A Case Report of Successful Pregnancy Maintenance Following Emergency Cervical Cerclage after Radiofrequency Ablation for Twin-to-Twin Transfusion Syndrome: A Systematic Literature Review

Abstract Background： Radiofrequency ablation (RFA) represents an effective intrauterine therapeutic option for monochorionic diamniotic（MCDA） twin pregnancies complicated by severe complications.Cervical cerclage represents an effective therapeutic approach for addressing cervical insufficiency.However, to date, there have been no documented cases of successful pregnancy maintenance following emergency cervical cerclage after intrauterine treatment.Therefore, this study presents a case of a patient who underwent laparoscopic preventive cervical cerclage prior to pregnancy, subsequently developed twin-to-twin transfusion syndrome (TTTS) stage II during gestation, successfully underwent radiofrequency ablation for treatment, and concurrently required an emergency vaginal cervical cerclage, ultimately resulting in delivery at 31 weeks and 6 days of gestation. Case presentation：This case report presents a patient with cervical insufficiency characterized by repeated painless mid-trimester miscarriages due to cervical dilation. Prior to conception, the patient underwent laparoscopic prophylactic cervical cerclage. This pregnancy was achieved via assisted reproductive technology and was further complicated by gestational diabetes mellitus. During the course of pregnancy, the patient experienced recurrent vaginal bleeding, which was subsequently followed by the onset of twin-to-twin transfusion syndrome (TTTS).A case of successful pregnancy maintenance following sequential interventions of amnioreduction, selective fetal reduction via radiofrequency ablation and emergency transvaginal cervical cerclage. The pregnant woman delivered at 31 weeks and 6 days of gestation, 93 days after undergoing radiofrequency ablation and 63 days following an emergency cervical cerclage. The newborn weighed 1.59 kg at birth and received Apgar scores of 9 and 10 at 1 minute and 5 minutes, respectively. The mother was discharged from the hospital on the fourth day post-delivery, while the newborn remained hospitalized in the Neonatal Intensive Care Unit（NICU） for 35 days. Conclusion:The success of this case is attributable to the close collaboration between fetal medicine and traditional obstetrics.This is currently the first case of successful pregnancy preservation after emergency transvaginal cervical cerclage following intrauterine treatment. It demonstrates that intrauterine treatment is not contraindicated for patients with cervical insufficiency and recurrent vaginal bleeding during pregnancy. Continued emergency cervical cerclage may potentially achieve better outcomes in extending gestational age. Therefore, it is recommended that pregnancy management be tailored and personalized, with careful consideration given to both maternal and fetal conditions.