Cervical Cerclage in Combination with Oral Progesterone and Vaginal Ring Pessary for Preventing Recurrent Previable Births in Women with Prior Failed Cervical Cerclage: An Exploratory Prospective Case Series
Keywords:
Adjunctive support techniques, cervical insufficiency, preterm birth prevention, ring pessary, progesterone, maternal-fetal medicineAbstract
Background: Recurrent previable births due to cervical insufficiency pose significant challenges, particularly after failed cerclage procedures.
Objectives: This case study evaluates a novel triple approach combining transvaginal cerclage, oral progesterone, and vaginal ring pessary in high-risk women with prior failed cerclage.
Methods: We conducted a prospective case series involving four women with recurrent previable births and previously failed cerclage at a tertiary centre in Nigeria between January 2024 and April 2025. Participants received transvaginal cervical cerclage between 10-13 weeks, followed by vaginal ring pessary (‘Donut type’) insertion two weeks later, and oral progesterone (dydrogesterone 10mg three times daily) until 28 weeks. The primary outcome was delivery beyond 34 weeks of gestation. Secondary outcomes included neonatal survival, birth weight, and maternal complications.
Results: Among the four participants (mean age 30.8 years, range 26-36), three (75%) delivered beyond 34 weeks of gestation (mean 35.2 weeks among those who delivered). Three had live births at term or late preterm (34weeks 1 day, 36weeks 3 days, and 37weeks 2 days) with favourable neonatal outcomes (birth weights 2.4kg, 3.1kg, and 2.7kg; APGAR scores 6/1, 9/1 and 9/1), while one experienced a previable birth at 26 weeks 1 day resulting in neonatal death. One maternal complication (cervical laceration) occurred that was successfully repaired.
Conclusion: This combined triplex approach appears feasible and potentially effective for high-risk women with recurrent previable births following failed cerclage. It may offer a less invasive alternative to open abdominal or laparoscopic cerclage, particularly valuable in resource-limited settings. These preliminary findings warrant validation through larger prospective or randomised controlled trials.
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