Incompetent Cervix
Included In This Lesson
Study Tools For Incompetent Cervix
Outline
Overview
- An incompetent cervix occurs when the cervix begins to thin and shorten too early in a pregnancy.
- Prior to 28 weeks
Nursing Points
General
- Dilation and effacement occur without contractions
- Dilation = widening
- Effacement = thinning
- Risk for miscarriage or preterm birth.
Assessment
- Vaginal bleeding or discharge (progressing from clear/white to pink/tan)
- Pelvic pressure
- Cramping
- Backache
Therapeutic Management
- Prevent contractions
- Bed rest, fluids, meds (tocolytics)
- Prepare for placement of a cervical cerclage (suture) if it appears that the pregnancy has been threatened
- May be monitored overnight for premature labor
- This reinforces the cervix, preventing further premature dilation
- Contraindications for cerclage
- Ruptured membranes
- Labor
- Intrauterine or vaginal infection
- Pregnancy beyond 28 weeks
- Fetus is too low in cervix
Nursing Concepts
- Reproduction
- Safety
- Patient Education
Patient Education
- Importance of bedrest and decreasing activity
- After cerclage – must educate on symptoms of infection, PROM, contractions
- Educate not to have sex or do much activity for a prescribed amount of time
- Educate to notify MD if contractions or bleeding
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Incompetent Cervix
Transcript
In this lesson I will explain about incompetent cervix, risk factors, treatment and your role in providing this care.
So what is an incompetent cervix? This is a cervix that can’t maintain the pregnancy. It starts to dilate and efface too early in the pregnancy. Dilation is widening of the cervix and effacement is the thinning. For a visual I want you to picture this donut. The circle in the middle is going to open up and get bigger or wider. That is the dilation. The flattening of the donut, so if you put it in your hand and squeezed it flat that is effacement. This patient is at risk for miscarriage or preterm birth if we don’t stop this from occurring.
Let’s talk about what your patient will look like that has an incompetent cervix. On assessment your patient will have vaginal bleeding or discharge. This could be clear or white discharge that progresses to pink spotting. The patient might complain of pelvic pressure. This pressure can sometimes make them feel like they are going to have a bowel movement. Cramping is another complain the patient might have. The uterus is irritating by what is occurring and causing cramping or contractions. Backaches can occur because of the uterine contractions and cramping that can radiate to the back.
Our management of this patient is going to involve preventing the cervix from making changes. So we want to prevent contractions. Contractions cause cervical change to happen. Imagine a water balloon. When you squeeze it the water is pushed down. With the uterus contractions it pushes the contents down. So it pushes the fetus and bag of water down which presses on the cervix and causes changes to occur like dilation and effacement. We can prevent contractions with bed rest, IV fluids, and tocolytic medication such as terbutaline. IV fluids help because if the patient is dehydrated it will cause the uterus to contract. The best way to manage this patient is with a cervical cerclage. As you can see in this picture there is a suture around the cervix keeping it closed. This is a stitch that goes through the cervix to keep it closed. Think of it as a reinforcement to prevent further dilation. When the patient receives a cerclage she may be monitored overnight for premature labor. This is great but there are some contraindications. If the patient has ruptured membranes, or is in true labor, or intrauterine infections. We don’t want to put a stitch that would keep the infection in. If the pregnancy has gone beyond 28 weeks then a cerclage wouldn’t be placed.
We need to educate on the importance of bedrest and/or decreasing activity. We want to keep the body calm to prevent contractions. If the patient has had a cerclage then she must be educated on symptoms to watch for. She needs to watch for signs of infection, rupture of membranes, and contractions. The patient might need to abstain from intercourse. Remember that this could cause oxytocin to be released which can cause contractions. She needs to also understand the importance of notifying the MD for contractions or bleeding.
Nursing concepts are reproduction, safety and patient Education. The patient has reproduced. We need to keep her fetus safe and the patient pregnant and there is a lot of education that revolves around having a cerclage and maintaining a pregnancy.
Let’s now review and look at our key points to remember. An incompetent cervix dilates and effaces and can not hold the pregnancy. So we can treat with a cerclage. The cerclage is a stitch that holds the cervix together and maintains the pregnancy. Contraindications are ruptured membranes or labor because that just means it is inevitable and delivery needs to happen. If there is an infection we do not want to cerclage because it is going to hold the infection in. If the patient is beyond 28 weeks they will usually not do a cerclage and just monitor until delivery. The patient will be taught signs to report. If she has signs of infection such a temperature she needs to report. If she has any leaking of fluid, bleedings or signs of labor she needs to notify the doctor.
Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
- Anxiety Disorders
- Depressive Disorders
- Trauma-Stress Disorders
- Substance Abuse Disorders
- Bipolar Disorders
- Psychotic Disorders
- Concepts of Mental Health
- Eating Disorders
- Personality Disorders
- Health & Stress
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Note Taking
- Concepts of Population Health
- Basics of Human Biology