Incompetent Cervix
Harold Bryant 6/23/2011

This brief report attempts to define what an Incompetent Cervix is, what are it s causes as well as lists and defines some of the treatment options currently available for this condition.

and is made when the cervical os (opening) isgreater than 2.  In a woman with cervical incompetence. Cervical incompetence occurs because of weakness of the cervix. rupture of the membranes and birth of a prematurebaby can result.cervical incompetence is relatively rarein the United States. dilation and effacement of the cervix mayoccur without pain oruterine contractions. internal os (portion of the cervixcloser to the baby) has begun to efface. w h i c h can cause anatomical defects.  In a normal pregnancy. d i l a t io n a nd e f f a c e m e nt o c c u r s i n r e s p o n s e to uterinecontractions.  If the responses are not halted. The use of ultrasonographyhas been very helpful wit h the diagnosis.  It may causemiscarriageorpreterm birthduring the second and third trimesters.Diagnosis can be made either manually or with ultrasonography. occurring in only 1²2% of all pregnancies.5 cm. The external os will be unaffected if diagnosed intime. or the length has shortened to less than 20 mm. Risk factorsfor premature birth or stillbirth due to cervical incompetence include: ‡Cervical Trauma ‡Hormonal influences ‡Congenitally short cervix ‡Forced D & C ‡Uterine anomalies ‡Diagnosis of cervical incompetencein a previous pregnancy. this is where the internal portion of the cervix. especially duringlate pregnancy) appear to create arisk. ‡Diethylstilbestrole x p o s u r e . ‡Previous preterm prematurerupture of membranes.It is generally categorized as premature opening of the cervix without labor or contractions. Sometimes funnelingis also seen. A medical condition in which apregnantwoman'scervixbegins todilate(widen) andefface(thin) before her pregnancy has reached term. and ‡Uterine anomalies ‡Repeated procedures (such asmechanical dilat ion. According to statistics provided by theMayo Clinic.which is made to open by the growing pressure in the uterus as pregnancyprogresses. but it is thought to cause asmany as 20²25% of miscarriages in the second trimester. .

. ending back in the 12 o'clock posit ion onthe other side of the cervix. fever over 101. and burning.Intercourse is also restricted once the stitch is in place due to increased risk of infection andtrauma to the cervix.How the stitch is tied off determines whether it will be removed or if it is permanent. It is also pulled tightly and tied to keep the cervix closed. premature rupture of t he m e m b e r s . It is often placedbetween 12-15 weeks in pregnancy. ‡The Hefner cerclageis commonly used when incompetent cervix is diagnosedlater in pregnancy. In cases of extensive cervical trauma or an anatomical defect. tearing of the cervix from excessive pressure. It is important to look for signsof increased discharge with odor. The st itch is weaved in and out of the cervix and pulledtightly and tied to keep the cervix closed.Once the cerclage has been placed. injury to the bladder. The cerclage is a purse-string stitch (suture) that acts as an cinch to keep the cervix from dilating. Spotting can occur as well as cramping. ‡The Shirodkar stitchcan be both permanent (requiring a cesarean section) and itcan be removed near term. it is urgent you contact yourphysician. A cesarean sect ion isrequired for delivery. maternal hemorrhage. This cerclage is removed closer to term as well. Theupper and lower partofthe cervix is st itched together. p r e . which involves a surgical procedure called a cerclage. epidural. you will be put on bed-rest from a period of 24-72 hours.Treatment Once inco mpetent cervix has been diagnosed. This st itch is started at a 12 o'clock posit ion. It has an added benefit when there is litt le cervix to work with. workedthrough the cervix to a 6 o'clock posit ion. although there is a chance that the woman may still need to spend the night in thehospital if she begins to experience cramping or extensive bleeding. ‡An abdo minal st itchis used when there is too litt le cervix to work with. a woman undergoes treatment for futurepregnancies. If you notice any of these symptoms. u t e r i n e rupture. this st itch can be used. The st itch is inserted surgically while the patient isunder spinal. or general anesthesia. c ho r io a m n i o n it i s ( i n f e c t io n o f t he m e m b r a n e s ) .t e r m l a bo r . ‡The Lash cerclageis the only type that is placed prior to pregnancy. heavy bleeding. They include infection.It is important to discuss risks with your doctor prior to undergoing surgery for a cerclage. itching. Often t imes the procedure is an outpatientsurgery. and rarely. orheavy cramping. There are 5 types of cerclages that can be used: ‡The McDonald st itchis the most common for it is the easiest to use and canallow for vaginal delivery. . It ispermanent and requires a cesarean delivery. There could be a restriction of activity or possibly continued bed-rest if complications occur.

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