Double cervical cerclage for cervical insufficiency: Case report.

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine

Background:

• Recurrent pregnancy loss (RPL) is a significant clinical challenge, particularly in the second trimester.
• Cervical insufficiency is a primary cause of second-trimester pregnancy loss.
• Abdominal cerclage is often considered for cases of failed transvaginal cerclage.

Observation:

• A 33-year-old woman with a history of nine second-trimester pregnancy losses experienced six failed transvaginal cerclages (McDonald's procedure).
• A novel transvaginal double cervical cerclage using mersilene tape was performed during her subsequent pregnancy.
• Sutures were placed submucosally, one below and one at the internal os, knotted at the 12 o'clock position.

Findings:

• The patient successfully carried her pregnancy to near term.
• A healthy baby girl weighing 2.5kg was delivered.
• This modified technique demonstrated efficacy in preventing second-trimester pregnancy loss.

Implications:

• Transvaginal double cervical cerclage with mersilene tape presents a viable alternative to abdominal cerclage for selected patients.
• This approach may improve outcomes for women with severe cervical insufficiency and RPL.
• Further research into modified transvaginal cerclage techniques is warranted to optimize management of RPL.