Diagnosis of Cervical Incompetence is established by use of which size Hegar&;s dilator?
Ans. is 'C' i.e. 8 o Diagnosis in pregnant state: 1) History: Painless second trimester abortion in previous gestation. 2) Shirodkar's digital palpation test: # In suspected cases (those with a previous abortion), do a weekly per vaginal examination. A finger introduced upto the internal os and if found open pass it a little beyond and withdraw the finger. While withdrawing feel for the sphincter - like tone of the internal os; if the os tends to close down with sphincter like or snapping action, the os is considered competent and no cerclage is necessary. This is a highly subjective test. 3) Cervical sonography: # Funelling of the cervix with changes in the form of Y, V, U. # Cervical length < 2.5 cm. # Funnelling of the internal os > 1 cm # Speculum examination: Detection of dilatation of internal os with herniation of the membranes. # Cervical index = (Funnel length + 1) / (endocervical length). # The "+1" allows an index to be calculated when funelling is absent. o Predictors of preterm birth: # Cervical index >0.52. # Cervical length < 18 mm # Funnel length > 9 mm. # Funnel width > 6 mm. o Diagnosis in non - pregnant state: Diagnosis of cervical incompetence in the non-pregnant female is done by Passage of no. 8 hegars dilator during the premenstrual phase of the menstrual cycle. 1) Passage without resistance and pain of No. 8 Hegarrs dilator. 2) Cervicogram : shows funnel shaped cervix. 3) Intracervical balloon studies: Pass a balloon (e.g. Foley's) into cervical canal and inflate it with a radio - opaque dye and then take x - rays after applying due traction. Pear shaped shadow of balloon due to funneling of cervical canal indicates incompetent os. 4) Traction studies : Pass foley's catheter through internal os of cervix and inflate it with 5 - 10 ml and apply traction. If traction of 600 gm or less is enough to pull out the bulb through the os, then the diagnosis is certain. 5) Bromen papaine test : This dye selectively dilates the cervico - uterine junction. After injecting the dye (locally into the cervix and intramuscularly.
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