Successful Transabdominal Cerclage for Recurrent Second-Trimester Loss in a Low-Resource Environment: A Case Report.

Abstract

Cervical insufficiency is a significant cause of recurrent midtrimester pregnancy loss. Although transabdominal cerclage (TAC) is an established option for selected patients with severe cervical insufficiency, its application and outcomes remain undocumented in West African clinical settings. This case report documents the first use of TAC in Ghana. Three Ghanaian women, aged 32-33, with severe cervical insufficiency and a cumulative history of eight prior midtrimester losses and multiple failed transvaginal cerclages, underwent open TAC using 5-mm Mersilene tape between 12 and 13 weeks of gestation at Oak Specialist Hospital in Kumasi, Ghana. All three reported pregnancies resulted in live births, yielding five neonates. Deliveries occurred at 38 weeks 4 days (singleton), 35 weeks 2 days (singleton) and 30 weeks 1 day (triplet gestation complicated by preeclampsia and peripartum cardiomyopathy). No major intraoperative or postoperative complications directly attributable to the surgery were observed. This case report demonstrates that TAC is a feasible intervention for severe cervical insufficiency in a Ghanaian specialist hospital setting. The preliminary outcomes are encouraging, but larger studies are needed to establish efficacy and generalizability across the West African region.