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what is cervical incompetence?
painless dilatation of the cervix
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how can CI present?
with preterm delivery
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what does CI precede?
some preterm deliveries
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what are the predisposing factors of cervical incompetence?
- 1. forceful dilatation of the cervix: eg multiple TOP or D&C, especially in people from abroad. especially TOP in early pregnancy. in UK TOP in early pregnancy is usually medically not surgically managed (misoprostol)
- 2. management of CIN or cervical carcinoma. LLETZ x 2; cone biopsy especially
- 3. manchester repair - amputate cervix as Rx of prolapse in a woman that has not completed her family
- 4. exposure to diethylstilbestrol - used in past to treat early miscarriage
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what investigation is used to determine CI and what sign?
- HSG
- funnel shaped cervix
- retrograde dilatation
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if you suspect CI early in pregnancy, what should be done?
- 1. cleanse vagina with clindamycin or metronidazole prevent BV and miscarriage
- 2. USS: measure cervical length. if < 2cm high chance will deliver soon. if < 15mm may miscarry
- 3. if < 2cm, need to close it so bacteria do not ascend.
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what are the 2 types of treatments for CI?
- 1. stitch
- 2. progestogens: support
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if had a cervical stitch, what are indications for removal?
- 1. bleeding
- 2. ROM
- 3. labour
- 4. > 37/40
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what are the 3 types of cervical cerclage (stitch)?
- 1. mcdonald cerclage: most common, purse string stitch to shut cervix. band of suture at upper part of cervix, while lower part already started to efface. done 12-34 weeks. removed at 37 weeks
- 2. shirodkar cerclage: sutures pass through walls of cervix so they're not exposed. closes internal os of cervix. more difficult. may reduce risk of infection.
- 3. abdominal cerclage: least common, permanent. do if cervix too short for standard cerclage or if vaginal (1, 2) have failed.
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aside from cervical incompetence, what 4 things do you want to look at on USS of fetes?
- 1. abdominal circumference: as eg malnutrition will have small AC as liver glycogen stores are all used up)
- 2. estimated fettle weight
- 3. amniotic fluid
- 4. placenta
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