Cerclage For Incompetent Cervix

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Cerclage For Incompetent Cervix

• Project Presentation
• By
• Shaila Sheth

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Normal Cervix
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Cervix

• The cervix is the narrow point at the base of the
  uterus. In a healthy pregnancy, the cervix
  dilates or opens near the very end of the term,
  before labor begins. When the cervix has been
  weakened, it may open too early in the pregnancy,
  threatening miscarriage or early (premature)
  delivery.

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Cervix
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Incompetent Cervix
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Incompetent Cervix
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Incompetent Cervix
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Incompetent Cervix

• Description
• It is an inability of the cervix to remain
  closed. As the baby grows the pressure of the
  baby on the cervix cause the cervix to start to
  open before the baby is ready to be born
• It lead to miscarriage or premature delivery
• It happens in only about 1 out of 100 pregnancies
  

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Incompetent Cervix
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Incompetent Cervix

• Causes and symptoms
• Some of the causes are
• Previous surgery on the cervix
• Prior cervical trauma
• Uterine anamolies or congenitally short cervix
• DES exposure
• Hormonal Influences

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Incompetent Cervix

• Diagnosis
• Incompetent cervix is not usually diagnosed until
  the 2nd or 3rd trimester pregnancy lost or
  miscarriage with a sudden rupture of the membrane
  followed by expulsion of the fetus
• It can be evaluated by ultrasound before
  pregnancy or in early pregnancy and also during
  the pelvic exam by the physician
• Ultrasound is the best technique to measure the
  cervical opening or the length of the cervix

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Incompetent Cervix

• Treatment
• Surgical treatment for incompetent cervix is the
  procedure known as CERCLAGE (suturing the cervix)
  
• It is performed to prevent dilation of the cervix
• Some other modifeid techniques such as Shirodkar
  or the McDonald are most commonly used
• An alternative treatment for an incompetent
  cervix is the bedrest, sometimes for several
  months

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Incompetent Cervix
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Cerclage
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Cerclage

• Origin
• The term cervical incompetence originated in a
  Lancet publication in 1865 by Gream. Pathological
  descriptions and initial attempts at surgical
  prevention of pregnancy wastage as a result of
  cervical incompetence began receiving attention
  in the early 1900s. It was not until the 1950s,
  however, that the techniques most commonly used
  today were described by Shirodkar and McDonald.
  Since the 1950s, the procedure of cerclage have
  become the mainstay of therapy for incompetent
  cervix.

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Cervical Cerclage

• Procedure for Cerclage
• Cervical cerclage is used for a shortened cervix
  incompetent cervix
• Cervical Cerclage is a surgical procedure that
  sews the cervix closed to reinforce the weak
  cervix in pregnant women
• The procedure is done by the doctor who is
  specially trained in high risk pregnancy care
• It is used for women who have history of
  miscarriage or for women whose cervix opens too
  early in the pregnancy usually second trimester
• It is also used on women who have damaged cervix
  due to abortion and cone biopsy
• This procedure is usually performed between 1214
  week of pregnancy the suture is removed between
  36 38 weeks before the patient goes in labor

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Cervical Cerclage

• Procedure
• Patient medical history will be reviewed and a
  thorough exam of the cervix will be made prior to
  the surgery
• Before the surgery cervix can be viewed and
  measure by performing transvaginal ultrasound
• In this procedure the patient receives either
  spinal or epidural anesthesia. The doctor will
  then stitch the cervix closed with a strong
  thread for the full-term of the pregnancy

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Cervical Cerclage

• Pre-Procedure
• Patient should not put anything into vagina 24
  hours prior to the surgery
• Patient should eat light meal at dinner prior to
  the day of the surgery should be NPO after
  midnight

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Cervical Cerclage

• Post Procedure
• Patient may have to stay in the hospital for
  several hours or overnight so that patient can be
  monitored for preterm labor
• There might be discomfort for 1-2 days some
  bleeding or spotting for approximately 3-4 days
• Doctor may prescribe a medicine to reduce the
  chance of premature labor, which is sometimes
  caused by the procedure

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Cervical Cerclage

• Benefits of the procedure
• Cervical cerclage is a very successful. It
  prevents premature delivery or miscarriage in 85
  to 90 of the cases
• Doctor would also recommend this procedure for
  each of the future pregnancies

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Cervical Cerclage

• Risks associated with the procedure are
• Premature labor
• Cervical infection
• Maternal hemorrhage
• Cervical rupture
• Bladder rupture
• Rupture of the fetal membranes (bag of water)
• Risk associated with cervical cerclage is very
  rare most health care providers feel that the
  procedure is a life saving worth the possible
  risks involved

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Cerclage
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• Are there signs I should look for after the
  cerclage is placed that indicate a problem?
• It is important to contact your doctor, if you
  experience any of the following symptoms after
  your cerclage is placed
• Contractions or cramping
• Lower abdominal or back pain that comes and goes
  like labor pain
• Vaginal bleeding
• A fever over 100 F or 37.8 C, or chills
• Nausea and vomiting
• Foul-smelling vaginal discharge
• Your water breaking or leaking

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References

• http//www.pennhealth.com/health_info/pregnancy/sp
  ecialcare/articles/cervix.html
• http//www.americanpregnancy.org/pregnancycomplica
  tions/incompetentcervix.html
• http//www.americanpregnancy.org/pregnancycomplica
  tions/cervicalcerclage.html
• http//www.birthsource.com/proarticlefile/proartic
  le38.html
• http//www.inletmedical.org/html/cervical_cerclage
  .htm
• http//www.ehendrick.org/healthy/000738.htm
• http//www2.mc.uky.edu/OBG/Newsletters/Paper/Cercl
  age.htm
• http//www.obgynsono.com/images/cxpreop.jpg