Cerclage For Incompetent Cervix

1. Cerclage For Incompetent Cervix Project Presentation By Shaila Sheth

2. Normal Cervix

3. 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.

4. Cervix

5. Incompetent Cervix

6. Incompetent Cervix

7. Incompetent Cervix

8. 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

9. Incompetent Cervix

10. 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

11. 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

12. 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

13. Incompetent Cervix

14. Cerclage

15. 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 1900’s. It was not until the 1950’s, however, that the techniques most commonly used today were described by Shirodkar and McDonald. Since the 1950’s, the procedure of cerclage have become the mainstay of therapy for incompetent cervix.

16. 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 12–14 week of pregnancy & the suture is removed between 36 – 38 weeks before the patient goes in labor

17. 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

18. 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

19. 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

20. 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

21. 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

22. Cerclage

23. 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

24. References http://www.pennhealth.com/health_info/pregnancy/specialcare/articles/cervix.html http://www.americanpregnancy.org/pregnancycomplications/incompetentcervix.html http://www.americanpregnancy.org/pregnancycomplications/cervicalcerclage.html http://www.birthsource.com/proarticlefile/proarticle38.html http://www.inletmedical.org/html/cervical_cerclage.htm http://www.ehendrick.org/healthy/000738.htm http://www2.mc.uky.edu/OBG/Newsletters/Paper/Cerclage.htm http://www.obgynsono.com/images/cxpreop.jpg