Multifactorial Approach to Emergent Cerclage

Role in Emergent Cerclage of Indomethacin and Antibiotics

Though cervical insufficiency is a common cause of second trimester pregnancy loss, the placement of an emergent cerclage in these patients is thought to improve perinatal outcomes. It is unknown whether the use of tocolytics and antibiotics prolongs pregnancies complicated by need for emergent cerclage.

The objective is to determine whether administration of peri-operative antibiotics and indomethacin to patients receiving emergent cerclages for cervical insufficiency increases latency period to delivery compared with patients receiving emergent cerclage alone.

Inclusion Criteria:

• GA 16+0 to 23+6 weeks
• Singleton gestation
• Presence of cervical dilation as diagnosed on digital examination
• Intact membranes

Exclusion Criteria:

• Age <18 years
• Allergy to NSAIDs
• Renal disease
• Allergy to penicillins AND clindamycin
• Currently on antibiotics or indomethacin for any reason
• HIV positive
• Pregnancies complicated by fetal congenital anomalies
• Preterm premature rupture of membranes
• Fever of 100.4 degrees Fahrenheit or higher
• Any patient having received a therapeutic cerclage during the current pregnancy