Cervical incompetence Flashcards
(32 cards)
What is cervical cerclage?
Cervical cerclage is a procedure used to prevent preterm birth or miscarriage in women with cervical insufficiency by placing a stitch around the cervix to reinforce it and prevent premature opening during pregnancy.
When is history-indicated cervical cerclage considered?
History-indicated cervical cerclage is considered for women with 3 or more consecutive midtrimester pregnancy losses that suggest cervical insufficiency. The cerclage is ideally placed at 13-14 weeks gestation.
What is ultrasound-indicated cervical cerclage?
Ultrasound-indicated cervical cerclage is offered to women with a previous preterm birth after cervical length screening. It is placed before 24 weeks gestation in women with a cervix shorter than 25mm.
What are the contraindications for cervical cerclage insertion?
Contraindications include active labor, vaginal bleeding, ruptured membranes, chorioamnionitis, placental abruption, lethal fetal anomalies, multiple pregnancies, and cervical dilation greater than 4 cm.
What is physical examination-indicated cervical cerclage?
Physical examination-indicated cervical cerclage is performed in the second trimester in women who present with cervical dilation in the absence of labor or placental abruption.
What are the common techniques for cervical cerclage insertion?
The most commonly used technique is the McDonald cerclage, which involves placing a circumferential purse-string suture around the cervix at the vesicocervical junction using non-absorbable sutures.
What is cervical insufficiency?
Cervical insufficiency is a clinical diagnosis characterized by painless cervical dilatation and spontaneous mid-trimester pregnancy loss (between 14 to 24 weeks gestation), occurring in the absence of labor or other causes.
What are the risk factors for cervical insufficiency?
Risk factors include a history of recurrent mid-trimester losses, previous cervical surgery (e.g., cone biopsy, large loop excision), congenital uterine abnormalities (e.g., septate or bicornuate uterus), and cervical shortening (<25mm before 28 weeks) on transvaginal ultrasound.
At what gestational age is cervical insufficiency typically diagnosed?
Cervical insufficiency is typically diagnosed between 14 to 24 weeks of gestation.
How is cervical insufficiency detected on physical examination?
Cervical insufficiency may be detected through physical examination by identifying cervical shortening, dilatation, or the presence of cervical tears without the presence of lab
When should history-indicated cervical cerclage be inserted?
History-indicated cervical cerclage should be placed as early as possible, ideally at 13-14 weeks gestation.
What is the general timing for cervical cerclage insertion?
Cervical cerclage is typically inserted between 13-24 weeks gestation, depending on the specific indications and risk factors.
When should ultrasound-indicated cervical cerclage be performed?
Ultrasound-indicated cervical cerclage should be offered before 24 weeks gestation in women found to have a short cervix (<25mm) on transvaginal ultrasound.
What are the key components of preoperative management for cervical cerclage?
Discuss the plan with a Consultant.
Consider antibiotic prophylaxis (e.g., Erythromycin 500 mg or Clindamycin 600 mg with Indomethacin 100 mg PO or PR q12 hours for 24 hours post-op).
Keep the patient in the hospital during treatment if antibiotics are given.
What is the immediate postoperative management for cervical cerclage?
Provide analgesia.
Continue antibiotics if initiated.
Allow a normal diet unless complications arise.
Assess and discharge the patient the next day if stable.
Bed rest as clinically indicated, though not routinely for all patients
What is the follow-up care after cervical cerclage insertion?
Routine antenatal care (ANC) unless otherwise indicated.
Monthly ANC visits.
For preterm labor, tocolysis is used for steroid administration if there are no contraindications and the gestation is less than 34 weeks.
Cerclage removal at 36-37 weeks gestation if no complications arise.
What is a McDonald cerclage?
McDonald cerclage is a type of cervical cerclage where a circumferential purse-string suture is placed around the cervix at the vesicocervical junction to reinforce it and prevent premature dilation.
How is the McDonald cerclage procedure performed?
The McDonald cerclage involves placing non-absorbable sutures (e.g., mersilene, nylon, prolene) around the cervix in 4 separate suture bites at the vesicocervical junction. The suture is tied anteriorly or posteriorly, avoiding vessels at 3 and 9 o’clock positions.
What is the typical timing for the removal of a McDonald cerclage?
The McDonald cerclage is typically removed at 36-37 weeks gestation if no complications arise, such as preterm labor, PPROM, intrauterine fetal death, or antepartum hemorrhage.
What are the potential complications during McDonald cerclage?
Potential complications include infection, bleeding, premature rupture of membranes (PROM), and the need for bed rest depending on clinical indications.
What is a Shirodkar cerclage?
A Shirodkar cerclage is a type of cervical cerclage where a suture is placed submucosally around the cervix to reinforce it, typically in women with a very short cervix or significant cervical damage.
How is the Shirodkar cerclage procedure performed?
The Shirodkar cerclage involves making a 2-3 cm anterior transverse submucosal incision at the vesicocervical junction, reflecting the bladder superiorly, and placing a suture around the cervix from anterior to posterior or vice versa. The incision is then closed, and mersilene tape is commonly used as the suture material.
In what situations is a Shirodkar cerclage preferred over a McDonald cerclage?
The Shirodkar cerclage is preferred in cases where the cervix is very short or hypoplastic, or where previous cerclages have failed. It is also used when a higher level of cervical support is needed.
What are the potential complications associated with a Shirodkar cerclage?
Potential complications include increased blood loss during the procedure, infection, premature rupture of membranes (PROM), and difficulty in suture removal due to its submucosal placement.
