10.
Cervical Insufficiency
Reyes || February 14, 2022 NCM109
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OUTLINE WHAT ARE THE RISK FACTORS OF CERVICAL
INSUFFICIENCY?
Legend: Premature cervical dilatation is usually associated with the
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following risk factors:
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(Exams) Trans Comm
▪ Increased Maternal age
▪ Congenital structural defects – short cervix
▪ Diagnosis of an incompetent cervix in a previous
Heading 1 pregnancy
1. Heading 2 ▪ Twins or multiple pregnancies – previous births of
multiples or large babies may cause trauma to the cervix
• The quick brown fox jumps over the lazy dog ▪ Cervical trauma which might have occurred with a cone
o The quick brown fox jumps over the lazy dog biopsy or repeated D&Cs or other procedures involving
▪ The quick brown fox jumps over the lazy dog the cervix in cases of miscarriages & suspected
• The quick brown fox jumps over the lazy dog malignancies.
1. Heading 3
ANATOMY REVIEW OF THE CERVIX
The cervix is a long, narrow passage at the end of the uterus. In a
healthy pregnancy, the cervix will remain its shape until late in the
third trimester, at which point it will soften, shorten & dilate in
preparation for birth. However, some women experience a
condition called cervical insufficiency.
WHAT IS CERVICAL INSUFFICIENCY?
A cervical cone biopsy is the removal of a cone-shaped tissue
in the cervix for examination to determine for presence of
abnormal cells.
HOW IS IT DIAGNOSED?
- If any of the risk factors for an incompetent cervix are
present, the healthcare provider should review the
woman’s history and perform a physical exam and
ultrasound tests to determine the length of the cervix.
History: An important indicator of an incompetent cervix is if the
woman has had one or more miscarriages or extremely
premature births (usually before week 28 of pregnancy). It is also
important to ask the patient about other risk factors for
incompetent cervix.
Physical exam: During the second or 3rd trimester, a pelvic exam
to check for incompetent cervix can reveal the partial opening of
the cervix (dilation) with shortening and thinning of the vaginal
Other terms of Cervical Insufficiency include: part of the cervix (effacement), which would indicate a weak
▪ Premature Cervical Dilation cervix.
▪ Cervical Incompetence
▪ Incompetent Cervix Tests: Transvaginal UTZ can help monitor the cervical length and
determine if the cervix is shortening/opening especially in women
DEFINITION: with risk factors.
▪ An incompetent cervix refers to a cervix that dilates
prematurely and therefore cannot retain a fetus until WHAT ARE THE SIGNS & SYMPTOMS?
term (Roman,2013) ▪ Painless cervical dilatation
▪ This means that the cervix begins to shorten & dilate ▪ Show – a pink-stained vaginal discharge
before the baby is ready to be born, putting the ▪ Increased pelvic pressure
pregnancy at risk for miscarriage or premature birth. ▪ Rupture of membranes
▪ This condition commonly occurs at approximately 20 ▪ Amniotic fluid discharge
weeks gestation when the fetus is still too immature to ▪ Braxton-Hicks-like contractions
survive.
COMPLICATIONS:
▪ Preterm labor
▪ Pregnancy loss/miscarriage
▪ Maternal sepsis
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[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Treatment for incompetent cervix
- As soon as an ultrasound confirms that the fetus of a next
pregnancy is healthy and is approximately 12-14 weeks, a
cervical cerclage is performed.
Newer techniques allow purse-string sutures to be placed before
a woman gets pregnant to ensure she does not miscarry before
week 14.
SURGICAL MANAGEMENT:
CERVICAL CERCLAGE – a procedure wherein purse-string
sutures are placed or sewn around the cervix thru the vagina
under regional anesthesia. Cerclage can also be done via
transabdominal route (via an incision in the lower abdomen).
Sutures are then removed at 37 to 38 weeks gestation so the
fetus can be born vaginally.
There are two types of surgical management for incompetent
cervix:
▪ McDonald’s technique. Nylon sutures are placed
horizontally and vertically across the cervix. They are
pulled back together until the cervical canal is only a few
mm in diameter.
▪ Shirodkar technique. Sterile tape is used for this
technique, where it is threaded in a purse-string manner
under the submucous layer of the cervix. Then, it is
sutured in place so it would close the cervix.
PURPOSE OF CERVICAL CERCLAGE:
- The sutures serve to strengthen the cervix & prevent it from
dilating until the end of pregnancy.
HEALTH EDUCATION FOR A PATIENT WHO HAD CERVICAL
CERCLAGE:
1. Teach the patient to remain on bed rest in a slight or
modified Trendelenburg position for a few days to
decrease pressure on the newly-sutured cervix.
2. Assure the patient that usual activities can be resumed
after this rest period.
3. Remind patient to practice good perineal hygiene to
prevent infection.
4. Remind patient to refrain from sexual intercourse to
avoid stimulating the cervix to open and the uterus to
contract.
5. Encourage patient to continue regular prenatal check-
ups so she & her baby can be monitored.
Women who are discovered to have cervical dilatation but with
membranes still intact at a prenatal visit may have emergency
cerclage sutures placed as prophylaxis against preterm birth.
END OF PRESENTATION
To give you a basic idea how cervical cerclage is performed, you
can watch this video simulation:
https://www.youtube.com/watch?v=E8TCzfypyR8
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