Expectant management of missed miscarriage in a post-trachelectomy patient with permanent cervical cerclage

A woman in her 30s with a history of simple trachelectomy and permanent cervical cerclage for stage IA1 cervical cancer presented with a missed miscarriage at 9 weeks gestation following IVF pregnancy. After a review of the literature and a failed medical management of miscarriage, a multidisciplinary decision was made to continue a prolonged expectant management protocol. The patient’s primary priority was the preservation of her fertility potential to facilitate future IVF following miscarriage resolution. Surgical approach to miscarriage management was considered with a high risk of complications including perforation, removal of cerclage and hysterectomy; therefore, this option was to be avoided unless absolutely necessary. Over a 7-month period with regular ultrasound follow-up we demonstrated gradual resolution with clearance of all products of conception 7 months from initial diagnosis. She remained clinically well throughout this process. This case highlights the challenges of managing early pregnancy failure in patients with a history of trachelectomy and supports the role of prolonged conservative management and individualised care plans.