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    Cervical Incompetence 1

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    Cervical incompetence is defined as the inability of the cervix to retain an intrauterine pregnancy due to structural or functional deficiencies, often resulting in recurrent second trimester abortions or preterm labor without bleeding. It has an incidence of 1-10 per 1000 pregnancies and is a common cause of mid-trimester abortions. Cervical incompetence can be caused by anatomical issues such as congenital abnormalities or cervical trauma from procedures like D&C, or physiological issues of unknown origin. Diagnosis involves examining the cervix for effacement and dilation during pregnancy ultrasound. Treatment is usually cervical cerclage surgery.

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    Cervical Incompetence 1

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    api-3705046
    1K views5 pages
    Cervical incompetence is defined as the inability of the cervix to retain an intrauterine pregnancy due to structural or functional deficiencies, often resulting in recurrent second trimester abortions or preterm labor without bleeding. It has an incidence of 1-10 per 1000 pregnancies and is a common cause of mid-trimester abortions. Cervical incompetence can be caused by anatomical issues such as congenital abnormalities or cervical trauma from procedures like D&C, or physiological issues of unknown origin. Diagnosis involves examining the cervix for effacement and dilation during pregnancy ultrasound. Treatment is usually cervical cerclage surgery.

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    Cervical incompetence is defined as the inability of the cervix to retain an intrauterine pregnancy due to structural or functional deficiencies, often resulting in recurrent second trimester abortions or preterm labor without bleeding. It has an incidence of 1-10 per 1000 pregnancies and is a common cause of mid-trimester abortions. Cervical incompetence can be caused by anatomical issues such as congenital abnormalities or cervical trauma from procedures like D&C, or physiological issues of unknown origin. Diagnosis involves examining the cervix for effacement and dilation during pregnancy ultrasound. Treatment is usually cervical cerclage surgery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    1K views5 pages

    Cervical Incompetence 1

    Uploaded by

    api-3705046
    Cervical incompetence is defined as the inability of the cervix to retain an intrauterine pregnancy due to structural or functional deficiencies, often resulting in recurrent second trimester abortions or preterm labor without bleeding. It has an incidence of 1-10 per 1000 pregnancies and is a common cause of mid-trimester abortions. Cervical incompetence can be caused by anatomical issues such as congenital abnormalities or cervical trauma from procedures like D&C, or physiological issues of unknown origin. Diagnosis involves examining the cervix for effacement and dilation during pregnancy ultrasound. Treatment is usually cervical cerclage surgery.

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    Download as DOC, PDF, TXT or read online from Scribd
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    of 5

    CERVICAL INCOMPETENCE

    DEFINITION:
    Cervical incompetence is the inability of the cervix to
    retain intrauterine pregnancy to term because of
    deficiency in structure or function resulting to abortion
    or premature labour.

    Classically it is described as recurrent, painless,


    second trimester spontaneous abortion without initial
    vaginal bleeding.

    INCIDENCE
    This is variable from 1 -10 per 1000. It is the
    commonest cause of habitual abortion in the mid-
    trimester.

    Brief History
    In 17TH century a form of cervical tear was first
    recognised
    -1865 Gream in lancent published the term cervical
    incompetence
    -1902 Hermam treated women by cervical repairs.
    -1948 Palmer and Lacombe in UK defined cervical
    incompetence.
    -1950 Lash and Lash USA also defined cervical
    incompetence.
    -1955 Shirodkar an INDIAN showed series of
    successful cerclage results using facia lata in pregnant
    women.
    -1957 McDonald an American simplified the cerclage
    procedure using non absorbable suture at the Lower
    level of the cervix.
    -1965 Benson advocated for abdominal approach in
    pregnant women
    -Wurm an AUSTRALIAN applied 2 mattress sutures
    at 12/6, 3/9 O’ clocks.

    AETIOLOGY:
    This can be Anatomical or Physiological
    Anatomical: Congenital
    Mullerian abnormalities –bicornate
    uterus, uterus didelphys, septate uterus, cervical tags
    and perforations.

    Diethylstilboestrol:
    -Abnormal lower uterine segment
    -Short cervix that is flushed with the vagina.
    -Short cervical canal
    -Few cervical fibrous tissues.
    Acquired Anatomical causes:
    D&C
    Cone biopsy & amputation of the cervix
    Lacerations
    Normal vaginal deliveries
    Precipitate labour
    Instrumental vaginal deliveries

    Infections: Bacterial activities in the cervix release


    cytokines which digest the collagen fibres

    Physiological cause: For unexplained reasons the


    cervix dilates spontaneously

    CLINICAL FEATURES
    History of;
    Recurrent mid-trimester abortions,
    D&C,
    Cervical surgeries,
    Instrumental vaginal deliveries
    Mucoid vaginal discharges &
    Rupture of fetal membranes
    Examination
    Speculum examination of the cervix will show
    effacement and dilated cervical os.
    Bulging membranes may be seen.
    Digital examination will confirm the same

    DIAGNOSIS:

    Non pregnant state;


    -History of cervical trauma following gynaecologic &
    obstetrical injuries.
    -History of recurrent midtrimester pregnancy losses.
    -Digital vaginal examination revealing effaced and
    dilated cervix
    -Passage of Hegar dilator size 8 starting with larger
    sizes.
    -Passage of size 16 Foley’s catheter inflated with 1ml
    of water.
    -Cervico-isthmography or hysterography showing
    funnel shaped canal and Abnormal uterus.
    MRI

    In pregnancy.
    -Ultrasound scan using transviginal probe should
    measure the internal os
    -Width and the cervical length. The bladder should be
    empty during the Procedure.
    Criteria for diagnosis –
    -Length 0f cervix <2 cm.
    -Width of internal os =7cm with membranes herniating
    into the cervical canal is an ominous sign. Varma et al

    -Width of internal os >15mm in the 1st trimester


    Mahran et al
    -Width of internal os >20mm in the 2nd trimester.
    -Cervical canal shortening at 0.41cm/wk between 15-
    24wks
    -funnelling of the internal os-U or V shape.
    -bulging of the membranes into the cervical canal.

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