Cervical Insufficiency Flashcards
It is a long, narrow passage at the end of the uterus that connects to the vagina.
Cervix
Refers to a cervix that dilates & effaces prematurely without uterine contractions
- usually occurs at approximately 20 weeks gestation when fetus is still too immature to survive.
Incompetent cervix
Risk Factors of Cervical Insufficiency
- Increased Maternal Age
- Congenitally short cervix
- Diagnosis of an incompetent cervix in previous pregnancy
- Multiple pregnancies
- Macrosomic babies
- DES (Diethlystilbestrol) exposure during pregnancy
Why is having a short cervix a risk factor for cervical insufficiency?
Fetal movement can cause cervix to open
Is a synthetic estrogen but has a different chemical structure compared to recent synthetic estrogens
Diethylstilbestrol
Why is DES exposure during pregnancy a risk factor for cervical insufficiency?
Can interfere with normal development of the cervix in female offspring
- underdeveloped, less elastic, or structurally weak cervixes
Why were surgical procedures involving the cervix in cases of miscarriages banned in 1971?
Causes weaking of the cervix
Common Signs & Symptoms of cervical insuffiency
- Pelvic pressure
- Lower back pain
- Mild Abdominal cramps
- Spotting or light vaginal bleeding
- Sensation of vaginal bulging
Advance Symptoms of Cervical Insuffiency
- Painless cervical dilation
- Amniotic sac bulging into the vagina
- Sudden rupture of membranes
- Early contractions (rare)
How to determine if amniotic sac is bulging into the vagina?
Seen in ultrasound or felt upon examination
Diagnostic Indicators
- History Taking
- Pelvic Exam
- Ultrasound
What to ask during history taking?
History of 2nd trimester pregnancy losses or preterm birth - particularly if they were painelss
What is seen on an internal examination?
Incompetent cervix can reveal partial dilation & effacement
Refers to the internal part of the cervix starting to open while the external part remains closed
Funneling of the cervix
Seen on UTZ
Complications of Cervical Insuffiency
1) Pregnancy Loss (Miscarriage) / Fetal Demise
2) Preterm Birth
3) Preterm Premature Rupture of Membranes
4) Infection
Pregnancy Loss
Cervic opens too soon, amniotic sac may rupture leading to preterm labor or miscarriage
Why is a premature baby at higher risk of neonatal respiratory distress syndrome?
Due to lung immaturity
Preterm Premature Rupture of Membranes
Weaken cervix allows the amniotic sac to bulge through the cervical opening, putting pressure on feral membranes. Leading to early rupture before 37 weeks, increasing risk of preterm labor
A life-threatening infection of the amniotic sac
Chrorioamnionitis
A severe blood infection that can endanger both the mother and the baby
Maternal sepsis
Goal of Treatment for Cervical Insufficiency
To strengthen the cervix & prevent premature cervical dilation until the end of the pregnancy
Treatments
1) Cervical Cerclage
2) Progesterone Therapy
3) Pessary (Cervical Support Device)
4) Monitoring & Early Detection
5) Address emotional & physical needs
6) Bed res, activity modification
Main treatment for cervical insufficiency
- a surgical procedure that involves temporarily stitching the cervix to close it using sutures / tape
- cannot be performed once (+) ROM
Cervical Cerclage
Timing of Cervical Cerclage
- Usually between 12-14 weeks (elective) but can be done up to 24 weeks in emergencies
- Cervix is still firm & less likely to be dilated or effaced.
Why not place a cerclage when uterus is already larger?
Uterus is already more irritable which can trigger uterine contractions and can lead to preterm labor.
Types of Cerclage
1) Transabdominal Cerclage
2) Transvaginal Cerclaage
3) McDonald Cerclage
4) Shirodkar Cerclage
Type of Cerclage
Done for severe cases; placed higher up through the abdominal surgery.
- permanent solution for cervical insuffiency.
- C-section delivery
- Removed when no more plans of conceiving or in rare cases of infection
Transabdominal cerclage
Types of Cerclage
Purse-string sutures are placed around the cervix through the vagina.
Transvaginal cerclage
Types of Cerclage
Most common, using a purse-string suture
McDonald Cerclage
Types of Cerclage
More deeper, placed deeper into the cervix
Shirodkar cerclage
A hormone that helps strengthen the cervix and prevent early contractions
Progesterone Therapy
Route of Progesterone therapy
Vaginal progesterone suppositories
A soft-ring shaped device placed around the cervix to help keep it closed.
- alternative for those who cannot have cerclage surgeries
- recommended for singleton pregnancies
Pessary (Cervical Support Device)
