Uterine Cervical incompetency -Symptoms, cause and treatment

Uterine Cervical incompetence is a condition in which cervix dilates with out causing pain causing delivery of premature fetus. Delivery occurs when the membranes ruptures. Thus cervical incompetence is a condition in which a cervix that is abnormally weak dilates and leads to miscarriage. Miscarriage occurs usually in a period of 16 to 24 weeks with out any prior symptoms like pain.

Symptoms

Usually there are no symptoms and at times there might be back pain, heavy vaginal discharge, little or no bleeding with or with out pain. Pain occurs with miscarriage only and not in prior stage.

Cause

Injuries caused during previous deliveries, previous D&C or scraping of tissues inside uterus, cervical surgery, uterine abnormalities etc can lead to cervical incompetence. But the cause for disease is not known. DES exposure, cervical trauma, hormonal problems, congenitally chort cervix etc are also causes.

Treatment

Usually stitch is done to make cervix firm. This is done during pregnancy. This method of stitching the cervix is known as cerclage. This is done during 14thto 16th week. It is better to do cerclage as earlier as possible for pregnancy to continue. But a ppatient with hyperirritability of cervix can not perform cerclage. If the dilation is more than four centimeters or if the baby is dead, if the water is broken cerclage can not be done.

There are mainly five methods of putting stitch. Most popular are McDonald and Shirodkar method. In all five methods spinal anesthesia is given to reduce pain. In McDonald method a 5mm permanent stitch is put on high cervix. Stitch is removed in 37 weeks. If there is any infection or preterm labor, rupture of membranes etc stitch is removed earlier. This is the most effective method.

Usually Shirodkar method is used mostly. In this method a cesarean is to be performed for delivery. A permanent stitch is put for life long in this method and that is why cesarean becomes necessary.

Another method is Hefner cerclage in which a U or mattress stitch is put which is useful to prevent minimal amount of cervix left. Method is also known as Wum procedure.

Uterosacral cardinal ligament cerclage is done after failure of McDonald or Shirodkar. It is otherwise useful when there is congenital shortened cervix or subacute cervix. It can be done abdominally as usual or vaginally. In this case also a cesarean is necessary for delivery.

Lash is done when the disease is detected before pregnancy. Usually it is done after cervical trauma that led to an anatomical defect. It might cause infertility.

But all these methods are not 100% successful. There are possibilities of premature rupture of membrane, infection to amniotic sac or Chorioamnionitis, bladder injury, uterine rupture, cervical dystocia, maternal hemorrhage, preterm labor, cervical laceration or amputation etc.

Links

http://www.ncbi.nlm.nih.gov/pubmed/4919334?dopt=Abstract

http://pregnancy.about.com/cs/incompetentcervix/a/aaincomp.htm

http://www.patient.co.uk/showdoc/40024690/

http://www.accessmedicine.com/search/searchAMResultImg.aspx?rootterm=uterine+cervical+incompetence&rootID=16273&searchType=1

http://www.curehunter.com/m/keywordSummaryD002581.do

http://health.discovery.com/centers/pregnancy/americanbaby/cervicalincompetence.html

http://medind.nic.in/maa/t06/i2/maat06i2p200.pdf

http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1985;volume=31;issue=3;spage=155;epage=7;aulast=Deshpande

http://www.blackwell-synergy.com/doi/abs/10.1046/j.1469-0705.2002.00770.x?cookieSet=1&journalCode=uog

Kala-azar (Leishmaniasis) - Disease spread by sand flie's byte

Leishmaniasis otherwise known as Kala-azar is a disease spread by sand fly. It is spread from the byte of sandfly and is parasitic in nature. It is a group of disease. Disease may be cutaneous or systemic. Cutaneous leishmaniasis affects mucous membrane and skin and in mucous membrane ulcers might develop. Systemic or visceral leishmaniasis affects the immune system of whole body and might cause death.

Causes

Leishmaniasis is spread by sand flies which is infected by biting an infected by biting any infected animal.

Symptoms

Children affected by the disease will show symptoms like vomiting, fever, weakness, cough, night sweat, change in skin tone, hair thinning, discomfort with abdomen, weight loss, diarrhea, fatigue etc. In adults fever might last for two weeks or two months. They will have weakness, fatigue, loss of appetite etc and along with the disease weakness increases. In those affected by cutaneous leishmaniasis there might be difficulty to breath, sores on skin, skin ulcer, nose bleeding, nose running, ulcers in mouth lips, nose etc.

Treatment

Spleen and bone marrow or skin biopsy and culture, immunofluorescent antibody test done indirectly, complete blood count, hemoglobin count, direct agultination assay, montenegro skin test, serum protein and albumin, immunoglobulins etc are done for detecting the disease.

Antimony containing compounds are the most important drugs used to treat the disease. Medicines usually given are Meglumine antimonate and Sodium stibogluconate. Amphotericin B , Pentamidine are also given. In case of visceral leishmaniasis removal of spleen might become necessary if it is drug resistant. If disfigurement occurs in cutaneous leishmaniasis plastic surgery might become necessary. Death occurs in a time span of two years due to other complications like other infections. Pentavalent antimony is the most common treatment or pentamindine is used as an alternative.

Usually two pentavalent antimonials (Pentostam and Glucantime) are used in treatment. In case they are not effective pentamidine and amphotericine B are given to patient. Allopurinol used in gout treatment is being tried as experiment. Similarly as part of experiments ambisome and ketaconazole are also given. Drugs are chosen according to the geographic location and infecting species. Drugs like Nastibogluconate or Meglumine antimonate are also given. Deoxycholate, Ishethionate, itraconazole, topical paromomycin etc are other drugs given to patient. Supportive measures like adequate nutrition, antibiotics etc are also needed.

Prevention

Sandfly bites must be prevented through insect repellent, appropriate clothing, window screening etc. There are no preventive vaccines for this disease.

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