Cervical Incompetence

A cervical incompetence (formerly known as “cervical incompetence” hereinafter) is a painless dilation of the cervix, which leads during the second trimester to the birth of live fetuses. A transvaginal ultrasound examination of the cervix during the second trimester can help to identify the risk in good time. The treatment consists in an amplification of the cervix by a seam (cerclage) or in a vaginal progesterone administration.

Cervical incompetence refers to an assumed weakness of cervical tissue which contributes to a premature birth or causes this, which can not be accounted for by another anomaly. The estimated incidence varies widely (1/100 to 1/2000).

A cervical incompetence (formerly known as “cervical incompetence” hereinafter) is a painless dilation of the cervix, which leads during the second trimester to the birth of live fetuses. A transvaginal ultrasound examination of the cervix during the second trimester can help to identify the risk in good time. The treatment consists in an amplification of the cervix by a seam (cerclage) or in a vaginal progesterone administration. Cervical incompetence refers to an assumed weakness of cervical tissue which contributes to a premature birth or causes this, which can not be accounted for by another anomaly. The estimated incidence varies widely (1/100 to 1/2000). Etiology The origin is not well understood, but her combination of structural changes and biochemical factors appears (eg inflammation, infection.) To be involved; these factors can be acquired or genetic. Risk Factors For most women with cervical incompetence no risk factors are; However, the following risk factors: Congenital disorders of collagen synthesis (. eg Ehlers-Danlos syndrome) Preceding cone biopsy (especially if ? 1.7 to 2.0 cm of the cervix are removed) Preceding deep injury to the cervix (usually after vaginal delivery or cesarean) Preceding massive or rapid instrumental dilatation (today (rare) Müllerian duct anomalies z. B. uterus bicornis or septus) ? 3 previous miscarriages during the second trimester relapse the general recurrence risk of miscarriage due to an incompetent cervix is ??probably at ? 30%; this leads to the question of what role have fixed structural abnormalities. The highest risk in women with ? 3 previous miscarriages in the second trimester. Symptoms and signs An incompetent cervix is ??often to the premature birth asymptomatic. Many women experience early symptoms such as vaginal pressure, vaginal bleeding or spotting, non-specific abdominal pain or lower back pain or vaginal discharge. The cervix may be soft, used up or expanded. Diagnostic Transvaginal sonography in the> 16th week in women with symptoms or risk factors usually is not discovered an incompetent cervix before a first premature birth. The diagnosis is suspected in women with risk factors or characteristic symptoms or complaints. Then, an ultrasound. The findings are most meaningful after the 16th week of pregnancy. Suspicious sonographic findings can be a shortening of the cervix to <2.5 cm, an opening of the cervix, and an incident fetal membranes in the cervix. It is not recommended to perform an ultrasound in women with no symptoms or risk factors, because the findings may not accurately predict preterm birth. Treatment cerclage Vaginal progesterone administered A cerclage (amplification of the cervix with non-absorbable sutures) may be indicated solely for the (history-indicated cerclage) or on the basis of the ultrasound findings plus history (ultrasound-indicated cerclage). A cerclage seems to prevent preterm birth in women with ? 3 previous miscarriages in the second trimester. In the remaining patients, this procedure should only be performed if the history suggests an incompetent cervix and if the ultrasound before the 22nd-24th Week a cervical thinning was documented. to restrict a cerclage to these patients, the risk of premature birth does not seem to increase and decrease the number of currently performed cerclage by two thirds. Recent evidence suggests that a cerclage may help prevent preterm birth in women who have an idiopathic preterm birth in the history and the cervix is ??<2.0 cm long. Zervicale cerclage var model = {thumbnailUrl: '/-/media/manual/professional/images/cervical_cerclage_high_blausen_de.jpg?la=de&thn=0&mw=350' imageUrl: '/-/media/manual/professional/images/cervical_cerclage_high_blausen_de.jpg ? lang = en & thn = 0 ', title:' Zervicale cerclage 'description:' 'credits'', hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'image-element-panel.'). ko.applyBindings (model, panel.get (0)); Vaginal progesterone administered (200 mg every night) can reduce the risk of preterm birth in certain women. You may be offered women who have a cervical thinning in their history idiopathic preterm birth or current pregnancy (detected by ultrasound) have, especially women, to which the criteria for a cerclage not apply. Whether vaginally administered progesterone further reduces the risk in treated by cerclage women is uncertain. If a premature birth after the 22-23rd SSW is feared corticosteroids may (to accelerate fetal lung maturation) and modified bed rest also be indicated. Summary Normally risk of Zervixnsuffizienz not be predicted before entering an initial premature birth. An ultrasound should be done after the 16th week in women with risk factors or symptoms. Women at high risk should be treated with cerclage or vaginally administered progesterone.

Health Life Media Team

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