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What is Funneling in cervicogram is seen in - and explain in detail?
Ans. is 'b' i.e., Cervical incompetence o Cervicogram is done for diagnosis of cervical incompetence. In other conditions, cervicogram is not done.Diagnosis of cervical incompetence: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: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.