WHAT IS INCOMPETENT CERVIX?

NURSING INTERVENTIONS
●​ Also called premature cervical dilatation or ●​ Assess complaints of vaginal drainage and
cervical insufficiency investigate history for previous cervical surgeries.
●​ Refers to a painless premature dilatation of the ●​ Prepare woman for cervical cerclage under
cervix; often leads second-trimester pregnancy loss regional anesthesia as indicated; monitor maternal
or preterm birth. vital signs and fetal heart rate patterns closely
●​ Generally occurs in the 4th to 5th month of ●​ Instruct the woman for signs and symptoms of
gestation or 20th weeks AOG labor with the need to notify the health care
provider if anything occurs.
PATHOPHYSIOLOGY ●​ Maintain bed rest after surgery as ordered; if
●​ Associated with congenital structural defects or necessary, place the woman in a slight or modified
previous cervical trauma resulting from surgery or Trendelenburg position to alleviate pressure of the
delivery. uterus on the sutured area.
●​ Also associated with increasing maternal age. ●​ Encourage follow-up to evaluate progress of
●​ Structural Weakness – Congenital or acquired pregnancy
defects in cervical connective tissue reduce its ●​ Advise the woman that the sutures will be removed
ability to withstand intrauterine pressure. around the 37th to 39th week of pregnancy.
●​ Altered Collagen Composition – A deficiency or
imbalance in collagen and elastin weakens the POSSIBLE COMPLICATIONS
cervical tissue. ●​ If left undiagnosed or untreated, cervical
●​ Hormonal Influence – Increased relaxin and insufficiency can lead to serious complications,
progesterone levels may soften the cervix including:
excessively. 1.​ Pregnancy Loss
●​ Inflammatory Processes – Infections or chronic ●​ Second-trimester miscarriage: The cervix may
inflammation (e.g., chorioamnionitis) can degrade open too early, leading to the premature expulsion
cervical integrity. of the fetus before viability (before 20-24 weeks).
●​ Recurrent pregnancy loss: Women with an
●​ Mechanical Trauma – Previous cervical surgeries
incompetent cervix often experience multiple
(e.g., LEEP, cone biopsy), repeated dilation and second-trimester losses.
curettage (D&C), or difficult deliveries can cause 2.​ Preterm Birth
scarring or damage. ●​ Preterm labor and delivery: Cervical insufficiency
can cause the baby to be born too early (before 37
ASSESSMENT weeks), increasing risks of neonatal
●​ History of repeated second trimester spontaneous complications like respiratory distress syndrome,
infections, and developmental delays.
abortions
3.​ Infection Risks
●​ Cervical dilation in the absence of contractions or ●​ Chorioamnionitis: Infection of the amniotic sac
pain and fluid due to early cervical dilation, which allows
●​ Pink-stained vaginal discharge bacteria to ascend from the vaginal canal.
●​ Increased pelvic pressure with possible ruptured ●​ Sepsis: Severe infection spreading to the mother
membranes and release of amniotic fluid. and fetus, leading to systemic complications.
4.​ Premature Rupture of Membranes (PROM)
●​ Preterm premature rupture of membranes
DIAGNOSTIC TEST FINDINGS
(PPROM): The amniotic sac can rupture too early,
●​ Ultrasound revealing defect - Gold Standard increasing the risk of infection, preterm labor,
-​ Measures cervical length (< 25 mm before 24 and neonatal complications.
weeks is concerning). 5.​ Psychological and Emotional Impact
-​ Detects funneling (progressive opening of the ●​ Emotional distress: Recurrent pregnancy loss or
internal os). preterm birth can cause significant emotional and
psychological trauma, including anxiety,
●​ Nitrazine test result indicates rupture of
depression, and PTSD.
membranes if it has occurred 6.​ Complications in Future Pregnancies
●​ Pelvic Exam ●​ Increased risk of recurrent cervical
-​ Digital examination may reveal a soft, shortened, insufficiency: Women with one occurrence of
or dilated cervix. cervical insufficiency have a higher likelihood of
●​ Placement of cerclage in the cervix help keep the experiencing it in future pregnancies.
cervix closed until term or the patient goes into ●​ Need for cervical cerclage: Some women may
labor require a cerclage (surgical stitching of the cervix)
in subsequent pregnancies to prevent premature
MCDONALD’S PROCEDURE opening.
●​ Using nylon sutures horizontally and vertically to
close off the cervix to only a few millimeters.

SHIRODKAR PROCEDURE
●​ Using sterile tape in a purse-string fashion to close
off cervix entirely

MANAGEMENT
●​ Bedrest after surgery
●​ Removal of sutures at 37 to 39 weeks AOG
●​ Emotional support