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OB/GYN (Britney) > Cervical incompetence > Flashcards

Cervical incompetence Flashcards

1
Q

What is Cervical Incompetence?

A

Painless dilation and shortening of the cervix, before the 37th week of gestation, in the absence of preterm labor→ :
1. Membrane prolapse
2. Premature rupture of membranes (PROM)
3. Mid-trimester pregnancy loss
4. Preterm birth

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2
Q

The causes Cervical Incompetence can be classified into?

A

Congenital and Acquired

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3
Q

What are the congenital causes of Cervical Incompetence?

A

Müllerian duct anomalies

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4
Q

What is another name for Cervical Incompetence?

A

Cervical Insufficiency/Cervical weakness

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5
Q

What is another name for Müllerian ducts?

A

Paramesonephric ducts

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6
Q

What is the purpose of the Müllerian ducts?

A

they develop into the: uterus, fallopian tubes, cervix and upper 2/3rds of the vagina during embryogenesis

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7
Q

Müllerian duct anomalies causes what?

A

structural abnormalities in the female reproductive system

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8
Q

What are the acquired causes of cervical incompetence?

A
  1. Conization of cervix
  2. Amputation of cervix
  3. Precipitous labor
  4. Repeated therapeutic abortion
  5. Instrumental delivery in an incompletely dilated cervix
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9
Q

What is another name for Conization of cervix

A

Cold Knife Cone (CKC) / Conical biopsy

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10
Q

What is conization of cervix?

A

the excision of a cervical lesion by removing the cone-shaped portion of the cervix and the entire transformation zone

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11
Q

What is precipitous labor?

A

when a baby is born < 3 hours of regular contractions

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12
Q

How do you diagnose Cervical incompetence?

A

Diagnosis is based on either your history or a combination of Speculum examination findings + Cervical measurements on Transvaginal U/S

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13
Q

What in information in your medical history suggest Cervical incompetence?

A
  1. H/o recurrent mid-trimester pregnancy losses
  2. H/o Preterm labor and delivery
  3. H/o Premature rupture of membranes (PROM) followed by the painless expulsion of the products of conception.
  4. H/o prior pregnancy with a cervical length < 2.5 cm before 27 weeks gestation
  5. H/o cervical trauma e.g.:
    ♦Repeated therapeutic abortion
    ♦Repetitive cervical dilatation
    ♦Cone biopsy
    ♦Cervical tears and lacerations
    ♦Trachelectomy
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14
Q

What findings on speculum exam during pregnancy suggest Cervical Incompetence?

A

Dilation of cervix with bulging or sacculation of membranes

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15
Q

What findings on speculum exam in a nonpregnant state suggest Cervical Incompetence?

A
  1. You can easily pass a # 8 Hegar’s dilator through the internal os, without closure.
  2. Very little traction (< 600g ) needed to pull a # 14 Foley catheter inflated with 2ml saline from the uterus after placement.
  3. Cervical funneling on Hysterosalpingogram (HSG)
  4. The Canal/Cannula ratio using hysteroscopy is 1.5 or more
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16
Q

What is a Cervical compliance index?

A
17
Q

What is the treatment for Cervical incompetence?

A

Cervical cerclage

18
Q

Another name for Cervical cerclage

A

Cervical stitch

19
Q

What is a Cervical Cerclage

A

an operation where a stitch is placed around the cervix to temporarily close it.

20
Q

During what gestational period is a Cervical Cerclage usually done?

A

Between 12-24weeks

21
Q

Why is a Cerclage done between 12 and 24 weeks gestation?

A
  1. Cervical insufficiency does NOT manifest itself before mid-second trimester.
  2. By this time fetal anomalies would have been ruled out by U/S.
  3. Chromosomally abnormal fetuses would have been spontaneously aborted
22
Q

What are the 2 main techniques used for a transvaginal cerclage?

A
  1. MacDonald approach
  2. Modified Shirodkar approach
23
Q

What suture materials are used during the MacDonald approach?

A

A Mersilene or Prolene suture

24
Q

Why is a Mersilene suture preferred over a Prolene suture ?

A

A Mersilene suture is a braided suture with a larger surface area than a Prolene, so when applied, its less likely to cut through the cervix.

25
Q

Which suture is preferred in the MacDonald approach?

A

Mersilene suture

26
Q

Why would some surgeons still use a Prolene suture, when a Mersilene is preferred?

A

A Prolene suture is cheaper, easier to remove and more available than a Mersilene suture.

OB/GYN (Britney) (7 decks)

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