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Infectious complications of cervical cerclage
American Journal of Obstetrics and Gynecology
|December 15, 1981
Summary
Performing cervical cerclage between 14 and 18 weeks of gestation is optimal. Delaying this procedure increases risks of chorioamnionitis and premature rupture of membranes, necessitating prompt amniocentesis and prophylactic antibiotics.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Cervical cerclage is a procedure to prevent preterm birth.
- The optimal timing for cervical cerclage is crucial for maternal and fetal outcomes.
Purpose of the Study:
- To determine the optimal timing for cervical cerclage.
- To assess the risks associated with delayed cerclage, including chorioamnionitis and premature rupture of membranes (PROM).
Main Methods:
- Retrospective study of 115 gravid patients undergoing cervical cerclage.
- Analysis of pregnancy outcomes based on the timing of cerclage.
- Amniocentesis performed in patients with suspected chorioamnionitis.
Main Results:
- The optimal window for cervical cerclage is between 14 and 18 weeks of gestation.
- Delaying cerclage past the second trimester significantly increases the risk of chorioamnionitis (2.6-fold) and PROM before 32 weeks (3-fold).
- Amniotic fluid infections in patients with chorioamnionitis are polymicrobial, involving organisms like Bacteroides bivius, Eubacterium lentum, and Staphylococcus epidermidis.
Conclusions:
- Performing cervical cerclage between 14 and 18 weeks is associated with better outcomes.
- Early amniocentesis is recommended for suspected chorioamnionitis.
- Prophylactic antibiotics are advised for cerclage performed after 18 weeks gestation.