Cervical Insufficiency Nursing Care Plans Diagnosis and Interventions
Cervical Insufficiency NCLEX Review and Nursing Care Plans
A cervical insufficiency, also known as an incompetent cervix, arises when weakened cervical tissue induces or contributes to preterm delivery or the termination of an otherwise healthy pregnancy. The cervix, the lower portion of the uterus that connects to the vagina, is generally closed and rigid before pregnancy.
As the pregnancy proceeds and the mother prepare to deliver a baby, the cervix relaxes, shortens (effaces), and dilates. However, if the mother has cervix insufficiency, the cervix may open prematurely, causing the mother to give birth too soon.
A cervical insufficiency might be challenging to diagnose and cure. Suppose the cervix opens prematurely or the mother has a past medical history of cervical insufficiency.
In that case, the doctor may advise prophylactic medications throughout pregnancy, regular ultrasounds, or cervical cerclage, a treatment that secures the cervix with firm sutures.
Signs and Symptoms of Cervical Insufficiency
In the early stages of pregnancy, a woman with cervix insufficiency might not experience any symptoms or signs. However, some women experience minor discomfort or spotting for several days or weeks between 14 and 20 weeks of pregnancy.
Keep an eye out for the following clinical manifestations:
- Vaginal discharge. The discharge of pink-tinged secretions from the vaginal vestibule indicates that the cervix has dilated.
- Elevated pelvic pressure. The fetus is already descending, exerting pressure on the mother’s pelvis.
- Cervical enlargement. The cervix would dilate upon examination by the doctor.
- An extreme backache
- Mild stomach cramps
- Vaginal bleeding
Risk Factors to Cervical Insufficiency
Cervical insufficiency risk factors are difficult to explain, but they are thought to be connected with the following:
- Late maternal age. Because of aging, the muscles surrounding the cervix begin to lose elasticity, which may lead to cervix weakness.
- Race. Cervical insufficiency appears to be more common in black women. However, the reason behind this risk factor is still unclear.
- Congenital disorders. An incompetent cervix can be caused by uterine abnormalities and genetic problems affecting a fibrous type of protein that composes the body’s connective tissues (collagen). Before birth, exposure to a synthetic version of hormone supplement has also been related to cervical insufficiency.
- Cervical trauma. Any trauma to the cervix may damage the muscles around it, causing it to dilate prematurely.
- Structural defects present at birth. Defects may contribute to the cervix’s inability to contain the fetus.
Causes of Cervical Insufficiency
What causes the cervix to become weak is unknown. In most cases, no precise reason can be established.
The following conditions enhance the likelihood of having cervical insufficiency.
- Ehlers-Danlos syndrome is an example of a congenital connective tissue condition.
- Cervical laceration
- Uterine birth abnormalities, including müllerian duct problems, conditions in which a uterus is not shaped typically.
- Two or more prior miscarriages in the second trimester
A prior delivery may have harmed the cervix. It can also be damaged when a large portion of tissue is removed from the cervix for a biopsy (known as a cone biopsy) or when medical devices are used to expand the cervix, as might happen during dilation and curettage.
Complications of Cervical Insufficiency
- Premature birth. One of the most common complications of cervical insufficiency is premature birth. Premature birth occurs more than three weeks before the baby’s expected delivery date. Consequently, premature birth happens before the beginning of the 37 completed weeks of gestation. Premature newborns can have complex health problems, especially those born very early, but birth complications typically vary. However, the earlier the baby is born, the higher the chance of having congenital abnormalities.
- Pregnancy loss or miscarriage. Cervical insufficiency, also known as “incompetent cervix,” occurs when a woman’s cervix compresses, softens, and begins having contractions and opening prematurely in pregnancy. This condition could result in a miscarriage.
Diagnosis of Cervical Insufficiency
The doctor may suspect cervical insufficiency if the mother has the following symptoms.
- A past medical history of painless cervical dilatation and deliveries in the second trimester
- Cervical dilatation and effacement prior to week 24 of pregnancy without painful contractions, excessive vaginal bleeding, water breaking (ruptured membranes), or infections
The following tests and procedures can be used to help diagnose an incompetent cervix during the second trimester:
- Transvaginal Ultrasound (TVS). The doctor may use transvaginal ultrasonography to measure the length of the cervix and detect whether membranes are protruding through the cervix. A slim transducer is put in the mother’s vagina to transmit sound waves that form images on a screen during this kind of ultrasound.
- Pelvic examination. The doctor will evaluate the mother’s cervix to see whether or not the amniotic sac has started protruding through the prolapsed fetal membranes. The presence of fetal membranes in the cervical canal or vagina implies cervical insufficiency. The doctor will also check for and if required, monitor contractions.
