 Sharadkar procedure was performed on a 33-year-old white female with a 20-week gestation and a diagnosis of incompetency of the internal loss of the cervix from traumatic dilatation. The abdominal examination reveals this woman to be approximately 18 to 20 weeks pregnant. Past obstetrical history reveals the following. 1942 term pregnancy stillbirth with incision of the cervix which extended into the left broad ligament. 1946 an abortion of a 20-week gestation a tracholorephy was performed at that time. 1947 a 12-week abortion. 1949 premature delivery of a three-pound nine-ounce fetus at 30 weeks gestation. 1951 a 24-week living abortion with subsequent neonatal death. 1952 premature delivery neonatal death of a 26-week gestation 2 pound 13-ounce fetus. 1954 stillborn premature interpartum death 32 weeks gestation due to premature rupture of the membranes and prolapse of the umbilical cord. 1955 a 16-week spontaneous abortion. This gives a salvage rate of one pregnancy in eight. Here is demonstrated the ideal type of case with cervical incompetency for which the shiradkar procedure was devised. Bulging membranes can be seen protruding through the internal loss. The finger is pushing these membranes back above the internal loss. The sight of the internal loss is demonstrated. The instruments which may be employed are the malleable fascial director. The circle size and angulation of this director can be modified according to the individual case. There are three sizes of the right and left cervical fascia directors. These demonstrated have been adapted from fascial needles brazed into handles of discarded surgical instruments. A right and left director of similar size must be employed. The fascial strip can be either homologous, autologous fascial strips obtained from the fascialata of the patient or ox fascialata as shown in the sterile tube. A dermal graft may also be employed. To obtain autologous fascialata the thigh is prepared. A lower incision is made. Section and mobilization of this end of the strip is affected with Alice Clamp's holding the lower portion of the strip. An incision is made and blunt dissection above and below the strip is accomplished. Then the upper thigh incision is made. Dissection and mobilization of the upper end of the strip is accomplished and a similar blunt dissection above and below is carried out. The strip of fascia is then removed. It is approximately 10 to 15 centimeters in length depending on the size of the cervix. The strip is placed in normal saline until needed. Subcuticular wire sutures are used to close the skin incision. Compression bandages beginning at the foot and continuing up the thigh are then applied. A weighted speculum is placed into the vagina and a finger inserted into the stump of cervix which is shortened as a result of the trachylorophy performed at the time of her second pregnancy. A posterior fornic incision is made and mobilization of the tissue started. The anterior fornic incision, dissection and mobilization of bladder and paracervical tissue at the level of the internal loss is accomplished. Oven forcips, a sponge stick or a dull tooth tenaculum can be employed to grasp the cervix. The incompetency of the internal loss is demonstrated in this case. The right and left fascial directors are shown demonstrating the use of each in its proper sequence. A slipknot is used to lead the fascia through the paracervical area at the level of the internal loss beneath the cervical fascia. The left fascial director is introduced and further blunt dissection carried out. The fascia is attached to this left director and the strip pulled out at the anterior fornic incision. A similar procedure is employed on the right side of the cervix with the right cervical director. It is introduced into the anterior fornic incision and brought out through the posterior fornic incision. If the peritoneum of the cul-de-sac is accidentally entered, it can be repaired and the operation continued. This is not an indication to discontinue the procedure. The fascia is now encircling the cervix at the level of the internal loss. The efficacy of the encircling strip is tested. First, the incompetency of the internal loss of the cervix is demonstrated. The fascia is secured with a suture into the cervix at the level of the internal loss. A second similar suture is employed. These sutures can be either the 40-day chromic cut-cut or a non-absorbable suture material. Both ends of the fascial strip are then sutured to another point on the fascial ring. The original slip knots are then cut free. The competency of the internal loss is again checked and as shown, the finger cannot pass through the internal loss. The anterior fornic incision is then closed with interrupted absorbable suture material. The posterior fornic incision is likewise closed after the fascial strip is secured to the internal loss of the cervix posteriorly. No drains are employed. An antibacterial cream is inserted into the vagina. A catheter is placed in the bladder and the patient returned to the recovery ward. Transfusion was not required. In conclusion, this procedure should be performed before an amnionitis with subsequent premature rupture of the membranes becomes apparent. In most cases, it is felt that the procedure is best performed after the first trimester, but early in the second, about the 14th to the 16th week of gestation.