In non pregnant uterus cervical incompetence is treated by –
Correct Answer: Counselling
Description: Ans. is 'a' i.e., Counselling Cervical incompetence treatment in INTERCONCEPTIONAL PERIOD (non pregnant uterus):o To alleviate anxiety and to improve the psychology couple should be counselled that even after three consecutive miscarriages, the chance of a successful pregnancy is high (70%). However, the success rate depends on the underlying etiology as well as the age of the woman.o Hysteroscopic resection of uterine septa, synechiae and submucous myomas improves the pregnancy outcome. Uterine unification operation (metroplasty) is done for cases with bicomuate uteruso Chromosomal anomalies - If chromosomal abnormality is detected in the couples or in the abortus, genetic counseling is undertaken. Karyotyping of the products of conception from future miscarriage is mandatory. Couples with chromosomal translocations or inversion are counseled for preimplantation genetic diagnosis (PGD) or prenatal diagnosis (cff DNA, amniocentesis or CVS) in subsequent pregnancy or pregnancy with donor gametes (sperm or oocyte).o Women with PCOS are best treated for their insulin resistance, hyperinsulinemia and hyperandrogenemia. Metformin therapy is helpful.o Endocrine dysfunction: Control of diabetes and thyroid disorders is done. Subclinical diabetes and/or thyroid disease may be treated when no other factor is present.o Genital tract infections are treated appropriately following culture of cervical and vaginaldischarge. Empirical treatment with doxycycline or erythromycin is cost-effective.Note: Operative management of cervical incompetence is done with cerclage operation.o Cerclage operation: Two types of operation are in current use during pregnancy each claiming an equal success rate of about 80-90%. The operations are named after Shirodkar (1955) and McDonald (1963).o Timing of cerclage: In a proven case, prophylactic cerclage should be done around 14 weeks of pregnancy or at least 2 weeks earlier than the lowest period of previous wastage, as early as the 10th week. Emergency (rescue) cerclage can be done when the cervix is dilated and there is bulging of the membranes.
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