Successful Term Pregnancy After Modified Shirodkar Cerclage Following Nine Failed McDonald Cerclages: A Case Report
DOI:
https://doi.org/10.53819/81018102t2603Abstract
Background: Cervical insufficiency is a significant cause of second-trimester pregnancy loss. The McDonald cerclage is widely used due to its simplicity and safety. However, in women with profound cervical insuffciency or multiple failed McDonald cerclages, a more robust high cerclage, such as the Shirodkar procedure, may be required.
Case Presentation: We report the case of a 39-year-old Cameroonian woman, gravida 13 para 0, with a history of twelve consecutive second-trimester miscarriages (16–19 weeks), all following failed McDonald cerclages, including a double McDonald cerclage in her eleventh pregnancy. In her thirteenth pregnancy, a modified Shirodkar cerclage using Mersilene tape was performed at 26 weeks under regional anaesthesia. Postoperative management included absolute bed rest and close follow-up. The pregnancy progressed uneventfully until 37 weeks and 2 days, when an emergency caesarean section was performed for labour onset, resulting in the delivery of a healthy male baby weighing 3,800 grams with Apgar scores of 9 and 10.
Conclusion: This case demonstrates that a modified Shirodkar cerclage, even when performed late in gestation, can achieve a successful term pregnancy in patients with multiple failed McDonald’s cerclages. It highlights the importance of individualised management for cervical insufficiency, especially in complex or recurrent cases.
Keywords: Cervical insufficiency, Shirodkar cerclage, McDonald cerclage failure, recurrent pregnancy loss, Cameroon, rescue cerclage
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