Integrated management of uterine prolapse during pregnancy: Case report and literature review of successful term delivery following cervical cerclage and pessary utilization

OBJECTIVE: This paper presents a comprehensive approach for managing uterine prolapse during first-trimester pregnancy complicated by poor obstetric history. A prophylactic cervical cerclage and an adjunctive ring pessary were used to maintain cervical integrity and achieve successful term delivery. CASE REPORT: A 43-year-old woman, Gravida 12, Para 2, with a history of recurrent pregnancy losses, including a second-trimester loss attributable to cervical incompetence, presented with stage III uterine prolapse at 11 weeks of gestation. Prophylactic McDonald cerclage was performed at 12 weeks, after which a ring pessary and vaginal progesterone were utilized. The pregnancy was successfully managed to term, resulting in vaginal delivery at 38 + 5 weeks of a baby with birth weight of 2790 g and an Apgar score of 9/9. CONCLUSION: This case highlights the successful use of cervical cerclage and a pessary for managing uterine prolapse complicated by cervical incompetence during pregnancy, emphasizing the need for personalized management strategies.