References:
- Dr. RPS Maternal and Newborn Care: A Comprehensive Guide and Source Book for Teaching and Learning, 2nd Edition, ISBN 978-971-98-2265-3, by Rosalinda Parado Salustiano (pp. 117-195)
- Lecturer (V)
A condition characterized by a mechanical defect in the cervix causing cervical effacement, dilation, and expulsion of the products of conception in the mid-trimester of pregnancy. Pregnant women are at risk for an incompetent cervix if they (a) have a congenital defect of the cervix (short cervix), (b) trauma to the cervix as in forceful dilatation, curettage, and difficult delivery, and (c) cervical lacerations procedures (conization, cauterization).
This appears as:
- Painless contractions resulting in the delivery of a dead or non-viable fetus
- History of abortions (habitual abortion)
- Finding of a relaxed cervical os on pelvic examination
Treatment and Nursing Management
Cervical cerclage during the 14th and 16th week of gestation or prior to the next surgery. A suture or ribbon is placed beneath the cervical mucosa to close the cervix during pregnancy to help prevent pregnancy loss or premature birth. This may be done via:
- Shirodkar-Barter Cerclage: a permanent suturing of the cervix, with future pregnancies delivered via cesarean section.
- McDonald Cerclage: a temporary purse-string suturing of the cervix removed at term in preparation for a vaginal delivery.