A Case of Term Delivery After Cervical Cerclage Following Hysteroscopic and Laparoscopic Uterine Scar Repair for Cesarean Scar Disorder.

A 33-year-old woman with secondary infertility after a term emergency cesarean delivery due to cesarean scar disorder (CSDi) underwent combined hysteroscopic and laparoscopic cesarean scar repair. Eight months later, at 34 years of age, she conceived spontaneously. Cervical length was 28.3 mm in early pregnancy (unchanged from preconception) but shortened to 20.5 mm at 13 + 5 weeks of gestation, and cervical insufficiency was suspected. A Shirodkar cerclage was performed at 15 + 4 weeks of gestation. Thereafter, cervical shortening did not progress and the pregnancy remained uncomplicated. Elective cesarean delivery at 37 + 1 weeks of gestation resulted in a healthy female infant, and both maternal and neonatal courses were uneventful. Cesarean scar repair may affect cervical competence; thus, pregnancies after CSDi repair should include close cervical length surveillance and consideration of cerclage when significant shortening is detected. Further evidence is needed to optimize postoperative pregnancy management.