- Laboratory tests. During pregnancy, if the fetal membranes are visible and an ultrasound shows inflammation but no signs of infection, the doctor may analyze an amniotic fluid sample to detect or rule out an infection of the amniotic sac and fluid (chorioamnionitis).
No diagnostics can be performed before pregnancy to predict cervical insufficiency. However, specific pre-pregnancy diagnostics, such as an MRI or an ultrasound, can assist in detecting uterine anomalies that may lead to an incompetent cervix.
Treatment of Cervical Insufficiency
- Medical Management
- Hormone replacement therapy. If the mother has a past medical history of premature births, the doctor may recommend weekly doses of hormone supplements during the second and third trimesters. However, more research is needed to determine the proper dose of hormones in cervical insufficiency.
- Series of ultrasounds. Suppose the mother has a history of premature birth or a family history of cervical insufficiency. In that case, the doctor may attentively examine the length of the cervix by giving the mother ultrasounds every two weeks from week 16 to week 24 of pregnancy. Cervical cerclage may be recommended if the mother’s cervix begins to open or gets shorter than a particular length.
- Surgical Management
- McDonald’s Cervical Cerclage. Nylon sutures are used to stitch the cervix vertically and horizontally. They are retracted until the cervical canal is only a few millimeters wide.
- Shirodkar Cervical Cerclage. Sterile tape is inserted in a purse-string pattern under the cervix’s submucosa layer for this method. It is then sutured in place to enclose the cervix.
- Lifestyle Remedies.
- If the mother experiences cervical insufficiency, the doctor may advise her to minimize sexual activity with her partner.
- If the mother has cervical insufficiency, the doctor may also advise her to limit strenuous activities during pregnancy since it may trigger the cervix to dilate.
The doctor may also recommend a device that fits within the vagina and aims to retain the uterus. This device is referred to as a pessary. A pessary relieves cervical pressure. However, more research is needed to determine whether a pessary is a viable treatment for cervical insufficiency.
Prevention of Cervical Insufficiency
Mothers cannot prevent cervix insufficiency, but they may do a lot to ensure a healthy, full-term pregnancy. Here are some of the helpful ways:
- Consider routine prenatal care. Prenatal checkups can assist the doctor in monitoring both the mother’s and the baby’s health. Mention any indications or symptoms to the doctor, even if they seem minor or insignificant.
- Maintain a nutritious diet. The mother needs more folic acid, calcium, iron, and other vital nutrients during pregnancy. Ideally, a daily prenatal vitamin beginning a few months before conception can help cover any nutritional shortages.
- Gain weight cautiously. Gaining the appropriate amount of weight can help the baby’s health. For healthy women before pregnancy, a weight gain of 25 to 35 pounds (11 to 16 kg) is often suggested.
- Avoid dangerous chemicals. Stop smoking. Alcohol and illicit drugs are also prohibited. Furthermore, seek medical advice before using any drugs or supplements, even those accessible over-the-counter.
Nursing Considerations on Cervical Insufficiency
- Determine if the mother is experiencing painless bleeding or if she feels severe pressure on her pelvis.
- Examine and keep the mother’s bleeding pads to detect any blockages or tissues that have already passed out.
- Determine whether the mother has actual contractions to prepare for the delivery of the fetus.
- Determine any additional elements that contribute to the mother’s anxiousness so she can avoid it.
- Monitor the patient’s vital signs to discover any bodily reactions affecting her condition.
- Empathize with the patient and build a therapeutic alliance to encourage her to express her emotions.
Cervical Insufficiency Nursing Diagnosis
Nursing Care Plan for Cervical Insufficiency 1
Risk for Disturbed Maternal-Fetal Dyad
Nursing Diagnosis: Risk for Disturbed Maternal-Fetal Dyad related to pregnancy complications such as early cervix dilation, physical or substance misuse, and treatment-related adverse effects secondary to cervical insufficiency.
As a risk nursing diagnosis, Risk for Disturbed Maternal-Fetal Dyad is entirely unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
- The patient will express comprehension of individual risk factors or abnormalities that may affect pregnancy.
- The patient will make essential changes to his or her lifestyle and everyday activities to manage the risks of pregnancy.
- The patient will recognize indications and symptoms that necessitate medical attention or evaluation.
