Cervical Cerclage in Combination with Oral Progesterone and Vaginal Ring Pessary for Preventing Recurrent Previable Births in Women with Prior Failed Cervical Cerclage: An Exploratory Prospective Case Series

George Uchenna Eleje; Obinna Kenneth  Nnabuchi; Ekeuda Uchenna  Nwankwo; Chigozie Geoffrey  Okafor; Chichi  Ukoha; Emmanuel Chukwubuikem  Egwuatu; Adanna Vivian  Egwim; Chukwuemeka Chukwubuikem  Okoro; Chukwudubem Chinagorom  Onyejiaka; Donald Ugochukwu  Nwasike; Henry Chinedu  Nneji; Charles Chukwuka  Ezema; Tobechi Kingsley  Njoku; Chidebe Christian  Anikwe; Isaiah Chukwuebuka  Umeoranefo; Odigonma Zinobia  Ikpeze; Charlotte Blanche  Oguejiofor; Emmanuel Onyebuchi  Ugwu; Joseph Ifeanyichukwu  Ikechebelu; Gerald Okanandu  Udigwe; Ahizechukwu Chigoziem  Eke

doi:10.55640/ijmsdh-12-05-10

Open Access

Cervical Cerclage in Combination with Oral Progesterone and Vaginal Ring Pessary for Preventing Recurrent Previable Births in Women with Prior Failed Cervical Cerclage: An Exploratory Prospective Case Series

Vol. 12 No. 05 (2026): Volume 12 Issue 05 | Pages: 89-97 | https://doi.org/10.55640/ijmsdh-12-05-10

Authors

George Uchenna Eleje
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.
https://orcid.org/0000-0002-0390-2152

Obinna Kenneth Nnabuchi
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0009-0002-9367-687X

Ekeuda Uchenna Nwankwo
Rural Community Clinical School, School of Medicine, Deakin University, Victoria, Australia.
https://orcid.org/0000-0003-0508-3848

Chigozie Geoffrey Okafor
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-4458-8216

Chichi Ukoha
Department of Obstetrics and Gynaecology, Barts Health NHS Foundation Trust, London, UK.
https://orcid.org/0009-0005-4870-3930

Emmanuel Chukwubuikem Egwuatu
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-2726-2302

Adanna Vivian Egwim
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-5015-1999

Chukwuemeka Chukwubuikem Okoro
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-5772-661X

Chukwudubem Chinagorom Onyejiaka
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-6471-2566

Donald Ugochukwu Nwasike
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0009-0003-2410-0591

Henry Chinedu Nneji
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0001-6497-0506

Charles Chukwuka Ezema
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0009-0006-6748-5681

Tobechi Kingsley Njoku
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-5690-9892

Chidebe Christian Anikwe
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-3730-621X

Isaiah Chukwuebuka Umeoranefo
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0009-0002-0975-7117

Odigonma Zinobia Ikpeze
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-2351-1076

Charlotte Blanche Oguejiofor
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-2925-1690

Emmanuel Onyebuchi Ugwu
Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
https://orcid.org/0000-0002-3342-434X

Joseph Ifeanyichukwu Ikechebelu
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0003-2515-8464

Gerald Okanandu Udigwe
Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria. / Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
https://orcid.org/0000-0002-0390-2152

Ahizechukwu Chigoziem Eke
Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
https://orcid.org/0000-0002-0070-9840

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Copyright (c) 2026 George Uchenna Eleje, Tobechi Kingsley Njoku, Chidebe Christian Anikwe, Isaiah Chukwuebuka Umeoranefo, Odigonma Zinobia Ikpeze, Charlotte Blanche Oguejiofor, Emmanuel Onyebuchi Ugwu, Joseph Ifeanyichukwu Ikechebelu, Gerald Okanandu Udigwe, Charles Chukwuka Ezema, Henry Chinedu Nneji, Donald Ugochukwu Nwasike, Obinna Kenneth Nnabuchi, Ekeuda Uchenna Nwankwo, Chigozie Geoffrey Okafor, Chichi Ukoha, Emmanuel Chukwubuikem Egwuatu, Adanna Vivian Egwim, Chukwuemeka Chukwubuikem Okoro, Chukwudubem Chinagorom Onyejiaka, Ahizechukwu Chigoziem Eke

