Evaluation of Perioperative antibiotics and indomethacin with cerclage for short cervix: A Retrospective Cohort Study with the International Collaborative for Cerclage Longitudinal Evaluation and Research (IC-CLEAR).

Publication/Presentation Date

11-13-2025

Abstract

BACKGROUND: There was a randomized trial that suggested benefit with indomethacin and antibiotics in the setting of an exam-indicated cerclage; however, there is little evidence to guide use of perioperative indomethacin and/or antibiotics in the setting of an ultrasound indicated cerclage.

OBJECTIVE: To determine whether perioperative antibiotics and/or indomethacin at time of ultrasound indicated cerclage placement reduce the rate of spontaneous preterm birth< 37 weeks.

STUDY DESIGN: This is a multi-center retrospective cohort study of singleton pregnancies who received a transvaginal cervical cerclage from June 2016 to July 2021. We aimed to evaluate whether perioperative antibiotics and/or indomethacin at time of cerclage was superior to no antibiotics/indomethacin in prevention of spontaneous preterm birth. Ten sites were involved, eight in the United States and two in Colombia. Because this is an observational cohort we conducted a few propensity score based analyses to adjust for potential confounding or assignment bias. First, propensity score for each treatment group comparison (indomethacin vs none, perioperative antibiotics vs none, indomethacin and perioperative antibiotics vs neither) was determined using multivariable logistic regression taking into consideration: study country (USA or Colombia), prior preterm birth history (yes or no), body mass index, cervical length prior to placement, cervical dilation, gestational age at placement, use of post operative progestogen (yes vs no) and use of other the other perioperative intervention (indomethacin or perioperative antibiotics). This propensity score was used for a weighted analysis (1/propensity score). Primary outcome was spontaneous preterm birth< 37 weeks. Secondary outcomes include rates of spontaneous preterm birth< 34 weeks, < 28 weeks, and latency (weeks) from randomization to delivery for the outcome of spontaneous preterm birth< 37 weeks. Data were weighted by propensity score for the primary and secondary outcomes with the respective predictors being indomethacin vs none, perioperative antibiotics vs none, or perioperative indomethacin and antibiotics vs neither in bivariate regression analysis. Two-sided alpha=0.05 for all analyses.

RESULTS: The database included cerclages placed in singleton pregnancies from March 2016- July 2021. 340 cases of ultrasound indicated cerclage were included in this study. Of note, 29.4% had documented cervical dilation at the time of surgery, 28.5% did not, and 42.1% did not have exam findings recorded. There were significant baseline differences between groups. In weighted regression analyses there was reduced risk of spontaneous preterm birth < 37 weeks associated with perioperative antibiotics (aOR 0.68 (0.49-0.94)), and increased risk of spontaneous preterm birth < 28 weeks associated with perioperative indomethacin (aOR 2.38 (1.31-4.36)). No intervention or combination was associated with increased latency to delivery.

CONCLUSION: Our data suggests possible benefit associated with perioperative antibiotics at the time of ultrasound indicated cerclage. The potential benefit or harm of indomethacin is less clear due to collinearity and low number of cases of very early preterm birth. Given potential risks of antibiotic use, including antibiotic resistance, and of indomethacin use, randomized trial data are needed to support use of perioperative antibiotics and/or indomethacin in setting of ultrasound-indicated cerclage.

TWEETABLE ABSTRACT: Perioperative antibiotics and/or indomethacin use was not associated with a reduction in preterm birth or latency to delivery in the setting of ultrasound-indicated cerclage.

First Page

101840

Last Page

101840

ISSN

2589-9333

Disciplines

Medicine and Health Sciences

PubMedID

41241093

Department(s)

Department of Obstetrics and Gynecology

Document Type

Article

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