Cervical incompetence

· Uncategorized

It means inability to support the pregnancy to term size due to defect in the cervix.

This condition is usually associated with mid trimester habitual abortions.Dilatation is painless and there is premature rupture of the membranes.

Diagnosis

History is very important.There is acute , painless dilatation of the cervix in the mid trimester leading to the sudden gush of vaginal fluid followed by abortion.

Cause

  • Congenital
  • Acquired–obstetric trauma to the cervix.

Treatment

Cervical cerclage–

Contraindications of cervical cerclage—

Prophylactic cerclage-usually performed at 13-16 weeks size .
Emergency cerclage–Is performed after dilatation of the cervix , when membranes are intact and no vaginal bleeding.Patient comes with the history of habitual abortions and ultrasound shows the placental location and if there is no congenital anomaly in the fetus, then it can be performed.

Complications of the cerclage

  • Vaginal bleeding
  • Rupture of the membranes
Long term complications are
  • Chorioamnionitis
  • Cervical lacerations
  • Migration of the suture
  • Bladder discomfort

Types of cerclage

Mac donald’s

Purse string suture is applied at the level of external os.No dissection of the bladder or rectum is required.

Shirodkar’s

After reflecting the bladder anteriorly and rectum posteriorly, a single suture is applied at the level of internal os.Suture is secured either anteriorly or posteriorly.
Regional anesthesia is preferred..
Tocolytic drugs, prophylactic antibiotics , strict bed rest is adviced.
Remove cerclage at 37-38 weeks or with the onset of labor.[3]

Mac Donald’s Suture[4]

This knol belongs The Collaborative Book on Obstetrics and Gynecology 

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