Which procedure is performed in order to prevent an abortion in case of cervical incompetence?

DSSSB -28 August 2019 (Shift-2)

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

Cervical incompetence, or cervical insufficiency, is a condition where the cervix begins to dilate and efface painlessly before the pregnancy has reached term.
This premature opening of the cervix can lead to second-trimester pregnancy loss or very preterm birth.
A cerclage is a surgical procedure that involves placing a stitch (suture) around the cervix to reinforce it and keep it closed.
This mechanical support helps the cervix remain competent and carry the pregnancy to term, thus preventing abortion or premature delivery.

Option B: Metroplasty is a surgical procedure to correct the shape of the uterus, not to strengthen a weak cervix.
Option C: Induction of labor is the process of initiating uterine contractions to start labor. This is the opposite of what is needed for cervical incompetence, as the goal is to maintain the pregnancy, not end it.
Option D: A colpotomy is a surgical incision into the vaginal wall. It does not provide any support to the cervix.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Cervical Incompetence as background academic context rather than a clinical decision trigger.
Post-cerclage nursing care is crucial for a successful outcome. The nurse must monitor the patient for signs of preterm labor (contractions), premature rupture of membranes (leaking fluid), and infection (fever, foul-smelling discharge).
Patient education is a key nursing responsibility. The patient should be taught to report any of the above signs immediately and to adhere to activity restrictions, such as pelvic rest (no intercourse) and avoiding heavy lifting.
What if? If a patient with a cerclage presents with regular, painful contractions and cervical change, it indicates that labor has started. In this situation, the cerclage must be removed promptly to prevent cervical laceration or uterine rupture.

How to Approach the Question

First, identify the core clinical problem presented in the question: 'cervical incompetence'. Understand that this means the cervix is weak and cannot stay closed during pregnancy.
Next, determine the goal of the intervention: 'to prevent an abortion'. This means you are looking for a procedure that supports the pregnancy.
Evaluate each option based on this goal.
Analyze 'Cerclage'. Recall or deduce that this is a procedure involving stitching the cervix closed, which directly addresses the weakness and helps prevent pregnancy loss.
Analyze 'Metroplasty'. Recognize this relates to uterine surgery, not cervical support.
Analyze 'Induction'. Understand this means starting labor, which is the opposite of the desired outcome.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 4-10