Perioperative antibiotics may improve outcome of cerclage

Administration of perioperative antibiotics and indomethacin may significantly prolong gestation after second-trimester cerclage, according to a study presented at the 34^th Annual Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting.  

Performed at a single tertiary care hospital, the randomized controlled trial looked at outcome in 50 women age 18 and older with a singleton pregnancy between 16+0 and 23+6 weeks’ gestation who were undergoing  exam-indicated cerclage. The participants where randomly assigned to receive perioperative antibiotics ( cefazolin 1 to 2 mg based on weight or 600 mg clindamycin intravenous given preoperatively followed by 2 additional doses) and indomethacin (50 mg immediately post-operative followed by 2 additional doses) or no perioperative prophylactic medications.

No significant differences in demographic characteristics, obstetric history, or preoperative cervical exams existed between the two treatment groups. The women who receive perioiperative antibiotics and indomethacine had significantly more pregnancies (24 [92.3%] vs 15 [62.5%], P = 0.01) prolonged by at least 28 days. No differences were seen in median latency, gestational age at delivery, and neonatal outcomes between the two groups.

The study authors concluded that administering perioperative indomethacin and antibiotics significantly increased the likeklihood that gestation would be prolonged by 4 weeks following second-trimester cerclage. They also urged larger studies to discover whether the increased gestation could lead to better neonatal outcomes.

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