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Premature cervical dilation

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Premature cervical dilation

Is a condition in which the cervix begins to dilate and efface

even before pregnancy has reached term.

Dilation and effacement may occur without pain or uterine

contractions, they occur due to weakness of the cervix itselfwhich gives way due to the growing pressure of the uterus as

the pregnancy progresses .

If changes are not halted rupture of membranes and

premature delivery may occur.

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Causes and Risk factors

It is rare and only occurs in 1 to 2 % of all pregnancies

But is thought to cause as many as 20 to 25% of miscarriagesin the 2nd trimester

Risk factors

Previous operation on the cervix(D and C or biopsy)

Damage due to previous difficult delivery

Malformation due to birth defect

Multiple pregnancy( Twins, triplets)

Hydramnios

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Signs and symptoms

Spotting or bleeding

Premature passage of bloody show

Sensation of pressure on lower abdomen

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Medical management

A. Cervical Cerclage

Suturing of the cervix early in the pregnancy to reinforce its

opening and prevent premature dilation and effacementTypes

1.) McDonalds - The most common, the cervix stitching

involves a band of suture at the upper part of the cervix while

the lower part has already started to efface. -this cerclage is usually placed between 12 weeks and 24

weeks of pregnancy. The stitch is generally removed around

the 37th week of gestation.

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2.) Shirodkar - is very similar to McDonalds, but the sutures

pass through the walls of the cervix so they're not exposed.

This type of cerclage is less common and technically more

difficult than a McDonald, and is thought (though not proven)

to reduce the risk of infection.

-The Shirodkar procedure sometimes involves a permanent

stitch around the cervix which will not be removed and

therefore a Caesarean section will be necessary to deliver the

baby.

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3.) Abdominal Cerclage -the least common

type, is permanent and involves stitching at

the very top of the cervix, inside the

abdomen. This is usually only done if the

cervix is too short to attempt a standard

cerclage, or if a vaginal cerclage has failed or is

not possible.

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Additional

1.)Bed rest

2.)Administration of tocolytics to lessen or haltuterine contractions. (Nifedepine)

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Nursing Management

1.) Evaluate fetal and maternal status

2.) Provide emotional support for mother and family

3.) Provide proper education and knowledge regarding

Incompetent cervix

4.) Coordinate with health care team for any medical

procedures to be done to the client.