{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine, Warwick Medical School, Coventry, England, UK"
      ],
      "name": "Sujaree Kuenghakit"
    },
    {
      "affiliations": [
        "University of Warwick, Coventry, England, UK",
        "University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England, UK"
      ],
      "name": "Amy Newnham"
    },
    {
      "affiliations": [
        "University Hospitals Coventry and Warwickshire NHS Trust, Coventry, England, UK"
      ],
      "name": "Mohamad Ismail"
    }
  ],
  "title": "Expectant management of missed miscarriage in a post-trachelectomy patient with permanent cervical cerclage",
  "uid": "0b495f96-9c29-53a5-815a-ca47913fd885"
}