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Nursing care for patients with cervical incompetence centers on teaching, psychological support, and prevention of injury to the mother and fetus. If a transvaginal ultrasound is going to be done to measure cervical length, be sure the patient has an empty bladder. Teach the woman about her condition and alert her to the potential for injury of the cervix if labor proceeds with a cerclage in place. Symptoms of labor, rupture of the membranes, and infection should be explained to the woman, with emphasis on the need to report such symptoms promptly if they occur. Consider the patient's support systems and coping mechanisms if the pregnancy is continuing. Determine if the patient has the social and financial resources to manage a difficult pregnancy, and make appropriate referrals if they are needed.

• Continuation of pregnancy: Cervical dilation and effacement; station of fetal presenting part; intactness of membranes; absence of bleeding, contractions, or foul discharge; maternal temperature; fetal heart tones and presence of fetal movement, if perceptible

• After spontaneous abortion: Pain; color, odor, and amount of bleeding; firmness and position of fundus; bladder function; vital signs

• Indicators of psychological status: Affect, verbalizations of feelings, grieving behaviors, presence of support people, acceptance of anticipatory guidance and resource materials, effectiveness of coping strategies

FOLLOWING CERCLAGE PLACEMENT. Be sure that the patient understands the importance of immediately reporting any signs of labor or infection. If vaginal rest has been prescribed, teach the patient to avoid vaginal intercourse, orgasm, douching, or tampon use. The patient should also avoid breast stimulation (causes uterine contractions), heavy lifting, and heavy housework. If antibiotics are prescribed, teach the patient to finish the prescription, even though she feels well. If bedrest has been prescribed, assist the patient and family to develop strategies for maintaining bedrest at home. Ensure that the patient understands and can carry out plans for follow-up surveillance and care. Alert the patient of the signs and symptoms of preterm labor.

FOLLOWING DELIVERY OF VIABLE INFANT. Be sure that the woman understands the likelihood of repeated cervical incompetence and the possibility of prophylactic cerclage placement in future pregnancies.

FOLLOWING PREGNANCY LOSS. Teach the patient to report signs of infection or hemorrhage. Be sure that the patient understands the need for pelvic rest until the follow-up gynecologic appointment. Provide the patient and family with resources to support grieving, including anticipatory guidance, reading lists or materials, contact information for support groups, and referral to counseling, if desired.

I nfection with Chlamydia trachomatis is the most common sexually transmitted infection (STI) in the United States today, with approximately 5 million cases reported annually. While chlamydial infections are reportable in all 50 states, underreporting of this STI is substantial owing to the number of individuals who may have the infection and not know it. Because 70% of women and 50% of men with chlamydial infections are asymptomatic, they transmit the disease but are unaware that they harbor the bacteria. Untreated infections in women can result in cervicitis, endometritis, acute salpingitis, bartholinitis, irregular menses, ectopic

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