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Nolan Nguyen
Nolan Nguyen

Obstetri Dan Ginekologi Pdf Download

Epidemiologic studies suggest an approximate incidence of 0.5% in the general obstetric population and 8% in women with a history of previous mid-trimester miscarriages. Wide variation in the incidence of cervical incompetence has been reported, which is likely due to real biologic differences among the study population, the criteria used to establish the diagnosis, and reporting bias between general practitioners and referral centers.

obstetri dan ginekologi pdf download

The digital or speculum examination reveals a cervix that is dilated 2 cm or more, effacement greater than or equal to 80%, and the bag of waters visible through the external orifice (os) or protruding into the vagina. The diagnosis is frequently made on the basis of history retrospectively after multiple poor obstetrical outcomes have occurred.[3],[1]

The diagnosis of cervical insufficiency is challenging because of the lack of objective findings and clear diagnostic criteria. Cervical ultrasound has emerged as a proven, clinically useful screening and diagnostic tool in the selected population of high-risk women based on an obstetrical history of a prior (early) spontaneous preterm birth. The transvaginal ultrasound typically shows a short cervical length, less than or equal to 25 mm, or funneling, ballooning of the membranes into a dilated internal os but with the closed external os.

The diagnosis and management of cervical incompetence is usually managed by an obstetrician. However, the maternity and L & D nurse should educate the patient that the non-surgical approaches of managing cervical incompetence like limiting activity, bed rest, and pelvic rest have not proven effective and their use is discouraged. Another nonsurgical treatment to be considered in patients at risk of cervical insufficiency is the vaginal pessary. The evidence is limited for a potential benefit of pessary placement in select high-risk patients. [1],[3] The decision to treat rests solely with the obstetrician.[9][10]