Incompetent Cervix as one of the Antenatal complications
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Transcript of Incompetent Cervix as one of the Antenatal complications
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INCOMPETENT
CERVIX
Reported by:
Agripo, Kenje Kate T.Oja, Grezzly
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INCOMPETENT CERVIX
Definition:
- Also called premature cervical dilation or
cervical insufficiency
- Refers to a painless premature dilation
of the cervix without contractions therefore
cannot hold a fetus until term
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INCOMPETENT CERVIX
Risk Factors:1. Congenital conditions
-Uterine abnormalities and genetic
disorders
- Exposure to diethylstilbestrol (DES)
2. Obstetric trauma
3. Dilation and curettage
4. Certain cervical procedures-Cone Biopsy
5. Unusually short cervix
6. Spontaneous abortion
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INCOMPETENT CERVIXDiagnostic Test:
1. Pelvic Exam
-Also called as internal or
vaginal exam
Procedure done:
Caregiver gently puts a warmed speculum
into the vagina.
This let the caregiver see the cervix(bottom
part of the uterus)
With gloved hands, the cargiver check thesize of the uterus and ovaries
2. Transvaginal
Ultrasound
-Monitor the cervical length
and to see if the cervix is
opening
Procedure done:
A slender transducer is placed in thevagina to send out sound waves
Gather pictures of the uterus, ovaries,
or cervix are seen on a TV- like screen
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INCOMPETENT CERVIX
Cervical Cerclage
Surgical Management:
-Suturing of the cervix early in the pregnancyto reinforce its opening and prevent premature
dilation and effacement
- The stitch is inserted surgically while the
patient isunder spinal, epidural, or general
anesthesia
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INCOMPETENT CERVIX
Types of Cervical Cerclage:
1. Mcdonalds Stitch
(Not permanent and houldbe taken out)
A purse string stitch around
the cervix to cinch it together
Stitch goes in & out of the
skin covering the cervix until
it is all the way around, the
string is seen in several placesas it comes out of and goes
back into the cervical skin all
around the cervix
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INCOMPETENT CERVIX
Types of Cervical Cerclage:2. Shirodkar Stitch
(Either be permanent or taken
out during near term)
A purse string stitch around
the cervix underneath the
skin of the cervix to help
cinch it together
The stitch is underneath the
skin of the cervix and
sutures are made through
the walls of the cervix so
theyre not exposed
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INCOMPETENT CERVIX
Types of Cervical Cerclage:
3. Abdominal Stitch
(Permanent)
A stitch around the lower part
of the uterus through an
abdominal incision to cinchthe lower part of the uterus
and upper cervix together.
Stitch is done at the very topof the cervix inside the
abdomen
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INCOMPETENT CERVIX
Pathophysiology:-During that time it is a firm structure that
predominantly consist of collagen , but in the prelude
to parturition the collagen is degraded and the cervix
becomes soft and pliable enough to dilate
-Infection and inflammation are causally related to
preterm labor and cervical ripening
-This relates to the cervical properties as the chance ofpreterm delivery is inversely related to the length of
the cervical canal, which contains mucus with
antibacterial properties.
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INCOMPETENT CERVIX
Pathophysiology:
-If the mechanical or antibacterial properties of the
cervix are functionally impaired, by surgery, trauma
to the cervix , the remaining strength of the cervixmay be insufficient to retain the pregnancy.
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INCOMPETENT CERVIX
NURSING PROCESS
ASSESSMENT
Cervical dilation in the absence
of contractions or pain
Pink-stained vaginal discharge
Increased pelvic pressure w/
possible ruptured membranes
and release of amniotic fluid
DIAGNOSIS
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INCOMPETENT CERVIX
NURSING PROCESS
PLANNINGAfter 8 hours of student-nurse
interaction, the client will be able
to :
INTERVENTION
Measures to promote:
Prepare the patient for cervical
cerclage under regionalanesthesia as indicated;
monitor maternal vital signs
and FHR patterns closely
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INCOMPETENT CERVIX NURSING PROCESS
INTERVENTION
Measures to promote:
Instruct her in signs and
symptoms of labor with the
needs to notify health careprovider if any occur
Maintain bed rest after surgery
as ordered; if necessary, place
the patient in a slight ormodified Trendelenburg
position to alleviate pressure of
the uterus on the sutured area
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INCOMPETENT CERVIX NURSING PROCESS
INTERVENTION
Measures to promote:
Encourage follow-up to
evaluate progress of
pregnancy
EVALUATION