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 unde rwent a Shirodkar cerclage following a failed McDonald procedure in pr evious pregnancy. The study included 62 women who underwent an electiv e Shirodkar procedure between week 9 and week 15 of their singleton pr egnancies. They had all failed to complete 34 weeks of gestation in th eir previous pregnancy despite the use of a McDonald cerclage. Complic ations observed included premature contractions in 18 patients (29.0%) , preterm premature rupture of the membranes (FROM) in 7 (11.3%), vagi nal bleeding in 6 (9.7%), chorioamnionitis in 2 (3.2%), cervical lacer ation 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 p remature delivery (21-33 weeks) in 10 (16.1%), and premature delivery (34-36 weeks) in 7 (11.3%) women. Pregnancies reached full term (>37 w eeks gestation) in 41 (66.1%) of the women. The fetal survival sate wa s 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 asso ciated with favorable pregnancy outcome.