2nd trimester of pregnancy, wherein the cervix begins to
dilate (and not by initiation of contractions) and there’s inability to
hold the weight of pregnancy leading to bulging of the amniotic
membranes into the vaginal canal rupture fetal loss or preterm
birth.
 •Review the causes of cervical incompetence.

•Describe the evaluation of cervical incompetence.

•Summarize the treatment of cervical incompetence.

Objectives: •Explain the importance of improving care coordination

among interprofessional team members to improve
outcomes for patients affected by cervical
incompetence.
What is
Incompetent
Cervix?
In the female reproductive system, the
cervix is the lower end of the uterus.
The cervix is the part of the uterus
which opens into the vagina.

Before pregnancy, the cervix is normally

firm and closed. During pregnancy, the
cervix softens, shortens and dilates
(opens) so you can give birth.
Incompetent
Cervix
- Incompetent cervix is a condition that
refers to the inability of the cervix to hold
the fetus any longer until term because it
has dilated too early.

- Incompetent cervix is also known as

cervical insufficiency. It can cause
problems including miscarriage (a fetus
that dies before birth) and premature birth
(a baby born before organs are fully
developed).
Etiology
History of traumatic birth

Repeated D&C (Dilation and Curettage)

Use of DES (Diethylstilbestrol) while patient was a fetus.

Congenitally short cervix.

Uterine anomalies.
What are the risk
factors for
Incompetent
Cervix?
Women at higher risk for
incompetent cervix include those
who have:
• An abnormally formed cervix or uterus.
• Experienced a premature birth or miscarriage in the second
trimester of pregnancy.
• Injured the cervix or uterus during previous pregnancy or
childbirth.
• Had cervical surgery in the past.
• Been exposed to DES.
In some cases, a genetic condition or disorder can increase your
risk for incompetent cervix. The genetic disorder Ehlers-Danlos
Syndrome can cause structural cervical weakness which can
lead to cervical insufficiency.
 CLINICAL
MANIFESTATION
Signs & Symptoms of
Incompetent Cervix
Incompetent cervix is often asymptomatic (which is why it is so
important for doctors to consider risk factors), although some
women experience mild symptoms. These typically appear
between weeks 14 and 20 of pregnancy, and include the following:
•A sensation of pelvic pressure
•A backache
•Abdominal cramps
•A change in vaginal discharge (volume, color, or consistency)
•Light vaginal bleeding/spotting
•Braxton-Hicks-like contractions
PATHOPHYSIOLOGY
The cervix plays a critical role in protecting the intrauterine
environment. Before parturition, the cervix is firm, composed
predominantly of collagen. Any con­dition that degrades collagen
enhances cervical softening and pliability, which sets the stage
for dilatation. As previously mentioned, this process involves
several mediators, including prostaglandins and cytokines; thus,
it is not surprising that inflammation is frequently seen in the
setting of preterm labor. The cervical canal normally contains
mucus with antibacterial properties. With cervical dilatation,
these antibacterial properties are impaired, increasing the risk of
ascending infection, which subsequently stimulates progressive
cervical dilatation. As a result, the cervix becomes incompetent
to retain intrauterine contents, and preterm delivery ensues.
MANAGEMENT
 Progesterone supplementation

- If the pregnant mother have a history of premature

birth, the doctor might suggest weekly shots of a form
of the hormone progesterone called
Medical hydroxyprogesterone caproate (Makena) during
second and third trimester. However, further research
is needed to determine the best use of progesterone in
cervical insufficiency.
 Repeated ultrasounds

- If the mother have a history of early premature birth,

or have a history that may increase risk of cervical
insufficiency, the doctor might begin carefully

Medical monitoring the length of the mother’s cervix by giving

ultrasounds every two weeks from week 16 through
week 24 of pregnancy. If the cervix begins to open or
becomes shorter than a certain length the doctor might
recommend cervical cerclage.
 Pessary

- Doctor might also recommend the use of a device that fits inside
the vagina and is designed to hold the uterus in place (pessary). A
Medical pessary can be used to help lessen pressure on the cervix.
However, further research is needed to determine if a pessary is an
effective treatment for cervical insufficiency.
Surgical
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.
 Surgical
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

Conservative Management
Bed rest

Avoidance of heavy lifting

Vaginal rest (no coitus)

MIDWIFERY
ROLE
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
Independent
any clots or tissues that already
passed out.
• Determine if the woman is
experiencing true contractions to
prepare for the birth of the fetus.
 Interventions:
• Determine any factors that further
contribute to the anxiety of the
woman so it could be avoided.
Independent • 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.
Evaluation:
• Patient would appear relaxed and
report that anxiety has been
reduced.
• Verbalize awareness of feelings of Independent
anxiety.
• Enumerate ways to deal with
anxiety.
• Use resources or support system
effectively.
 Tests: The physician should order serial
transvaginal ultrasound studies (TVS) for
women with risk factors for cervical
incompetence. Transvaginal ultrasounds
can help monitor the cervical length and
Dependent determine if the cervix is
shortening/opening.
(Doctor’s
Order) Diagnose and he/she operate and
recommend some things to lessen the
impact or pressure of the cervix and the
doctor might recommend some lifestyle and
home remedies after the surgery/treatment.
Collaborative Seek assistance and guide them in managing or take over.
They give optimal care at the appropriate level and do not
(Referral) unnecessarily costly.
 References:

https://nurseslabs.com/incompetent-cervix/

https://my.clevelandclinic.org/health/diseases/17912-incompetent-cervix

https://youtu.be/XMYsLw57azQ

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

https://www.sciencedirect.com/topics/medicine-and-dentistry/cervical-incom
petence

https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/premat
ure-birth-and-prevention/incompetent-cervix/

 
 Torres, Cyrelle Jen
Tulab, Jessabel
Tumamao, Princess
Members
Valdez, Joyce Ann
Viernes, Jireh Faith