Circlage operation is the surgical management of choice for?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

A circlage operation, or cervical cerclage, is a surgical procedure where a suture is placed around the cervix to reinforce it.
This procedure is specifically indicated for cervical incompetence (also known as cervical insufficiency), a condition where the cervix begins to dilate and efface painlessly before the pregnancy has reached term.
The goal of the cerclage is to provide mechanical support to the weak cervix, preventing premature dilation and reducing the risk of second-trimester pregnancy loss or preterm birth.

Option A: The treatment for cervical cancer is not a cerclage. Management depends on the stage and may include excisional procedures (like conization or hysterectomy), chemotherapy, and/or radiation.
Option C: Fibroid uterus (leiomyomas) are benign tumors of the uterine muscle. Treatment, if necessary, involves medication to manage symptoms or surgical removal of the fibroids (myomectomy) or the uterus (hysterectomy). A cerclage does not address fibroids.
Option D: Cervical polyps are typically benign growths on the cervix that can be easily removed in an outpatient setting via a simple procedure called polypectomy. A cerclage is not indicated.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical management of cervical incompetence as background academic context rather than a clinical decision trigger.
Post-cerclage nursing care is critical. The nurse must monitor the patient for signs of preterm labor (e.g., regular contractions, low back pain), infection (e.g., fever, chills, foul-smelling vaginal discharge), and premature rupture of membranes (PPROM).
Patient education is a key nursing responsibility. The patient should be taught to report any warning signs immediately and may be advised to maintain pelvic rest (avoiding intercourse, douching, and tampons) and reduce strenuous activity for a period after the procedure.
What if? If a patient scheduled for a cerclage presents with active uterine contractions and vaginal bleeding, the procedure is contraindicated. These signs indicate that labor may be imminent or that an inevitable abortion is in progress. Placing a cerclage in this situation could cause severe cervical trauma or increase infection risk.

How to Approach the Question

This is a factual recall question that tests your knowledge of specific gynecological and obstetric procedures.
First, identify the key term in the question: 'Circlage operation'. Understand its definition, which means to encircle with a stitch or band.
Next, consider the function of such a procedure in the context of the female reproductive system. A stitch around the cervix would serve to reinforce it or hold it closed.
Evaluate each option to see which condition would be treated by reinforcing a weak cervix.
Option A (Cancer cervix), C (Fibroid uterus), and D (Cervical polyp) all involve abnormal growths that require removal (excision), not reinforcement.
Option B (Cervical incompetence) is the medical term for a weak cervix that cannot stay closed during pregnancy. This directly matches the purpose of a cerclage operation.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 4-11

E6 Gynecology Williams p. 118-147