# The Effectiveness of Double Cervical Cerclage and Bed Rest in Managing Complete Cervical Incompetence During the Second Trimester: A Case Presentation

## TL;DR

A woman with a history of miscarriages successfully carried a pregnancy to term using two cervical cerclages and strict bed rest.

## Contribution

Demonstrates the potential effectiveness of a second cervical cerclage combined with supportive care in managing severe cervical insufficiency.

## Key findings

- A second Shirodkar cerclage helped maintain cervical stability after the first failed.
- Strict bed rest and medical management contributed to a successful term delivery.
- The case suggests that double cerclage may be a viable option in severe cervical insufficiency.

## Abstract

Cervical insufficiency is a known cause of recurrent pregnancy loss and preterm delivery. Although cervical cerclage is the primary management option, some patients require additional reinforcement due to cervical failure.

This report describes a 45-year-old woman with a history of 5 second-trimester miscarriages who conceived through in vitro fertilization (IVF) using a donor oocyte. A prophylactic Shirodkar cerclage was placed at 12 weeks of gestation. Despite this, an ultrasound at 23 weeks showed funneling and almost complete loss of cervical length. A second emergency Shirodkar cerclage was inserted. The patient was hospitalized, maintained in the Trendelenburg position, and treated with tocolytics, antibiotics, progesterone, corticosteroids, and thromboprophylaxis while on strict bed rest. Cervical stability and fetal well-being were closely monitored until term. At 37 weeks and four days, a cesarean section was performed due to breech presentation after removal of both sutures, resulting in the delivery of a healthy female infant.

This case demonstrates that a second cervical cerclage can successfully maintain pregnancy up to term in cases of complete cervical insufficiency when the initial suture fails. The favorable outcome suggests that, in carefully selected patients, a double cerclage combined with comprehensive supportive management may help achieve term delivery. Although bed rest was implemented, its specific contribution remains uncertain and should be viewed as an adjunctive rather than a definitive therapeutic measure.