- The patient will have typical fetal growth and will sustain a healthy pregnancy.
|Cervical Insufficiency Nursing Interventions||Rationale|
|Examine the patient’s previous pregnancy history.||This technique is intended to screen for the existence of pregnancy complications. A history of the patient’s prior pregnancies is also taken to examine past and present obstetrical, clinical, and surgical difficulties to uncover potential risks for the mother and her baby.|
|Obtain a history of prenatal testing and the amount and timing of care.||Prenatal screening tests can determine whether or not the baby is more likely to have various congenital disabilities, many of which are hereditary illnesses. These procedures include blood tests, ultrasounds, and prenatal cell-free DNA screening. Thus, a lack of prenatal care might endanger both the mother and the fetus.|
|Take into account the patient’s maternal age.||Maternal age greater than 35 years equates to elevated risks. On the other hand, preterm delivery is one of the most prevalent high-risk conditions among pregnant teenagers.|
|Examine the patient’s present living condition.||The patient may have a history of dysfunctional relationships or insufficient or lack of shelter, which impairs safety and overall well-being.|
|As necessary, provide information and help the patient with ultrasonography.||This intervention identifies the presence of pregnancy complications.|
|Examine the patient for signs of maltreatment while she is pregnant.||Preterm birth and early cervix dilation are linked to prenatal maltreatment.|
|At every prenatal visit, instruct the patient on how to disclose reportable symptoms and keep an eye out for odd complaints.||This strategy allows for early intervention in the case of difficulties developing.|
|Effective listening, empathy, and problem resolution can all help with constructive adaptation to a circumstance.||This intervention aids in the successful completion of pregnancy’s psychological responsibilities.|
|Examine the patient’s medication regimen.||Prenatal treatment for maternal disorders may necessitate changes for mother and fetus safety.|
|Recommend modified or total bed rest as directed.||The activity level may need to be adjusted depending on the signs of uterine activity and cervical insufficiency.|
|Emphasize the patient’s pregnancy normalcy, pregnancy milestones, and the “countdown to delivery.”||This strategy fosters a sense of hope that the adjustments or limitations will fulfill a meaningful purpose.|
|Discuss the patient’s preexisting condition and its potential implications on pregnancy.||Pregnancy may have no effect or lessen or worsen the intensity of chronic disease symptoms.|
|Take note of any conditions that may be exacerbating cervix insufficiency.||Some conditions may have a direct impact on uteroplacental perfusion and gas exchange.|
Nursing Care Plan for Cervical Insufficiency 2
Nursing Diagnosis: Anxiety related to premature cervical dilatation, situational dilemma, stress, neonatal mortality threat, and risk of a change in health condition secondary to cervical insufficiency as evidenced by voiced concerns as a result of a shift in life events, feeling worried, knowledge of physiological symptoms, difficulties concentrating, and an elevation in vital signs.
- The patient will feel relaxed and remark that his or her anxiety has improved to a reasonable degree.
- The patient will express his or her awareness of his or her anxiety.
- The patient will learn appropriate techniques to cope with and express anxiety.
- The patient will show appropriate problem-solving abilities.
|Cervical Insufficiency Nursing Interventions||Rationales|
|Examine the patient’s physiological aspects.||These psychological aspects can create or increase anxiety.|
|Thoroughly observe the patient’s vital signs.||This intervention aims to detect physical reactions connected with medical and emotional issues.|
|Assess the patient’s most up-to-date information of prescribed or over-the-counter medications.||These drugs can intensify emotions and increase anxiety.|
|If feasible, provide a primary nurse or caregiver.||This intervention promotes continuity of care and boosts the patient’s trust in healthcare practitioners.|
|Examine the patient’s actions.||This method can reveal the client’s level of anxiousness.|
|Examine the patient’s obstetric history.||The client’s level of anxiety may be affected by a history of fetal death, the patient’s comprehension of the issue, and potential interventions.|
|Examine the patient’s diagnostic test results.||This approach may give information on the patient’s physiological causes of anxiousness.|
|Examine previous coping strategies.||This intervention seeks to identify coping skills that may be useful in present conditions.|
|Create a therapeutic relationship by demonstrating sympathy and unconditional positive respect.||This method tries to prevent anxiety’s contagious effect or transmission.|
|Provide correct information regarding the circumstance.||This intervention assists the client in recognizing situations that are based on fact.|
|Encourage psychological support.||This intervention aims to help the patient be at ease.|
|Allow the patient’s actions to speak for themselves; do not respond inappropriately.||The nurse’s response could be inappropriate, pushing the situation to a non-therapeutic engagement.|
|Examine the patient’s psychological signs of anxiety, such as blood pressure, pulse, respiration rate, and excessive sweating.||Variations in vital signs may indicate psychological abnormalities.|
|Explain to the patient what is happening and what should be expected. Give accurate information about the causes, consequences, and treatment.||By enhancing awareness of the issue, this strategy may lessen anxiety.|
Nursing Care Plan for Cervical Insufficiency 3
Nursing Diagnosis: Deficient Knowledge related to information misunderstanding and lack of exposure or recollection secondary to cervical insufficiency as evidenced by numerous questions being asked, a lot of information requests, declaration of misunderstanding, and incorrect or excessive behavior.
