Premature dilation of the cervix often occurs in the 4th or 5th mo and is associated with repeated second-trimester spontaneous abortions accounting for 15%–20% of second-trimester pregnancy losses.
CLIENT ASSESSMENT DATA BASE
Ego Integrity
Feelings of failure at a life event; expressions of shame/guilt
Expressions/manifestations of anxiety and/or fear
Elimination
Urinary frequency/urgency
Pain/Discomfort
Absence of pain, although lower abdominal pressure may be noted
Safety
May present with premature rupture of membranes (PROM) during second trimester
Sexuality
History of repeated, relatively painless, bloodless, second-trimester fetal loss (habitual spontaneous aborter).
Premature shortening, effacement, and dilation of cervix during current pregnancy.
Cervical trauma associated with previous deliveries with D & C, conization, cauterization, abortions (therapeutic, elective), or cervical lacerations.
Sterile vaginal examination reveals dilation, cervical effacement.
Membranes may be felt or seen protruding though cervical os.
Social Interaction
Concern about response of others; report of conflicted relationship with mother (e.g., especially if she used diethylstilbestrol [DES]).
Teaching/Learning
Reported previous occurrence of spontaneous abortion
Family history of DES use by mother
DIAGNOSTIC STUDIES
Diagnosis is usually made on basis of history of repeated second-trimester abortions.
Serial Ultrasonography: Beginning at 6–8 weeks’ gestation can detect cervical shortening and premature dilation and aid in diagnosis, especially in women without clear-cut history of cervical dysfunction.
Nitrazine and/or Fern Test: Detects presence of amniotic fluid, indicating ruptured membranes.
NURSING PRIORITIES
1. Evaluate client/fetal status.
2. Assist with efforts to maintain the pregnancy, if possible.
3. Provide emotional support.
4. Provide appropriate instruction/information.
DISCHARGE GOALS
1. Client/fetal condition stable following procedure
2. Uterine contractions absent
3. Therapeutic needs and concerns understood
CLIENT ASSESSMENT DATA BASE
Ego Integrity
Feelings of failure at a life event; expressions of shame/guilt
Expressions/manifestations of anxiety and/or fear
Elimination
Urinary frequency/urgency
Pain/Discomfort
Absence of pain, although lower abdominal pressure may be noted
Safety
May present with premature rupture of membranes (PROM) during second trimester
Sexuality
History of repeated, relatively painless, bloodless, second-trimester fetal loss (habitual spontaneous aborter).
Premature shortening, effacement, and dilation of cervix during current pregnancy.
Cervical trauma associated with previous deliveries with D & C, conization, cauterization, abortions (therapeutic, elective), or cervical lacerations.
Sterile vaginal examination reveals dilation, cervical effacement.
Membranes may be felt or seen protruding though cervical os.
Social Interaction
Concern about response of others; report of conflicted relationship with mother (e.g., especially if she used diethylstilbestrol [DES]).
Teaching/Learning
Reported previous occurrence of spontaneous abortion
Family history of DES use by mother
DIAGNOSTIC STUDIES
Diagnosis is usually made on basis of history of repeated second-trimester abortions.
Serial Ultrasonography: Beginning at 6–8 weeks’ gestation can detect cervical shortening and premature dilation and aid in diagnosis, especially in women without clear-cut history of cervical dysfunction.
Nitrazine and/or Fern Test: Detects presence of amniotic fluid, indicating ruptured membranes.
NURSING PRIORITIES
1. Evaluate client/fetal status.
2. Assist with efforts to maintain the pregnancy, if possible.
3. Provide emotional support.
4. Provide appropriate instruction/information.
DISCHARGE GOALS
1. Client/fetal condition stable following procedure
2. Uterine contractions absent
3. Therapeutic needs and concerns understood
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