Background: Emergency cervical cerclage is an established intervention for women presenting with painless cervical dilatation; however, outcomes are strongly influenced by the degree of cervical compromise at presentation and multiple other factors. Cervical pessary is a non-invasive option for preventing preterm birth, but its role as an adjunct to emergency cerclage remains inadequately explored.

Methods: This was a retrospective observational study in women with cervical insufficiency who underwent emergency cervical cerclage between January 2020 and December 2025 at a tertiary care centre in India. Pregnancy and neonatal outcomes were compared between women who underwent emergency cerclage with adjunctive pessary(Group A) and those who underwent cerclage alone(Group B). A predefined subgroup analysis was performed among women presenting with advanced cervical dilatation(≥2 cm).

Results: Thirty women were included(Group A, n=7; Group B, n=23). Women in Group A presented with significantly greater cervical dilatation at admission(2.57 vs 1.44 cm; p=0.002). Overall pregnancy outcomes, including latency period, gestational age at delivery, and neonatal survival, were comparable between groups. In the subgroup with cervical dilatation ≥2 cm at the time of presentation(Subgroup A, n=6; Subgroup B, n=6), early pregnancy expulsion occurred more frequently in Subgroup B(50%) than Subgroup A(0%), showing a trend toward statistical significance(p=0.053). Subgroup A demonstrated a longer mean latency period(10.8 vs 6.8 weeks), though this difference was not statistically significant(p = 0.37).

Conclusion: In women undergoing emergency cervical cerclage, particularly those with advanced cervical dilatation, adjunctive pessary use may reduce pregnancy loss at earlier gestation and support pregnancy prolongation.

Keywords: Cervical insufficiency; Emergency cerclage; Cervical pessary; Preterm birth

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