Rescue cerclage revisited: the role of adjunctive pessary in cervical incompetence

Abstract

Background: Emergency cervical cerclage is an established intervention for women presenting with painless cervical dilatation; however, outcomes are strongly influenced by the degree of cervical compromise at presentation and multiple other factors. Cervical pessary is a non-invasive option for preventing preterm birth, but its role as an adjunct to emergency cerclage remains inadequately explored.

Methods: This was a retrospective observational study in women with cervical insufficiency who underwent emergency cervical cerclage between January 2020 and December 2025 at a tertiary care centre in India. Pregnancy and neonatal outcomes were compared between women who underwent emergency cerclage with adjunctive pessary (Group A) and those who underwent cerclage alone (Group B). A predefined subgroup analysis was performed among women presenting with advanced cervical dilatation (≥2 cm).

Results: Thirty women were included (Group A, n=7 and Group B, n=23). Women in group A presented with significantly greater cervical dilatation at admission (2.57 vs 1.44 cm; p=0.002). Overall pregnancy outcomes, including latency period, gestational age at delivery, and neonatal survival, were comparable between groups. In the subgroup with cervical dilatation ≥2 cm at the time of presentation (Subgroup A, n=6; Subgroup B, n=6), early pregnancy expulsion occurred more frequently in subgroup B (50%) than subgroup A (0%), showing a trend toward statistical significance (p=0.053). Subgroup A demonstrated a longer mean latency period (10.8 vs 6.8 weeks), though this difference was not statistically significant (p=0.37).

Conclusions: In women undergoing emergency cervical cerclage, particularly those with advanced cervical dilatation, adjunctive pessary use may reduce pregnancy loss at earlier gestation and support pregnancy prolongation.