Management of an incompetent mid-second (mid-2nd) trimester absent ecto-cervix: a case series. Cervical amplification pre-cerclage insertion

Abstract

Cervical cerclage is a treatment for an incompetent cervix, the latter being a contributor to spontaneous preterm birth. There is signi cant di culty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2 nd trimester period resulting in a higher risk of late miscarriages, extremely preterm labour with subsequent neonatal morbidity and mortality.A retrospective review of cases managed by additional surgical techniques and protocols increased the likelihood of a successful insertion in this cohort of patients. This was supported by adjuvant postoperative management protocol which included vaginal progesterone use, regular infection screening and lifestyle advice.Cerclage insertion was mostly from 18-20 weeks gestational age (GA) with an increased gestational latency of 13 gestational weeks (range 12-18) with all deliveries after 34 weeks GA. Mean gestational age at delivery was 36 weeks +1 (253 days) with a range of 241-264 days in this small cohort of patients with minimal surgical complications and corresponding good neonatal outcomes.This technique has the potential to be a bene cial therapeutic option in management of an incompetent mid-2nd trimester absent ecto-cervix.