Incompetent Cervix

Pregnancies are a gift of life. Women feel complete once they have undergone this event in their lives, and no matter how great a change occurs, they can always adjust and immerse fully into the role of a mother. However, when peril occurs during pregnancy, nurses are always there to extend their knowledge to the woman and her folks. Incompetent cervix, also known as cervical insufficiency, is a challenging obstetric condition that poses significant risks to pregnancy outcomes. This condition occurs when the cervix begins to efface and dilate prematurely, often leading to late miscarriages or preterm births. As caring and knowledgeable nursing professionals, understanding the complexities of incompetent cervix and providing comprehensive care is essential to support women facing this distressing and potentially devastating diagnosis.

This article aims to provide nursing professionals with a comprehensive guide to incompetent cervix, including its etiology, risk factors, clinical manifestations, and evidence-based interventions. By equipping nurses with the knowledge and tools necessary to recognize and manage incompetent cervix, we aim to improve pregnancy outcomes and ensure emotional support for women navigating this difficult journey.

Table of Contents

• What is Incompetent Cervix?
• Pathophysiology
• Risk Factors
• Signs and Symptoms
• Diagnostic Tests
• Medical Management
• Surgical Management
• Nursing Management
  • Nursing Assessment
  • Nursing Diagnosis
  • Nursing Interventions
  • Evaluation

What is 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 prematurely.

Pathophysiology

1. When the fetus reaches its 20^th week, it starts to become heavy and gain fats.
2. The mother’s cervix is weak, and it could not hold the fetus’ weight anymore as it slowly starts to dilate.
3. This would cause the appearance of a show, a pink-tinged vaginal discharge.
4. Then, the membranes would rupture and amniotic fluid would be discharged.
5. Uterine contractions would start followed by a short labor, then the birth of the fetus.

Risk Factors

The causes of incompetent cervix are somehow difficult to explain, but it is believed to be associated with the following:

• Increased maternal age. The muscles around the cervix start to slowly lose its elasticity because of increasing age, and could contribute to the weakening of the cervix.
• Congenital structural defects. There are defects might contribute to the cervix’ incapability of holding in the fetus.
• Trauma to the cervix. Any trauma experienced by the cervix could weaken the muscles surrounding it, thus leading to its premature dilation.

Signs and Symptoms

The signs and symptoms of every danger to a pregnancy must be reviewed by the health care provider to the woman on her clinic visit. This could give her ideas on how to further take great caution of her pregnancy.

• Show. This is a pink-tinged vaginal fluid that is discharged from the vaginal opening as a sign that the cervix has dilated.
• Increased pelvic pressure. The fetus is already descending, causing a pressure felt by the mother on her pelvis.
• Cervical dilation. Upon inspection of the physician, the cervix would show dilation.

Diagnostic Tests

There are few diagnostic tests that could detect an incompetent cervix before it usually happens. It is usually diagnosed after the pregnancy has already been lost.

• Ultrasound. This is the only test that the physician could order if an incompetent cervix is already suspected.

Medical Management

Medical management by the physician would not include any medications that could hinder the dilation of the cervix. Surgical procedures are immediately enforced to prevent compromising the pregnancy.

Surgical Management

There are two types of surgical management for incompetent cervix:

• 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.
• 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
• These sutures are removed on the 37^th or 38^th week of pregnancy for the fetus to be born vaginally.

Nursing Management

As nurses, here is what we could do to help in our own way.

Nursing 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 any clots or tissues that already passed out.
• Determine if the woman is experiencing true contractions to prepare for the birth of the fetus.

Nursing Diagnosis

• Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix.

Nursing Interventions

• Determine any factors that further contribute to the anxiety of the woman so it could be avoided.
• 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.
• Provide accurate information about the situation to help client back into reality.

Evaluation

• Patient would appear relaxed and report that anxiety has been reduced.
• Verbalize awareness of feelings of anxiety.
• Enumerate ways to deal with anxiety.
• Use resources or support system effectively.

Once a pregnancy is deemed dangerous, extra care is enforced to ensure the safety of your little one. As health care providers, we have to collaborate with each other to preserve a life that is sure to contribute a lot when he is already out in the world.