Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix begins to dilate and efface prematurely during pregnancy, potentially leading to second-trimester pregnancy loss or preterm birth. This nursing diagnosis focuses on identifying risk factors, implementing preventive measures, and managing complications associated with cervical insufficiency.
Causes (Related to)
Cervical insufficiency can develop due to various factors that affect cervical strength and integrity:
- Previous cervical trauma from:
- Multiple dilations and curettages
- Loop electrosurgical excision procedures (LEEP)
- Cone biopsies
- Cervical lacerations during delivery
- Congenital factors including:
- Uterine anomalies
- Exposure to diethylstilbestrol (DES)
- Genetic disorders affecting collagen
- Mechanical factors such as:
- Multiple pregnancies
- Polyhydramnios
- Large uterine fibroids
Signs and Symptoms (As evidenced by)
Cervical insufficiency presents with specific signs and symptoms that healthcare providers must recognize for timely intervention.
Subjective: (Patient reports)
- Pelvic pressure or discomfort
- Mild cramping
- Increased vaginal discharge
- Low back pain
- The sensation of “something coming down.”
- Light spotting or bleeding
Objective: (Nurse assesses)
- Cervical dilation without contractions
- Shortened cervical length on ultrasound (<25mm)
- Funneling of the internal os
- Prolapsing membranes
- Changes in cervical consistency
- Progressive cervical changes on serial examinations
Expected Outcomes
Successful management of cervical insufficiency is indicated by:
- Pregnancy continuation to term or near-term
- Maintenance of cervical length and integrity
- Prevention of preterm labor
- Absence of infection
- Adequate fetal growth and development
- Patient compliance with prescribed activity restrictions
- Successful placement and maintenance of cerclage (if applicable)
Nursing Assessment
Monitor Cervical Status
- Assess cervical length via transvaginal ultrasound
- Document any changes in the cervical position
- Monitor for signs of funneling
- Track any bleeding or discharge
- Note cervical consistency changes
Evaluate Risk Factors
- Review obstetric history
- Document previous cervical procedures
- Assess current pregnancy status
- Monitor multiple gestations if present
- Review family history
Monitor Fetal Status
- Assess fetal movement
- Monitor fetal heart rate
- Track fetal growth parameters
- Document any signs of fetal distress
Check for Complications
- Monitor for signs of infection
- Assess for preterm labor
- Watch for membrane rupture
- Check for vaginal bleeding
- Monitor maternal vital signs
Assess Support System
- Evaluate home support
- Document work responsibilities
- Assess financial resources
- Review transportation access
- Check understanding of the care plan
Nursing Care Plans
Nursing Care Plan 1: Risk for Preterm Labor
Nursing Diagnosis Statement:
Risk for Preterm Labor related to cervical insufficiency as evidenced by shortened cervical length and history of second-trimester loss.
Related Factors:
- Cervical structural changes
- Previous pregnancy losses
- Current cervical changes
- Multiple risk factors
Nursing Interventions and Rationales:
- Monitor cervical changes regularly
Rationale: Early detection of progressive cervical changes allows timely intervention - Implement activity restrictions
Rationale: Reduces pressure on the cervix and minimizes the risk of further dilation - Teach signs of preterm labor
Rationale: Enables prompt recognition and reporting of concerning symptoms
Desired Outcomes:
- The patient will maintain pregnancy to a viable gestational age
- The patient will demonstrate an understanding of warning signs
- The patient will comply with prescribed activity restrictions
Nursing Care Plan 2: Anxiety
Nursing Diagnosis Statement:
Anxiety related to pregnancy complications as evidenced by expressed concerns about pregnancy loss and frequent seeking of reassurance.
Related Factors:
- Uncertain pregnancy outcome
- Previous pregnancy losses
- Activity restrictions
- Financial concerns
Nursing Interventions and Rationales:
- Provide emotional support and counseling
Rationale: Reduces anxiety and promotes coping - Facilitate access to support groups
Rationale: Connects patient with others in similar situations - Teach relaxation techniques
Rationale: Provides tools for managing stress and anxiety
Desired Outcomes:
- The patient will verbalize decreased anxiety
- The patient will demonstrate effective coping mechanisms
- The patient will maintain emotional well-being
Nursing Care Plan 3: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to cervical changes and possible cerclage placement as evidenced by increased vulnerability to ascending infection.
Related Factors:
- Altered cervical barrier
- Surgical intervention
- Increased vaginal examinations
- Compromised mucus plug
Nursing Interventions and Rationales:
- Monitor for signs of infection
Rationale: Enables early detection and treatment - Teach infection prevention measures
Rationale: Reduces risk of ascending infection - Monitor temperature and vital signs
Rationale: Identifies early signs of infection
Desired Outcomes:
- The patient will remain free from infection
- The patient will demonstrate proper hygiene practices
- The patient will report signs of infection promptly
Nursing Care Plan 4: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to prescribed bed rest as evidenced by activity restrictions and limited movement.
Related Factors:
- Prescribed activity restrictions
- Risk of cervical changes
- Prevention of complications
- Medical management requirements
Nursing Interventions and Rationales:
- Teach safe positioning techniques
Rationale: Maintains comfort while adhering to restrictions - Implement DVT prophylaxis
Rationale: Prevents complications of immobility - Assist with range of motion exercises
Rationale: Maintains muscle tone while respecting restrictions
Desired Outcomes:
- The patient will maintain skin integrity
- The patient will remain free from complications
- The patient will comply with activity restrictions while maintaining function
Nursing Care Plan 5: Interrupted Family Processes
Nursing Diagnosis Statement:
Interrupted Family Processes related to high-risk pregnancy management as evidenced by altered family routines and roles.
Related Factors:
- Activity restrictions
- Frequent medical appointments
- Changed family dynamics
- Increased care needs
Nursing Interventions and Rationales:
- Assess the family support system
Rationale: Identifies resources and needs - Facilitate family coping strategies
Rationale: Promotes adaptation to changed circumstances - Provide family education
Rationale: Enables family members to provide appropriate support
Desired Outcomes:
- The family will demonstrate effective coping strategies
- The family will maintain a functional support system
- Family will verbalize understanding of care needs
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Chatzakis C, Efthymiou A, Sotiriadis A, Makrydimas G. Emergency cerclage in singleton pregnancies with painless cervical dilatation: A meta-analysis. Acta Obstet Gynecol Scand. 2020 Nov;99(11):1444-1457. doi: 10.1111/aogs.13968. Epub 2020 Sep 16. PMID: 32757297.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Wei Y, Wang S. Comparison of emergency cervical cerclage and expectant treatment in cervical insufficiency in singleton pregnancy: A meta-analysis. PLoS One. 2023 Feb 24;18(2):e0278342. doi: 10.1371/journal.pone.0278342. PMID: 36827361; PMCID: PMC9956608.
- Wu Q, Chen J, Zou Q, Zeng X, Yang Y, Zhou Y, He G, Luo C, Wu F. An Analysis on the Factors for Cervical Insufficiency Causing Adverse Emotions Among Pregnant Women at Different Gestation Phases. Front Psychiatry. 2022 Apr 6;13:764345. doi: 10.3389/fpsyt.2022.764345. PMID: 35463533; PMCID: PMC9019485.
