Nursing Care Plan for Incompetent Cervix

Pathophysiology

Incompetent cervix, or cervical insufficiency, is the premature thinning and dilation of the tubular end of the uterus (cervix).  When the cervix is weakened, it cannot withstand the pressure of a growing fetus and begins to open too early. This can lead to premature birth or miscarriage, usually between 14 – 24 weeks gestation. Incompetent cervix likely affects more women than reported, but occurs in approximately 1 out of 100 pregnancies.  It is estimated that 25% of second-trimester miscarriages are due to incompetent cervix. A cervical cerclage may be placed vaginally to tie the cervix closed until the latter part of the third trimester, but not all patients are candidates for this procedure.

Etiology

Damage to the cervix either through surgery, dilation and curettage, or a previous difficult birth may result in an incompetent cervix. Abnormal Pap smears that require treatments such as LEEP procedures and cone biopsies may weaken the cervix as well. Patients with birth defects that affect the shape of the uterus or cervix are also at higher risk. Advanced maternal age (over 35 years old) may also be a factor of increased risk.

Desired Outcome

Maintain viable pregnancy; avoid preterm delivery or miscarriage

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 Interventions and Rationales

  1. Obtain gynecological history from patient

  2. Information regarding previous pregnancies, difficult births, gynecological treatments, abnormal Pap smears and other history can help determine if the patient is high risk.

  3. Assess for vaginal discharge; note volume, color and consistency

  4. Patients often report a change in vaginal discharge from clear or white to pink or tan, or that there is an increase in the amount of discharge.  Light vaginal bleeding may also be noted.

  5. Screen patient for any history of substance abuse.

  6. Certain medications and substances may cause premature dilation of the cervix.

  7. Encourage patient to decrease physical activity, avoid exercise and intercourse and take frequent breaks

  8. It is believed by many that continued pressure on the cervix can cause dilation to progress, thus increasing the risk of preterm labor.

  9. Administer medications as appropriate

  10. 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

  11. Assist with amniocentesis

  12. Amniocentesis is performed by doctor, but may be required to determine if patient is eligible for cerclage placement.

  13. Prepare patient for cerclage placement

  14. Cervical cerclage is done as an outpatient procedure, usually vaginally to tie the cervix closed. The stitches will be removed toward the end of the third trimester before labor begins.

  15. Provide nutrition and lifestyle education

  16. Encourage patient to maintain healthy weight gain during pregnancy and avoid smoking or drinking alcohol.


References

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