Two successful live births following trans-abdominal cervicoisthmic cerclage in a woman with recurrent miscarriages

Abstract

Cervical insufficiency, previously known as cervical incompetence, has been described as painless cervical dilation that leads to mid-trimester miscarriage in the absence of other causes. Recently, it has expanded to include women with a prior spontaneous preterm birth and evidence of cervical shortening (<25mm) on transvaginal ultrasound at a gestational age less than 18 weeks. Cerclage is an obstetric procedure performed for prevention of miscarriage and preterm birth in women with cervical incompetence; it can be done via vaginal or abdominal route. We present a case of a 32-year-old woman, now P2+5 (2 alive), with a history of five recurrent midtrimester pregnancy losses who was evaluated and worked up for abdominal cerclage after several failed cervical cerclages, who later had two successful pregnancies and deliveries via elective caesarean section. This case is presented as a reminder that such cases still exist, and the skill must be passed on to a younger generation of doctors as it may become useful when such cases are presented.