Should Primigravidas or Secundigravidas be Routinely Screened for Cervical Insufficiency? Insights from Two Cases of Emergency Cerclage Using a Modified Macdonald Technique

George Uchenna Eleje*, Isaiah Chukwuebuka Umeoranefo, Chichi Ukoha, Ekeuda Uchenna Nwankwo, Emmanuel Chukwubuikem Egwuatu, Odigonma Zinobia Ikpeze, Charles Chukwuka Ezema, Obinna Kenneth Nnabuchi, Chigozie Geoffrey Okafor, Kingsley Chidiebere Nwaogu, Michel Chiedu Egbuniwe, Emeka Philip Igbodike, Kenechukwu Ezekwesili Obi, Adanna Vivian Egwim, Chukwuemeka Chukwubuikem Okoro, Chukwudubem Chinagorom Onyejiaka, Chiemezie Mac-Kingsley Agbanu, Donald Ugochukwu Nwasike, Emeka Godswill Igboekwe, Chijioke Ogomegbunam Ezeigwe, Stanley Chigaemezu Egbogu, Casmir Chukwudi Madubuko, Alexander Arinze Mathias, Martin Chinedu Andeh, Nkejesus Chidube Obi, Ebube BelieveGod Akosa, Lambert Chukwu Onyejiaku, James Egwuatu Okonkwo, Ifeanyi Kingsley Nwaeju, Tochukwu Chukwuemeka Obiechina, Chidebe Christian Anikwe, John Chukwuemeka Nkesi, Felix Nwabunwanne Emodi, Samuel Nnaji Ugadu, Ijeoma Rita Chukwuka, Florence Olumma Ndu, Emmanuel Onyebuchi Ugwu, Joseph Ifeanyichukwu Ikechebelu, Gerald Okanandu Udigwe, Ahizechukwu Chigoziem Eke

Department of Obstetrics and Gynaecology, Effective Care Research Unit, Nnamdi Azikwe University, Nigeria
Department of Obstetrics and Gynaecology, Nnamdi Azikwe University Teaching Hospital, Nigeria
Department of Obstetrics and Gynaecology, Barts Health NHS Foundation Trust, UK
Rural Community Clinical School, School of Medicine, Deakin University, Australia
Department of Radiology, Nnamdi Azikwe University Teaching Hospital, Nigeria
Department of Nursing, University of Sunderland, Sunderland, United Kingdom
Department of Obstetrics and Gynaecology, University of Lagos, Nigeria
Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nigeria
Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School
of Medicine, USA

^*Correspondance to: George Uchenna Eleje 

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Abstract:

Cervical insufficiency is a significant contributor to mid-trimester pregnancy loss and preterm birth. Emergency cervical cerclage is a potentially life-saving intervention, but its use remains controversial, especially in primigravidas or secundigravidas with no identifiable risk factors. We report two cases involving a primigravida and a secundigravida, both presenting with painless cervical dilation and bulging fetal membranes at 22- and 21-weeks’ gestation, respectively. Neither had a history of cervical procedures or prior pregnancy losses. Following emergency transvaginal cervical cerclage the first case progressed to a live birth at 36 weeks gestation while the second, unfortunately experienced pregnancy loss at 23 weeks. We presented these case reports to highlight that cervical insufficiency could present unexpectedly in women without traditional risk factors, and that emergency cerclage may improve outcomes, but risks remain. Routine second-trimester cervical length screening may therefore be warranted in primigravidas or secundigravidas to identify at-risk pregnancies and allow for timely elective intervention.

Keywords:

Cervical insufficiency; Emergency cerclage; Primigravida; Secondigravida; Modified MacDonald technique; Preterm Birth prevention; Cervical incompetence

Cite the Article:

Eleje GU, Umeoranefo IC, Ukoha C, Nwankwo EU, Egwuatu EU, Ikpeze OZ, et al. Should Primigravidas or Secundigravidas be Routinely Screened for Cervical Insufficiency? Insights from Two Cases of Emergency Cerclage Using a Modified Macdonald Technique. Clin Case Rep Int. 2026; 10: 1768.