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Antibiotics and indomethacin as perioperative management for cerclage: A systematic review and meta-analysis

Erica Delatorre1, Henrique Provinciatto2, Liliam Cristine Rolo3

  • 1Department of Medicine, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|November 28, 2024
PubMed

Insights

Perioperative antibiotics or indomethacin do not appear to improve outcomes for pregnant individuals undergoing cerclage procedures to prevent preterm birth. The study found no significant reduction in preterm birth or perinatal mortality with these interventions.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Perinatal Health

Background:

  • Prematurity complications are a leading cause of perinatal morbidity and mortality.
  • Cervical cerclage is utilized to prevent preterm birth, but the role of perioperative management is not well-defined.

Approach:

  • A systematic review and random-effects meta-analysis was performed.
  • Ten studies involving 838 pregnant women undergoing cerclage were analyzed.
  • The analysis compared cerclage with perioperative antibiotics, indomethacin, or their combination versus cerclage alone.

Key Points:

  • Perioperative management (antibiotics, indomethacin, or combination) showed no significant association with preventing preterm birth before 28 weeks.
  • No significant reduction in perinatal mortality was observed with the addition of perioperative management.
  • The findings suggest these interventions do not offer additional benefits to cerclage alone.

Conclusions:

  • Current evidence indicates that perioperative antibiotics and indomethacin may not provide additional benefits when used with cerclage for preterm birth prevention.
  • Further research may be needed to explore optimal perioperative strategies, if any, for cerclage procedures.
Abstract

Keywords:
AntibioticsCerclageCervical stitchIndomethacinPrematurityPreterm birthTocolysis

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