Rescue Cervical Cerclage in the Second Trimester: A Case Series Evaluating Maternal and Perinatal Outcomes

Abstract

Rescue cervical cerclage is an emergent procedure performed for women in the second trimester presenting with painless cervical dilatation and exposed fetal membranes. It is a critical intervention aimed at preventing extreme preterm birth. This report details the outcomes of three antenatal women (aged 23-27 years) who underwent emergency McDonald cerclage between 20 and 22 weeks of gestation due to cervical insufficiency with membrane exposure. All patients received preoperative infection screening, tocolytics, prophylactic antibiotics, and progesterone support postoperatively. The latency period from cerclage to delivery was recorded. The gestational age at cerclage ranged from 20+1 to 21+4 weeks. The subsequent delivery occurred at 32, 36, and 37+5 weeks, respectively, yielding a mean latency period of 13.6 weeks. All three neonates were live-born with good Apgar scores, and there were no major maternal complications. This case series demonstrates that rescue cerclage, when performed in carefully selected patients under aseptic conditions with adjunctive medical therapy, can significantly prolong pregnancy to viable and near-term gestations, resulting in favourable perinatal outcomes. It remains a valuable procedure for mitigating second-trimester pregnancy loss.