Preservation of Cervical Cerclage After Cesarean Section for Prevention of Cervical Incompetence in Subsequent Pregnancy: A 4- Year Clinical Study

Abstract

Objective: To evaluate the clinical efficacy and safety of preserving transvaginal
cervical cerclage in situ during cesarean section for reuse in subsequent pregnancies
among women with confirmed cervical incompetence.
Methods: This four-year retrospective observational study (April 2022- April 2026) initially
enrolled 180 pregnant women with confirmed cervical insufficiency from the gynecology OPD
of AERO Hospital. Inclusion was limited to singleton pregnancies with a history of mid-trimester
loss or a cervical length <2.5 cm. Patients with multiple gestations and co- morbidities
(Diabetes Mellitus, Gestational Diabetes, Hypertension, and Thyroid disorders) were excluded.
All participants underwent cesarean delivery where suture integrity was assessed
intraoperatively and reassessed for two months post-delivery. Primary outcomes included
gestational age (GA)at delivery in the subsequent pregnancy, and secondary outcomes
included the effect on fertility.
Results: Final analysis included 176 cases. In the subsequent pregnancy, 76.70% (n=135)
delivered between 36-38 weeks,21.02% (37delivered between 34-35.6 weeks), and only
2.27%(n=4) delivered before 34 weeks. Statistical analysis using Chi-square tests showed a
significant improvement in pregnancy prolongation compared to historical cohorts without
cerclage(p<0.05). Regarding the secondary outcome, 98.29% (n=173) of participants
successfully conceived within 12 months, with 88.64% (n=156) conceived within 6 months of
trying. Only one case (0.56%) required suture removal due to localized infection.
Conclusion: Preserving cervical cerclage during cesarean section is a safe and effective
strategy for managing recurrent cervical insufficiency.
This approach significantly improves neonatal outcomes by ensuring a high rate of term
deliveries while reducing the necessity for repeated invasive surgical procedure. It offers a
cost-effective and clinically sound solution for high-risk obstetric population,
particularly in resource-limited settings.
Key Words: Cervical Incompetence, Cervical Cerclage, Gestational Age, fertility.

1.Introduction