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

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.