vaginal cervicoisthmic cerclage versus mcdonald cerclage in women with a previous failure of prophylactic cerclage a retrospective study aim compare preterm births before 30 weeks of gestation in women with a previous failed mcdonald cerclage that benefit from another mcdonald cerclage or simplified shirodkar cerclage or a vaginal cervicoisthmic cerclagemethods women with a cerclage performed at the end of the first trimester of a singleton pregnancy with a previous failed prophylactic mcdonald cerclage were included in this mutlicenric study involving four teaching hospitals comparisons between groups were done using a chi square test and a student ttestresults we enrolled130 women 85 in the vaginal cervicoisthmic cerclage group and 45 in the classic cerclage group there was no significant difference in the rate of delivery after 30 weeks of gestation 92 versus 93 p075 however in the cervico isthmic cerclage women were significantly older presented more late foetal loss and fewer live children in the cervicoisthmic cerclage group rate of antenatal hospitalization andantenatal corticotherapy were significantly higher in the classic cerclage group 69 versus 46 p005 and 56 versus 29 p005conclusions rate of delivery before 30 weeks of gestation was not significantly different between the two groups but women in the vaginal cervicoisthmic cerclage group seem to be at higher risk for late foetal loss or premature delivery this procedure generates less threatened premature delivery thus less hospitalization and antenatal corticotherapy these arguments are important for women with previous pregnancy loss