Incompetent Cervix - Nursing Case Study

by - June 16, 2020

DESCRIPTION:
Premature cervical dilatation or known as incompetent cervix is when the cervix of a woman dilates prematurely and therefore the fetus cannot retain until term. At first, a woman will show a pink – stained vaginal discharge or increased in pressure which is followed by rupture of membranes and discharge of amniotic fluid. There will be a uterine contractions and short labor will happen until the fetus will be born. Unfortunately, this usually occurs at week 20 of pregnancy wherein the fetus is still too immature to survive.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
A woman with an incompetent cervix might experience a sensation of pelvic pressure, mild abdominal cramps, back pain, and increased in pink – stained vaginal discharge. The healthcare provider might observe that the woman is not experiencing pain while the cervix is dilating, a bulging of fetal membranes during the second trimester, preterm premature rupture of membranes (PPROM), and a rapid delivery of a previable infant.

DIAGNOSTIC AND LABORATORY TEST:
Transvaginal ultrasound, pelvic examination, and laboratory tests are needs to perform in order to diagnose this condition. Ultrasound should be done to see if the cervix is competent or not and in order to measure the length of the cervix and check if the membranes are protruding, transvaginal ultrasound is needed. A transducer will be inserted inside the vagina to send out sound waves that will generate images on monitor. Pelvic examination will be done to see if the amniotic protrudes through the opening and will check if there is contractions that is needed to monitor, if necessary. Lab tests is also needed in order to check if there is an infection in the amniotic sac and fluid called chorioamnionitis.

RISK FACTORS:
This condition is often associated with increased maternal age, congenital conditions, and cervical trauma. If a woman is old enough and she got pregnant she is at risks to this condition because her cervix is weak enough to keep it intact until the term delivery since their muscles around the cervix starts to lose its elasticity. Congenital structure defects may be the cause of cervical insufficiency because uterine abnormalities and genetic disorders affects the fibrous type of protein that makes up the body’s connective tissue or collagen. When a women has a trauma to the cervix due to cone biopsy or repeated dilation and curettage (D&C) could weaken the surrounding muscles of the cervix thus leading it to this kind of condition.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix
Deficient Knowledge related to lack or recall
Grieving related to perceived potential fetal loss
Risk for Fetal Injury related to premature dilation of cervix
Risk for Disturbed Maternal – Fetal Dyad related to premature dilation of cervix

NURSING CARE PLAN:
Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix
Deficient Knowledge related to lack or recall
Grieving related to perceived potential fetal loss
NURSING MANAGEMENT / INTERVENTION:
After performing the cervical cerclage, the nurse should advise the woman to have a bed rest for a few days to decrease the pressure on the new sutures. They should be aware that their usual activities and sexual relations can be resumed after the rest periods. If they get pregnant again, it is certain to ask women who are reporting painless bleeding whether they had past cervical operations to remind them that may have sutures in place. They must be informed that their sutures will only be removed at 37 to 38 weeks of pregnancy so the fetus can be born vaginally. But when she had a transabdominal route during their suturing, the sutures must be left in place and a cesarean birth will be performed.

MEDICAL / SURGICAL MANAGEMENT:
In order to treat this condition, a surgical operation called cervical cerclage will be performed in order to prevent this situation from happening again on the next pregnancy. When a women become pregnant again and it was confirmed that it is a healthy pregnancy on the 12 to 14 weeks, a purse – string sutures will be placed on the cervix by vaginal or transabdominal route under regional anesthesia. This suturing have two kinds, the first one is McDonald procedure in which a nylon suture will be placed horizontally and vertically across the cervix and pulled tight to reduce the cervical canal to few millimeters in diameter and the second one is Shirodkar technique where a sterile tape is threaded in a purse – string manned under the submucous layer of the cervix.

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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