Cervical incompetence Flashcards
What is Cervical Incompetence?
Painless dilation and shortening of the cervix, before the 37th week of gestation, in the absence of preterm labor→ :
1. Membrane prolapse
2. Premature rupture of membranes (PROM)
3. Mid-trimester pregnancy loss
4. Preterm birth
The causes Cervical Incompetence can be classified into?
Congenital and Acquired
What are the congenital causes of Cervical Incompetence?
Müllerian duct anomalies
What is another name for Cervical Incompetence?
Cervical Insufficiency/Cervical weakness
What is another name for Müllerian ducts?
Paramesonephric ducts
What is the purpose of the Müllerian ducts?
they develop into the: uterus, fallopian tubes, cervix and upper 2/3rds of the vagina during embryogenesis
Müllerian duct anomalies causes what?
structural abnormalities in the female reproductive system
What are the acquired causes of cervical incompetence?
- Conization of cervix
- Amputation of cervix
- Precipitous labor
- Repeated therapeutic abortion
- Instrumental delivery in an incompletely dilated cervix
What is another name for Conization of cervix
Cold Knife Cone (CKC) / Conical biopsy
What is conization of cervix?
the excision of a cervical lesion by removing the cone-shaped portion of the cervix and the entire transformation zone
What is precipitous labor?
when a baby is born < 3 hours of regular contractions
How do you diagnose Cervical incompetence?
Diagnosis is based on either your history or a combination of Speculum examination findings + Cervical measurements on Transvaginal U/S
What in information in your medical history suggest Cervical incompetence?
- H/o recurrent mid-trimester pregnancy losses
- H/o Preterm labor and delivery
- H/o Premature rupture of membranes (PROM) followed by the painless expulsion of the products of conception.
- H/o prior pregnancy with a cervical length < 2.5 cm before 27 weeks gestation
- H/o cervical trauma e.g.:
♦Repeated therapeutic abortion
♦Repetitive cervical dilatation
♦Cone biopsy
♦Cervical tears and lacerations
♦Trachelectomy
What findings on speculum exam during pregnancy suggest Cervical Incompetence?
Dilation of cervix with bulging or sacculation of membranes
What findings on speculum exam in a nonpregnant state suggest Cervical Incompetence?
- You can easily pass a # 8 Hegar’s dilator through the internal os, without closure.
- Very little traction (< 600g ) needed to pull a # 14 Foley catheter inflated with 2ml saline from the uterus after placement.
- Cervical funneling on Hysterosalpingogram (HSG)
- The Canal/Cannula ratio using hysteroscopy is 1.5 or more
What is a Cervical compliance index?
What is the treatment for Cervical incompetence?
Cervical cerclage
Another name for Cervical cerclage
Cervical stitch
What is a Cervical Cerclage
an operation where a stitch is placed around the cervix to temporarily close it.
During what gestational period is a Cervical Cerclage usually done?
Between 12-24weeks
Why is a Cerclage done between 12 and 24 weeks gestation?
- Cervical insufficiency does NOT manifest itself before mid-second trimester.
- By this time fetal anomalies would have been ruled out by U/S.
- Chromosomally abnormal fetuses would have been spontaneously aborted
What are the 2 main techniques used for a transvaginal cerclage?
- MacDonald approach
- Modified Shirodkar approach
What suture materials are used during the MacDonald approach?
A Mersilene or Prolene suture
Why is a Mersilene suture preferred over a Prolene suture ?
A Mersilene suture is a braided suture with a larger surface area than a Prolene, so when applied, its less likely to cut through the cervix.
Which suture is preferred in the MacDonald approach?
Mersilene suture
Why would some surgeons still use a Prolene suture, when a Mersilene is preferred?
A Prolene suture is cheaper, easier to remove and more available than a Mersilene suture.
