Name of the Condition

• Maternal Care for Cervical Incompetence, Third Trimester
• Also known as cervical insufficiency

Summary

Cervical incompetence in the third trimester is a condition where a pregnant woman's cervix begins to open (dilate) and thin (efface) prematurely, often without pain or contractions. This can lead to preterm birth or the loss of a pregnancy if not managed appropriately.

Causes

• Anatomical cervical issues (congenital or acquired defects)
• Previous cervical surgeries like a cone biopsy or LEEP procedure
• Obstetric trauma
• Collagen disorders

Risk Factors

• History of cervical incompetence or preterm birth
• A short cervical length found in an ultrasound
• Multiple pregnancies (e.g., twins or triplets)
• Uterine anomalies

Symptoms

• Sensation of pelvic pressure
• Backache
• Mild abdominal cramping
• Change in vaginal discharge

Diagnosis

• Transvaginal ultrasound to measure cervical length
• Manual pelvic examination
• Review of medical history and physical symptoms

Treatment Options

• Cervical cerclage: Surgical procedure that places stitches in the cervix to hold it closed
• Progesterone supplementation to strengthen the cervical tissue
• Bed rest or activity restriction to reduce pressure on the cervix
• Use of a pessary, a device inserted into the vagina to support the cervix

Prognosis and Follow-Up

• With appropriate intervention, many women carry pregnancies to term.
• Regular monitoring with ultrasounds to check cervical length.
• Frequent prenatal visits to assess maternal and fetal health.

Complications

• Preterm labor and delivery
• Premature rupture of membranes
• Infection risk associated with certain treatments (e.g., cerclage)

Lifestyle & Prevention

• Avoid activities that may put stress on the cervix, such as heavy lifting.
• Smoking cessation
• Following doctor's recommendations on activity levels and monitoring
• Early prenatal care to monitor cervical length and signs of incompetence

When to Seek Professional Help

• Onset of preterm labor symptoms, such as regular contractions or leakage of fluid
• Unexpected increase in vaginal discharge or bleeding
• Intense pelvic pressure

Additional Resources

• March of Dimes: www.marchofdimes.org
• American College of Obstetricians and Gynecologists (ACOG): www.acog.org
• Pregnancy and Infant Loss Support Network

Tips for Medical Coders

• Ensure documentation specifies the trimester to code accurately.
• Verify the condition is described as cervical incompetence rather than other cervical conditions.
• Be aware of overlapping codes for prenatal care that may accompany this condition and avoid duplicates.