Outcome of shirodkar cervical cerclage following a failed McDonald cerclage in a previous pregnancy

Our objective was to determine the pregnancy outcome in women who underwent a Shirodkar cerclage following a failed McDonald procedure in previous pregnancy. The study included 62 women who underwent an elective Shirodkar procedure between week 9 and week 15 of their singleton pregnancies. They had all failed to complete 34 weeks of gestation in their previous pregnancy despite the use of a McDonald cerclage. Complications observed included premature contractions in 18 patients (29.0%), preterm premature rupture of the membranes (PROM) in 7 (11.3%), vaginal bleeding in 6 (9.7%), chorioamnionitis in 2 (3.2%), cervical laceration in 1 (1.6%), and a single case (1.6%) of rupture of the uterus. Spontaneous abortion (<20 weeks) occurred in 4 (6.5%) patients, very premature delivery (21-33 weeks) in 10 (16.1%), and premature delivery (34-36 weeks) in 7 (11.3%) women. Pregnancies reached full term (>37 weeks gestation) in 41 (66.1%) of the women. The fetal survival rate was 88.7% (55 viable newborns). In women undergoing repeat cerclage who failed to complete 34 weeks of gestation after a McDonald procedure in their previous pregnancy, the use of the Shirodkar technique was associated with favorable pregnancy outcome.