- The patient will express comprehension of her situation and treatment.
- The patient will practice self-care in order to maintain a healthy pregnancy.
|Cervical Insufficiency Nursing Interventions||Rationale|
|Determine the patient’s level of understanding.||This intervention attempts to provide an opportunity to explain previous learning, uncover cultural myths, and rectify errors.|
|Determine the patient’s level of anxiousness.||Anxiety can impede the learning process. Thus, anxiousness may discourage the patient from learning about her condition.|
|Include essential people in the discussion.||This intervention aids in the reinforcement of understanding among all those concerned.|
|Provide the patient with information about what to expect in the future.||The client may be concerned about whether or not complications will arise.|
|Determine which signs and symptoms should be disclosed to a healthcare provider.||Immediate examination and management may help to avoid or limit problems.|
Nursing Care Plan for Cervical Insufficiency 4
Nursing Diagnosis: Activity Intolerance related to excessive physical exertion, stress, and muscular hypersensitivity secondary to cervical insufficiency as evidenced by unexpected dilations of the cervix and decreased activity level.
- The patient will decide to participate in activities that are appropriate for the situation.
- The patient will have reduced unexpected cervical dilations.
|Cervical Insufficiency Nursing Interventions||Rationale|
|As per procedure, evaluate the patient’s cervix dilatation and fetal reaction.||Fetal heart monitoring is used to determine the presence or absence of contractions, frequency, length, and palpated strength to inform the course of treatment for cervical insufficiency. The nurse may also evaluate cervix dilation by monitoring the patient’s behavior and listening to the patient about the frequency and discomfort of contractions to evaluate premature cervical dilation.|
|Examine the patient’s vital signs and a history of circumstances that led to cervical insufficiency.||The evaluation serves as a starting point for future comparisons.|
|Provide patients with comfort measures such as back massages, changes in position, and reduced stimuli in the room.||Relaxation and comfort measures reduce muscular tension and exhaustion while promoting a sense of well-being. Education in relaxation techniques can improve a person’s psychophysiological well-being.|
|Explain to the patient why bed rest and activity limitations are necessary.||Bed rest is prescribed because it helps prevent cervical insufficiency and is suitable for both the mother and the fetus. However, some researchers claim that strenuous maternal exercise does not raise the risk of premature birth. Leisure-time exercise has been shown to improve high-risk pregnancy outcomes and lower the chance of premature cervix dilations.|
|Reduce strenuous activity and place the patient in a lateral recumbent position, such as side-lying.||These precautions are meant to keep the fetus away from the cervix and may improve uterine perfusion. Positioning the patient on her side for optimal placental blood flow, monitoring vital signs often, and contacting the healthcare practitioner if tachycardia arises are all essential nursing care for patients at risk for cervical insufficiency.|
Nursing Care Plan for Cervical Insufficiency 5
Risk for Injury (Fetal)
Nursing Diagnosis: Risk for Injury (Fetal) related to premature delivery of the fetus secondary to cervical insufficiency.
As a risk nursing diagnosis, Risk for Injury (Fetal) is entirely unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
- The patient will keep the pregnancy going until the fetal phase is complete.
- The patient will have a complication-free baby.
|Cervical Insufficiency Nursing Interventions||Rationale|
|Examine for maternal problems that make specific therapies contraindicated.||The nurse should constantly be aware of medications contraindicated for the patient’s condition and may worsen cervical insufficiency.|
|Examine the Fetal Heart Rate (FHR); take note of any uterine activity or cervical changes.||Tocolytics can increase FHR. Overdose can harm the cardiorespiratory system. Sleepiness may occur if the fetus is born while on magnesium therapy, and resuscitation may be necessary. If prolonged uterine contractions are refractory to tocolytics or if cervical insufficiency persists, a little infant may be delivered very quickly.|
|Provide information to the patient about the pharmacological therapy’s actions and side effects.||The patient or couple needs to be aware of the medication’s side effects.|
|During check-ups, thoroughly educate the patient.||During the consultation, the healthcare provider should concentrate on personalized patient’s needs and home care and provide follow-up guidelines, as well as clinical manifestations that necessitate urgent medical care, such as increased frequency and intensity of contractions and significantly reduced fetal movement.|
|Thoroughly monitor the patient’s vital signs and look into any cardiac abnormalities.||Irregularities in the mother’s vital signs may also suggest risks for the fetus, which is why it is critical to ensure that the mother is free of pregnancy complications.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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