Nursing Care Plan (NCP) for Incompetent Cervix

Understanding of Incompetent Cervix:
- Gain a comprehensive understanding of incompetent cervix, including its definition, causes, and risk factors, to provide effective care and education.
Recognition of Signs and Symptoms:
- Learn to recognize the signs and symptoms of incompetent cervix, such as painless cervical dilation and second-trimester pregnancy loss, enabling early identification and intervention.
Risk Assessment and Prevention:
- Understand the risk factors associated with incompetent cervix and the preventive measures, including cervical cerclage and progesterone supplementation, to promote optimal maternal and fetal outcomes.
Maternal and Fetal Monitoring:
- Explore methods for monitoring both maternal and fetal well-being, including cervical length measurement via ultrasound, to identify any deviations from the norm and implement timely interventions.
Patient Education and Support:
- Develop strategies for patient education and emotional support, empowering expectant mothers with the knowledge and resources needed to actively participate in their care and make informed decisions.

Pathophysiology of Incompetent Cervix

Structural Weakness:
- Incompetent cervix is characterized by the structural weakness of the cervix, particularly the cervical tissue and its supporting structures.
Connective Tissue Changes:
- Changes in the connective tissue of the cervix, often related to a combination of genetic and environmental factors, contribute to its inability to withstand the pressure of a growing fetus.
Cervical Dilation:
- The cervix may start to dilate prematurely, usually during the second trimester, without the presence of contractions or labor. This early dilation can lead to pregnancy loss or preterm birth.
Absence of Symptoms:
- Incompetent cervix often progresses without noticeable symptoms, making early detection challenging. As a result, it may only be identified after the occurrence of pregnancy loss or preterm birth.
Repeated Pregnancy Loss:
- Women with an incompetent cervix may experience recurrent second-trimester pregnancy losses or preterm deliveries, emphasizing the need for proactive monitoring and interventions in subsequent pregnancies.

Etiology of Incompetent Cervix

Structural Abnormalities:
- Congenital or acquired structural abnormalities of the cervix, such as a weakened or short cervix, can contribute to incompetence. These abnormalities may be present from birth or result from cervical trauma or surgery.
Previous Trauma or Procedures:
- Past surgical procedures on the cervix, such as cone biopsy or dilation and curettage (D&C), can weaken the cervical tissue and increase the risk of incompetence.
Congenital Factors:
- Genetic or developmental factors may contribute to an inherent weakness in the cervical tissue, making it more prone to dilation under the pressure of a developing pregnancy.
Hormonal Influences:
- Hormonal changes, particularly an imbalance of hormones involved in maintaining cervical integrity, can impact the strength and resilience of the cervix. This imbalance may be associated with certain medical conditions.
Multiple Pregnancies:
- Carrying multiple pregnancies simultaneously can exert increased pressure on the cervix, leading to its premature dilation. This risk is especially relevant in the case of twin or higher-order pregnancies.

Desired Outcome for Incompetent Cervix

Prevention of Preterm Birth:
- The primary goal is to prevent preterm birth by addressing the factors contributing to cervical incompetence, thereby allowing the pregnancy to progress to full term.
Maintenance of Cervical Integrity:
- Maintain the structural integrity of the cervix throughout the pregnancy to prevent premature cervical dilation and the associated risks.
Optimal Maternal and Fetal Health:
- Ensure the overall health and well-being of both the mother and the fetus by minimizing the risks associated with preterm birth, such as respiratory and developmental issues in the newborn.
Successful Term Delivery:
- Achieve a successful term delivery with a healthy newborn, promoting positive maternal and neonatal outcomes.
Psychosocial Support:
- Provide psychosocial support to the expectant mother and her family, addressing any concerns, fears, or emotional challenges associated with the diagnosis and management of incompetent cervix.

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 Assessment for Incompetent Cervix

Medical History:
- Gather information on the patient’s obstetric history, including any previous preterm births, cervical trauma, or surgical procedures that may impact cervical integrity.
Physical Examination:
- Perform a thorough pelvic examination to assess cervical length, dilation, and effacement. Monitor for any signs of cervical insufficiency, such as cervical funneling or shortening.
Ultrasound Evaluation:
- Utilize ultrasound to measure cervical length and identify any structural abnormalities or signs of cervical incompetence, providing valuable insights into the risk of preterm birth.
Symptom Assessment:
- Inquire about symptoms such as pelvic pressure, backache, or changes in vaginal discharge, which may indicate cervical changes or potential issues.
Cervical Assessment Tests:
- Administer cervical assessment tests, such as fetal fibronectin (fFN) testing, to identify potential markers of preterm labor and assess the risk of premature delivery.
Psychosocial Assessment:
- Evaluate the patient’s emotional well-being, understanding any anxieties or concerns related to the diagnosis. Provide appropriate support and resources for coping.
Monitoring for Contractions:
- Monitor uterine contractions using methods like tocodynamometry to identify any signs of preterm labor.
Laboratory Tests:
- Conduct relevant laboratory tests, such as cultures for infections, to identify and address any potential contributors to preterm birth, such as infections that may affect cervical integrity.

Implementation for Incompetent Cervix

Cervical Cerclage:
- Consider cervical cerclage, a surgical procedure involving the placement of a stitch around the cervix, to provide mechanical support and prevent cervical changes leading to preterm birth.
Progesterone Supplementation:
- Administer progesterone supplementation, which has shown efficacy in reducing the risk of preterm birth in certain cases by supporting uterine and cervical function.
Bed Rest and Activity Modification:
- Prescribe bed rest or modified activity to reduce physical strain on the cervix and decrease the risk of cervical changes. This may include avoiding heavy lifting and minimizing strenuous activities.
Hydration and Nutritional Support:
- Encourage adequate hydration and provide nutritional counseling to ensure the patient maintains optimal health during pregnancy, promoting overall well-being and potentially reducing the risk of preterm labor.
Education and Emotional Support:
- Provide thorough education on the condition, its management, and the importance of compliance with prescribed interventions. Offer emotional support to address any concerns or anxiety the patient may experience.

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.

Evaluation for Incompetent Cervix

Cervical Length Monitoring:
- Regularly assess cervical length through ultrasound examinations to monitor for any signs of shortening or changes that may indicate progression towards cervical incompetence.
Symptom Assessment:
- Evaluate the patient for symptoms such as vaginal discharge, pelvic pressure, or changes in cervical consistency. Any new or worsening symptoms should be promptly addressed.
Review of Interventions:
- Assess the effectiveness of implemented interventions, such as cervical cerclage and progesterone supplementation, by reviewing patient outcomes and determining if there is a reduction in the risk of preterm birth.
Patient Compliance:
- Evaluate the patient’s adherence to prescribed interventions, bed rest or activity modifications, and any recommended lifestyle changes. Non-compliance may impact the effectiveness of the management plan.
Psychosocial Assessment:
- Consider the emotional well-being of the patient. Evaluate the impact of the condition and its management on the patient’s mental health and provide additional support or resources as needed.

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.