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Case Report: History-Indicated McDonald's Cerclage for Uterine Didelphys and History of Cervical Insufficiency
Eleanore Rominger1, Henry Tal Lesser1, Fereshteh Boozarjomehri1
1Geisinger Health System, Department of Obstetrics and Gynecology, Danville, Pennsylvania, USA, geisinger.org.
Introduction:
Mullerian anomalies alone are not an indication for prophylactic and history indicated cerclage (HIC). Data on the use of cerclage for patients with mullerian anomalies is therefore limited to case reports of ultrasound indicated cerclage (UIC) and physical exam indicated cerclage (PIC). Given these limitations, there is a hesitancy towards cerclage use in this subset of patients. This case report aims to highlight that HIC is a safe and effective intervention for patients with mullerian anomalies and a history of cervical insufficiency (CI).
Case:
We present a case of a patient with uterine didelphys and a history of CI that underwent a successful McDonald HIC in a subsequent pregnancy. Surveillance throughout pregnancy was reassuring and the patient delivered preterm at 32 weeks and 0 days' gestation with a favorable final outcome.
Conclusion:
Although data is limited regarding cerclage use in patients with mullerian anomalies, this case suggests that a HIC is a low risk and effective intervention that should not be withheld from this subgroup of patients.
