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. Incompetent cervix likely affects more women than reported, but occurs in approximately 1 out of 100 pregnancies. It is estimated that 25% of second-trimester miscarriages are due to incompetent cervix. A cervical cerclage may be placed vaginally to tie the cervix closed until the latter part of the third trimester, but not all patients are candidates for this procedure.
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
- Obtain gynecological history from patient
Information regarding previous pregnancies, difficult births, gynecological treatments, abnormal Pap smears and other history can help determine if the patient is high 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 in the amount of discharge. Light vaginal bleeding may also be noted.
- 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
It is believed by many that 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. The stitches will be removed toward the end of the third trimester before labor begins.
- Provide nutrition and lifestyle education
Encourage patient to maintain healthy weight gain during pregnancy and avoid smoking or drinking alcohol.
References
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell
