Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Incompetent Cervix


Related Terms

  • Cervical Incompetence
  • Cervical Insufficiency

Differential Diagnosis

  • Abruptio placentae
  • Chorioamnionitis
  • Infections causing preterm labor
  • Uterine and placental insufficiencies
  • Uterine contractions
  • Uterine distension
  • Uterine distortion

Specialists

  • Obstetrician/Gynecologist

Comorbid Conditions

Factors Influencing Duration

Duration depends on the consequences of the cervical incompetence, the therapeutic and surgical methods used in support of the condition, and the general health of the individual. In the event of premature birth, the patient's emotional strength and family support will be critical.

Medical Codes

ICD-9-CM:
654.53 - Abnormality of Organs and Soft Tissues of Pelvis, Cervical Incompetence; Presence of Shirodkar Suture with or without Mention of Cervical Incompetence, Antepartum Condition or Complication

Overview

The cervix is the lower, narrow end of the uterus that communicates with the vagina. Uterine contractions at the end of pregnancy trigger cervical dilation, and a normal birth takes place. However, an incompetent cervix opens without uterine contractions, simply as a result of pressure from the growing fetus and its own weakness. This generally occurs during the late second trimester or early third trimester of pregnancy and results in premature delivery or, more likely, miscarriage.

There is no confident method of determining before or even during early pregnancy whether the cervix will be incompetent. However there are certain risk factors that suggest the possibility such as a previous history of an incompetent uterus, cervical trauma, exposure to diethylstilbestrol (DES), and abnormalities of the cervix. A family of disorders called congenital Müllerian duct abnormalities, and a connective tissue problem called Ehler-Danlos syndrome have also been implicated. In most cases, however, the cause is unknown.

If history suggests incompetency, the surgeon may close the cervix in a stitching procedure called cerclage to prevent premature delivery.

Incidence and Prevalence: Although cervical incompetence is a complicating factor in as few as 0.1% to 2% of all pregnancies (Norwitz), 20% of the time, when miscarriage occurs between the sixteenth and twenty-fourth weeks of pregnancy, incompetent cervix is the cause (Schwarz), and it factors into 10% of all the preterm deliveries ("Cervical Incompetence").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Factors that increase the risk of cervical incompetence (CI) include structural weaknesses or abnormalities of the cervix. They may be congenital (inherited), involve exposure to DES, or result from trauma (such as from D&C procedures). Pap smear biopsy does not increase risk, but the removal of a wedge of cervix used in the treatment of precancerous conditions called the cold knife cone biopsy is associated with a 2% risk of cervical incompetence. There may be little added risk from two first-trimester surgical terminations of pregnancy (surgical dilatation of the cervix); beyond that, successive procedures result in a 12% risk (Tucker).

Source: Medical Disability Advisor



Diagnosis

History: The only telling history of CI is a miscarriage between the sixteenth and twenty-eighth week of an otherwise uneventful pregnancy. A similar event having occurred during a previous pregnancy is the best predictor of cervical incompetence and will alert the physician to an increased likelihood in future pregnancies.

Physical exam: Physical examination of the cervix during the second or third trimester may reveal partial opening of the cervix (dilation) with shortening and thinning of the vaginal part of the cervix (effacement). This results in cervical structural weakness which may cause premature labor and delivery.

Tests: There are no absolute tests to predict this condition, but the health care provider may order serial transvaginal ultrasound studies (TVS) after the sixteenth week in women with a history suggesting cervical incompetence. Ultrasound studies determine the length of the cervix, which in a compromised cervix may be shortened. Even in this case, there is no certainty that imaging studies are superior to digital examination. Further, the imaging studies are poor predictors of the condition in woman with no history of second- or third-trimester miscarriages.

Source: Medical Disability Advisor



Treatment

There is usually no treatment without a history suggesting an incompetent cervix. When the condition is anticipated, the surgeon may close the cervix using a procedure called cervical cerclage. There are two approaches to cerclage: the transabdominal approach, which reaches the cervix through an incision made into the abdomen exposing the cervix, or the transvaginal approach, which enters the cervix through the vagina (transvaginally). There are advantages and disadvantages to each procedure. In both cases the cervix is banded or stitched so it will remain closed under the weight of the growing fetus. The cerclage is removed just before the time of delivery or during cesarean section. Studies surrounding the absolute value of cerclage are often contradictory, but at this time it seems to offer the best treatment option. The physician might also consider bed rest, antibiotics, progestins, and the use of medications to stop labor (tocolysis); however, there are no firm studies validating the benefits conferred.

Source: Medical Disability Advisor



Prognosis

The outlook for a woman with an incompetent cervix will be an ongoing tendency to premature labor and miscarriage. The damage is more likely to be emotional rather than physical. Physical trauma to the mother following a premature birth is generally modest, and recovery should be uneventful. Other than premature births and possible pregnancy and treatment complications, there are no health risks directly associated with an incompetent cervix.

Source: Medical Disability Advisor



Complications

General complications will be associated with the general health of the patient. Complications arising from cerclage are the same as those associated with any invasive procedure. Specifically, emergency cervical cerclage may result in excessive blood loss, abortion, cervical laceration, complications from anesthesia, infection or rupture of the fetal membranes, suture displacement, and stricture of the cervix (cervical stenosis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The degree of mental and physical trauma will dictate any work restrictions. For some, work may prove emotionally therapeutic.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has individual had previous pregnancies spontaneously terminated, approximately between the fourteenth and twenty-eighth weeks?
  • Does individual have a history of DES exposure or congenital cervical weakness?
  • Has individual had prior trauma to the cervix from D&C procedures or cold knife cone biopsy?
  • Has ultrasound cervical measurement been considered?

Regarding treatment:

  • Has individual undergone cervical cerclage?
  • Have bed rest, antibiotics, progestins, or tocolysis been considered?
  • Is individual receiving emotional support?

Regarding prognosis:

  • Has miscarriage resulted?
  • Has cerclage been performed to help bring the fetus to term?
  • Has individual developed complications from treatment of the condition, such as infection or heavy bleeding?

Source: Medical Disability Advisor



References

Cited

"Cervical Incompetence." CrashCards Inc. 3 Jan. 2005 <http://www.crashcards.com/Medifocus%20Guides/cervicalincompetenceGY007.htm>.

Norwitz, Errol R. "Emergency Cerclage: What do the Data Really Show?" Contemporary OB/GYN. 3 Jan. 2005 <http//www.contemporaryobgyn.net/be_core/ content/journals/g/data/2002/1001/gnorwitz2.html>.

Schwarz, Richard. "Cervical Incompetence Facts." Discoveryhealth.com. Duke Orthopaedics. 3 Jan. 2005 <http://health.discovery.com/centers/pregnancy/americanbaby/cervicalincompetence.html>.

Tucker, D. E. "Cervical Incompetence." Women's Health Information. Mar. 2004. 3 Jan. 2005 <http://www.womens-health.co.uk/cxinc.asp>.

Source: Medical Disability Advisor






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