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Eight months later, at 34\u2009years of age, she conceived spontaneously. Cervical length was 28.3\u2009mm in early pregnancy (unchanged from preconception) but shortened to 20.5\u2009mm at 13\u2009+\u20095\u2009weeks of gestation, and cervical insufficiency was suspected. A Shirodkar cerclage was performed at 15\u2009+\u20094\u2009weeks of gestation. Thereafter, cervical shortening did not progress and the pregnancy remained uncomplicated. Elective cesarean delivery at 37\u2009+\u20091\u2009weeks of gestation resulted in a healthy female infant, and both maternal and neonatal courses were uneventful. Cesarean scar repair may affect cervical competence; thus, pregnancies after CSDi repair should include close cervical length surveillance and consideration of cerclage when significant shortening is detected. 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