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Incompetent Cervix - An incompetent cervix is also called cervical insufficiency.

The cervix is the bottom part of your uterus (womb). Normally, the cervix remains closed during pregnancy until your baby is ready to be born. A normal pregnancy lasts for about nine months. An incompetent cervix may begin to open at 4 to 6 months of pregnancy. At this time, the cervix may begin to thin and widen without any pain or contractions. The amniotic sac, also called the bag of water, bulges down into the opening of the cervix until it breaks. This may cause a miscarriage or premature (early) delivery of your baby.

Risk Factors: Previous surgery on the cervix Damage during a difficult birth Malformed cervix or uterus from a birth defect Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage DES (Diethylstilbestrol) exposure

Diagnosis: Ultrasound Pelvic Exam Physical Assessment

Signs and Symptoms Backache. Discomfort or pressure in the lower abdomen (stomach). Gush of warm liquid from your vagina. Mucous-like vaginal discharge. Pain when passing urine. Sensation or feeling of a lump in the vagina

Nursing Implementation

-Provide client and family teaching. Describe problems that must be reported immediately (ie,pink-tinged vaginal discharge, increased pelvic pressure, and rupture of the membranes).

-Maintain an environment to preserve the integrity of the pregnancy.

a. Prepare for cervical cerclage, if appropriate.

b. Maintain activity restrictions as prescribed.

c. Discuss the need for vaginal rest (ie, no intercourse or orgasm)

-Prepare for the birth if membranes are ruptured.

-Address emotional and psychosocial needs.

Placenta Previa -Placenta previa is a complication of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix. There are different forms of placenta previa:

Marginal: The placenta is next to cervix but does not cover the opening. Partial: The placenta covers part of the cervical opening. Complete: The placenta covers all of the cervical opening.

Risk Factors: Multiparity Advance Maternal Age Smoking, Cocaine use Past Uterine Curettage (D&C), Multiple Induced Abortion Past CS Multiple Gestation Asian, African ethnicity

Diagnosis: Ultrasound Pelvic Exam Physical Assessment

Signs and Symptoms Sudden Bright Red, Painless Vaginal Bleeding Soft Uterus (-) Engagement

Nursing Implementation

-Ensure the physiologic well-being of the client and fetus a. Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh perineal pads before and after use to estimate blood loss. b. Observe for shock, which is characterized by a rapid pulse, pallor, cold moist skin and a drop in blood pressure c. Monitor the FHR d. Enforce strict bed rest to minimize risk to the fetus e. Observe for additional bleeding episodes.

-Provide client and family teaching a. Explain the condition and management options. To ensure an adequate blood supply to the mother and fetus, place the woman at bed rest in a side-lying position. Anticipate the order for a sonogram to localize the placenta. If the condition of mother or fetus deteriorates, a cesarean birth will be required. b. Prepare the client for ambulation and discharge ( may be within 48 hours of last bleeding episode) c. Discuss the need to have transportation to the hospital available at all times. d. Instruct the client to return to the hospital if bleeding recurs and to avoid intercourse until after the birth. e. Instruct the client on proper handwashing and toileting to prevent infection.

Address emotional and psychosocial needs a. Offer emotional support to facilitate the grieving process, if needed b. After birth of the newborn, provide frequent visits with the newborn so that the mother can be certain of the infants condition

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