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Eleje, G. U., Nnabuchi, O. K. ., Nwankwo, E. U. ., Okafor, C. G. ., Ukoha, C. ., Egwuatu, E. C. ., Egwim, A. V. ., Okoro, C. C. ., Onyejiaka, C. C. ., Nwasike, D. U. ., Nneji, H. C. ., Ezema, C. C. ., Njoku, T. K. ., Anikwe, C. C. ., Umeoranefo, I. C. ., Ikpeze, O. Z. ., Oguejiofor, C. B. ., Ugwu, E. O. ., Ikechebelu, J. I. ., … Eke, A. C. . (2026). Cervical Cerclage in Combination with Oral Progesterone and Vaginal Ring Pessary for Preventing Recurrent Previable Births in Women with Prior Failed Cervical Cerclage: An Exploratory Prospective Case Series . International Journal of Medical Science and Dental Health, 12(05), 89-97. https://doi.org/10.55640/ijmsdh-12-05-10

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Abstract

Background: Recurrent previable births due to cervical insufficiency pose significant challenges, particularly after failed cerclage procedures.

Objectives: This case study evaluates a novel triple approach combining transvaginal cerclage, oral progesterone, and vaginal ring pessary in high-risk women with prior failed cerclage.

Methods: We conducted a prospective case series involving four women with recurrent previable births and previously failed cerclage at a tertiary centre in Nigeria between January 2024 and April 2025. Participants received transvaginal cervical cerclage between 10-13 weeks, followed by vaginal ring pessary (‘Donut type’) insertion two weeks later, and oral progesterone (dydrogesterone 10mg three times daily) until 28 weeks. The primary outcome was delivery beyond 34 weeks of gestation. Secondary outcomes included neonatal survival, birth weight, and maternal complications.

Results: Among the four participants (mean age 30.8 years, range 26-36), three (75%) delivered beyond 34 weeks of gestation (mean 35.2 weeks among those who delivered). Three had live births at term or late preterm (34weeks 1 day, 36weeks 3 days, and 37weeks 2 days) with favourable neonatal outcomes (birth weights 2.4kg, 3.1kg, and 2.7kg; APGAR scores 6/1, 9/1 and 9/1), while one experienced a previable birth at 26 weeks 1 day resulting in neonatal death. One maternal complication (cervical laceration) occurred that was successfully repaired.

Conclusion: This combined triplex approach appears feasible and potentially effective for high-risk women with recurrent previable births following failed cerclage. It may offer a less invasive alternative to open abdominal or laparoscopic cerclage, particularly valuable in resource-limited settings. These preliminary findings warrant validation through larger prospective or randomised controlled trials.

Keywords:

Adjunctive support techniques, cervical insufficiency, preterm birth prevention, ring pessary, progesterone, maternal-fetal medicine

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Cervical Cerclage in Combination with Oral Progesterone and Vaginal Ring Pessary for Preventing Recurrent Previable Births in Women with Prior Failed Cervical Cerclage: An Exploratory Prospective Case Series

Authors

George Uchenna Eleje

Obinna Kenneth Nnabuchi

Ekeuda Uchenna Nwankwo

Chigozie Geoffrey Okafor

Chichi Ukoha

Emmanuel Chukwubuikem Egwuatu

Adanna Vivian Egwim

Chukwuemeka Chukwubuikem Okoro

Chukwudubem Chinagorom Onyejiaka

Donald Ugochukwu Nwasike

Henry Chinedu Nneji

Charles Chukwuka Ezema

Tobechi Kingsley Njoku

Chidebe Christian Anikwe

Isaiah Chukwuebuka Umeoranefo

Odigonma Zinobia Ikpeze

Charlotte Blanche Oguejiofor

Emmanuel Onyebuchi Ugwu

Joseph Ifeanyichukwu Ikechebelu

Gerald Okanandu Udigwe

Ahizechukwu Chigoziem Eke

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