1Postgraduate, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam-603103, Tamil Nadu, India. Email: sukeeratchopra@gmail.com
2Professor & HOD, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam-603103, Tamil Nadu, India. Email: sailatha.ramanujam@rediffmail.com
3Senior Resident, A4 Fertility Centre, No:278/2A-1A, OMR, ECR Bypass, Padur, Kelambakkam, Chennai, Tamil Nadu, 603103. Email: drnehachaudhary94@gmail.com
*Corresponding Author: Prof Dr Sailatha R, Professor & HOD, Department of Obstetrics and Gynaecology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam-603103, Tamil Nadu, India. Email: sailatha.ramanujam@rediffmail.com
Received: 19th Oct, 2025; Revised: 21th Dec, 2025; Accepted: 21th Jan, 2026; Available Online: 16th Feb, 2026
Cervical insufficiency occurs when the cervix fails to remain closed without uterine contractions, leading to repeated mid‑pregnancy losses and premature birth. Most of the published literature on this condition comes from high‑income countries or from twin pregnancies, leaving a data gap in South Asia.
This retrospective case series reviewed medical records from the Department of Obstetrics and Gynaecology at Chettinad Hospital & Research Institute in Tamil Nadu, India, between July 2023 and July 2025. We included singleton and twin pregnancies between 14 and 26 weeks' gestation that presented with painless cervical dilation or a trans‑vaginal ultrasound cervical length of 25 mm or less, provided membranes were intact. Women with mono‑amniotic twins, major fetal anomalies, placenta praevia, severe maternal disease or who declined treatment were excluded. Data collected included maternal demographics, obstetric history, cervical length, management strategy (emergency cerclage, rescue cerclage, ultrasound‑guided trans‑vaginal cerclage (TVC), trans‑abdominal cerclage (TAC), TVC combined with progesterone or a pessary, progesterone alone, pessary alone or observation) and gestational age at delivery. The primary outcome was gestational age at delivery.
Sixty‑four pregnancies met the inclusion criteria: 58 singletons and 6 twins. The mean maternal age was 27.5 years, and most women were multigravida. All deliveries were by caesarean section. In singleton pregnancies, prophylactic approaches such as ultrasound‑guided TVC, TAC and TVC combined with progesterone achieved the longest gestations (36.3–37.1 weeks) and the highest rates of term birth. Emergency and rescue cerclage delayed delivery by about 8–10 weeks but resulted mainly in late preterm births around 34–35 weeks. Adding vaginal progesterone improved outcomes. Using a pessary alone or expectant management led to mean deliveries around 35–36 weeks. In the small twin cohort, the mean gestational age at delivery was 35.4 weeks, similar to a previous prospective twin study at our centre; TAC and ultrasound‑guided TVC achieved the longest pregnancies, whereas rescue or emergency cerclage resulted in births before 34 weeks.
These findings suggest that early, prophylactic cerclage—via TVC or TAC—combined with progesterone provides the best chance of near‑term delivery, whereas emergency or rescue cerclage offers more modest benefit. Early cervical length screening and proactive intervention may improve outcomes, and larger prospective studies are needed to confirm these observations in South Asian populations.
Keywords: cervical insufficiency; cervical length; cerclage; progesterone; pessary; singleton pregnancy; retrospective case series.
How to cite this article: Chopra S, Sailatha R, Chaudhary N, Management of Cervical Insufficiency in Singleton‑Predominant Pregnancies: A Retrospective Case Series from a Tertiary Hospital in India (July 2023–July 2025)...Int J Drug Deliv Technol. 2026; 16(2): 310-314; DOI: 10.25258/ijddt.16.2.33
Source of support: Nil.
Conflict of interest: None