Nursing Care Plan (NCP) for Incompetent Cervix

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Outline

Pathophysiology

Incompetent cervix, or cervical insufficiency, is the premature thinning and dilation of the tubular end of the uterus (cervix).  When the cervix is weakened, it cannot withstand the pressure of a growing fetus and begins to open too early. This can lead to premature birth or miscarriage, usually between 14 – 24 weeks gestation. It occurs in 1 out of 100 pregnancies and leads to 25% of second-trimester miscarriages. A cervical cerclage may be placed vaginally to tie the cervix closed until the latter part of the third trimester.

Etiology

Damage to the cervix either through surgery, dilation and curettage, or a previous difficult birth may result in an incompetent cervix. Abnormal Pap smears that require treatments such as LEEP procedures and cone biopsies may weaken the cervix as well. Patients with birth defects that affect the shape of the uterus or cervix are also at higher risk. Advanced maternal age (over 35 years old) may also be a factor of increased risk.

Desired Outcome

Maintain viable pregnancy; avoid preterm delivery or miscarriage

Incompetent Cervix Nursing Care Plan

Subjective Data:

  • Pelvic pressure
  • Abdominal cramping (premenstrual-like)
  • Backache
  • Change in vaginal discharge

Objective Data:

  • Light vaginal bleeding or spotting

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Obtain gynecological history from patient Information regarding previous pregnancies, difficult births, gynecological treatments, abnormal Pap smears and other history can help determine risk
Assess for vaginal discharge; note volume, color and consistency Patients often report a change in vaginal discharge from clear or white to pink or tan, or that there is an increase of discharge and vaginal bleeding
Screen patient for any history of substance abuse. Certain medications and substances may cause premature dilation of the cervix.
Encourage patient to decrease physical activity, avoid exercise and intercourse and take frequent breaks continued pressure on the cervix can cause dilation to progress, thus increasing the risk of preterm labor.
Administer medications as appropriate Tocolytics and Steroids may be given to help stop preterm labor and help the baby’s lungs mature faster

Analgesics (acetaminophen) may be given following cerclage procedure

Assist with amniocentesis Amniocentesis is performed by doctor, but may be required to determine if patient is eligible for cerclage placement.
Prepare patient for cerclage placement Cervical cerclage is done as an outpatient procedure, usually vaginally to tie the cervix closed.  Stitches removed third-trimester pre-labor 
Provide nutrition and lifestyle education maintain healthy weight gain during pregnancy and avoid smoking or drinking alcohol.

Writing a Nursing Care Plan (NCP) for Incompetent Cervix

A Nursing Care Plan (NCP) for Incompetent Cervix starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://www.mayoclinic.org/diseases-conditions/incompetent-cervix/symptoms-causes/syc-20373836

https://my.clevelandclinic.org/health/diseases/17912-incompetent-cervix

Incompetent Cervix: Weakened Cervix

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Transcript

Hello, everyone. We are going to be discussing a nursing plan for incompetent cervix. So, here we go. First, we’re going to go over the pathophysiology. So, this is the premature thinning and dilation of the tubular end of the uterus or the cervix. When the cervix is weakened, it cannot withstand the pressure of the growing fetus. Therefore it begins to open too early. Some nursing considerations: obtain gynecological history, assess for vaginal bleeding, encourage decreasing physical activity, administer medications, assist with an amniocentesis, and educate on nutrition and lifestyle. Some desired outcomes are maintaining viable pregnancy and avoiding a preterm delivery or miscarriage. 

So as we go through the care plan, we’re going to be discussing a lot of the subjective data that we’re going to see in a patient and some objective data. So one of the things that you’re going to hear a patient talk about is some cramping. That’s very, very common. Also any sort of changing of discharge. Those are going to be some of the big things that they’re going to talk about. And also any sort of back pain is also going to be a complaint by the patient. You might also see some light vaginal bleeding or some spotting from the patient as well. 

Some interventions that we’re going to talk about. We want to get a full gynecological history from the patient. So with this, you’re going to want to see about their previous pregnancies, any difficult births that the patient may have had, any sort of gynecological treatments that the patients had, any abnormal pap smears and any other sort of history that might help determine the risk for this patient. We want to assess for a vaginal discharge. So you want to make sure that you’re noting the volume and you are noting the color and the consistency of the discharge. Patients often report a change in the vaginal discharge, usually from a clear color to like a white, or a pink color, maybe even tan. There might be an increase in discharge or vaginal bleeding. You want to get a history of substance abuse; patients typically are on medications or substances that may cause premature dilation of the cervix. Some other interventions that we want to think about with these patients, we want to make sure we’re encouraging them to decrease physical activity and avoid any exercise or intercourse and to take frequent breaks, because ,unfortunately, any sort of continued pressure that is put on the cervix can cause premature dilation, thus increasing the risk of preterm labor. We also want to administer any sort of medications when it’s appropriate, such as tocolytics or steroids as they are going to help stop preterm labor and also help the baby’s lungs mature faster. Also analgesics as they may be complaining of any sort of pain, especially after having a procedure if needed. They may do an amniocentesis, which may be required to determine if a patient’s eligible for the cerclage procedure. When they have a cerclage placement, it’s going to help keep that cervix closed. They will have stitches that are placed by the physician and it will help prevent any sort of preterm labor. And usually they’ll be taken out the third trimester before birth. Other things you want to consider are nutrition and lifestyle education. You want to make sure the mom’s maintaining a healthy weight gain during pregnancy and avoid any sort of smoking or drinking alcohol. 

So some key points that we want to be sure we’re going over patho and etiology of an incompetent cervix. Cervical insufficiency is the premature thinning and dilation of the tubular end of the uterus or cervix damage to the cervix either through surgery, dilation and curettage or previous difficult burst may result in an incompetent cervix. Subjective and objective data. So what are we going to see with these patients? They’re going to have pelvic pressure, abdominal cramping, backache, changes in vaginal discharge, and light vaginal discharge. Making sure you note the volume, color, and consistency. You want to decrease activity and give medication. So encourage decreased activity, avoiding exercise, and intercourse, taking frequent breaks. You may be giving tocolytics that will help with preterm labor and steroids with the preterm labor for lung maturity. Cerclage placement prevents preterm labor. You want to make sure you’re educating the patient to maintain healthy weight gain during pregnancy and also avoid smoking and drinking alcohol. 

You guys are doing wonderful. Thank you so much. We love you guys. Go out, be your best self and as always happy nursing.

 

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