Cerclage (encircling cervix with suture) is done for patients with

ESIC Nursing Officer - 2019 (Shift-2)

Obstetrics & Gynaecology

Easy

Appeared in: ESIC Nursing Officer - 2019 (Shift-2)

Explanation

Cervical cerclage is the specific treatment for an incompetent cervix, also known as cervical insufficiency.
The procedure involves placing a suture around the cervix to provide mechanical strength and prevent premature dilation and effacement.
It is typically performed prophylactically at 12-14 weeks of gestation for patients with a history of second-trimester loss due to cervical issues.
The goal is to prolong the pregnancy and prevent preterm birth or late miscarriage.

Option A: In an incomplete abortion, some fetal or placental tissue remains in the uterus. The priority is to evacuate the uterus to prevent hemorrhage and infection, not to suture the cervix closed.
Option B: In a complete abortion, all products of conception have already been expelled from the uterus. There is no pregnancy to preserve, so a cerclage serves no purpose.
Option C: A threatened abortion involves vaginal bleeding while the cervix remains closed. The standard management is conservative, with rest and monitoring. A cerclage is not indicated and could potentially worsen the situation.

Visual 1: Diagram - A diagram illustrating the McDonald and Shirodkar techniques for cervical cerclage, showing the placement of the suture around the cervix.
Visual 2: Ultrasound Image - A transvaginal ultrasound image showing a shortened cervix, which is a key diagnostic criterion for cervical insufficiency.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Indications for cervical cerclage in pregnancy as background academic context rather than a clinical decision trigger.
Patient education is a critical nursing role. The nurse must explain the signs of preterm labor, infection, or suture rupture (e.g., contractions, vaginal bleeding, leakage of fluid, fever) and the need for pelvic rest.
Post-procedure monitoring is vital. Nurses must assess for uterine contractions, fetal heart rate, and signs of infection or ruptured membranes.
What if? - If a patient with a cerclage presents at 38 weeks with regular contractions, the nursing priority is to prepare for the removal of the cerclage suture. Leaving it in during labor can cause cervical laceration or uterine rupture.

How to Approach the Question

First, define the key term in the question: 'Cerclage' is a procedure to suture the cervix.
Understand the purpose of suturing the cervix closed during pregnancy: to prevent it from opening too early.
Evaluate each option based on this purpose.
Option A (Incomplete abortion) & B (Complete abortion): In these cases, the pregnancy is already ending or has ended. Suturing the cervix is illogical.
Option C (Threatened abortion): This involves bleeding, but the cervix is closed. The problem isn't a weak cervix, so cerclage is not the primary treatment.
Option D (Incompetent cervix): This is the classic definition of a cervix that is too weak to stay closed during pregnancy. Therefore, suturing it for support is the correct indication.

Concept Tested & Keywords

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