Management of an Incompetent Mid-second (Mid-2nd) Trimester Absent Ectocervix: 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 significant difficulty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2nd 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 post-operative 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 beneficial therapeutic option in management of an incompetent mid-2nd trimester absent ecto-cervix.