Usage of cervical cerclage in pregnancy with Mullerian anomalies and cervical insufficiency: A case report

Usage of cervical cerclage in Mullerian anomalies remains unclear due to the few studies and reports conducted on such cases. This case report wishes to highlight the usage of cervical cerclage in Mullerian abnormalities and repeated preterm labour. A 26-year-old G3P2A0 with 13 weeks of pregnancy came with a history of repeated preterm birth, which ended at 23-24 and 28-29 weeks consecutively. Ultrasound examination revealed that she had 14-15 weeks of pregnancy and cervical length 2.2 cm. The patient was diagnosed with cervical insufficiency, and cervical cerclage was performed. The patient then presented at 36th-37th weeks of pregnancy with labour pain and fetal distress, emergency cesarean section was performed. During the operation bicorporeal uterus was found. The fetus was delivered weighing 2.690 g with 1-min APGAR score of 7 and 5 min at 9. We performed ultrasonography and pelvic MRI 2 months after delivery, which identified a U3bC0V0 as in the European Society of Human Reproduction and Embryology classification and a bicornuate uterus (serosal indentation >1 cm) as in the 2021 American Society of Reproductive Medicine classification. Patient presented with two preterm births and fulfilled classic historic features of cervical insufficiency which history-indicated cerclage is mandatory. Uterine anomalies themselves increase the risk of recurrent pregnancy loss, preterm birth, and cervical insufficiency. Only half of a pregnancy with a bicorporeal uterus lasts till term, and half of it ends up as early preterm pregnancy loss. It is important to diagnose or exclude Mullerian abnormalities in cases of repeated preterm labour or second-trimester pregnancy loss. Usage of cerclage has been useful in some cases, including this case; further research should be conducted for stabilizing the guidelines of cerclage in pregnancy with Mullerian abnormalities.