Abstract:

Advanced maternal age in conjunction with assisted reproductive technology (ART) and cervical insufficiency constitutes a significant risk factor for mid-trimester pregnancy loss and extreme preterm delivery. The effective management of this condition is crucial for improving the pregnancy outcomes. This report presents a case of an advanced maternal patient, 36-year-old, who conceived via ART. During the second trimester, the emergency cervical cerclage was performed due to the cervical incompetence manifested as cervical dilation of 4 cm with protrusion of the amniotic sac through the external cervical os. The secondary emergency cervical cerclage was performed after eight days of the first operation, due to the recurrent amniotic sac protrusion lateral to the cervical canal. The adjunctive management included anti-infective therapy, tocolysis, and fetal preservation treatment. Through comprehensive multidisciplinary management, the patient successfully maintained the pregnancy to term and achieved vaginal delivery. This successful case suggested that for those elderly patients with ART-assisted pregnancy and cervical insufficiency, if cervical dilation and amniotic sac protrusion occur repeatedly, the multiple emergency cervical cerclage combined with perioperation management is a feasible treatment option for achieving full-term pregnancies.

Key words: Cerclage, cervical, Uterine cervical incompetence, Pregnancy, Reproductive techniques, assisted, Term birth