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Incompetent Cervix
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.
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
- 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
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