Good Pregnancy Outcome with Emergent Cerclage Placed in the Presence of Intra-Amniotic Microbial Invasion

Abstract

Cervical insufficiency with dilation can be associated with amniotic fluid microbial invasion. Cerclage placement in the presence of infection is contraindicated because it is associated with poor fetal and maternal outcome. A 30-year-old gravida 4 para 0 with cervical insufficiency had emergent cervical suture placement at 19 weeks. The patient underwent amniocentesis to screen for infection. After the screen for infection using amniotic fluid glucose and white blood cells had indicated negative results, the patient had cerclage placed. Post cerclage placement, amniotic culture results were positive for KLEBSIELLA PNEUMONIAE, CITROBACTER FREUNDII, and STAPHYLOCOCCUS coagulase negative. The patient was counseled about the need to remove the cerclage and she declined. She was treated with azithromycin and Unasyn and a repeat amniocentesis 7 days later indicated negative results. The patient had a 14 week cerclage to delivery interval, delivery at 33 2/7 weeks. Immediate evaluations of the newborn were negative for infection. Our satisfactory outcome with treatment of very early intra-amniotic infection suggests that this option may be considered in strictly selected patients in similar clinical scenarios as an alternative to cerclage removal and evacuation of the uterus.

Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid

“…In support of this view, Miller et al found that, among women receiving an examination-indicated cerclage, pregnancy was significantly more likely to be prolonged by 28 days when patients received perioperative indomethacin and antibiotics [24]. Moreover, Mvundura et al reported good pregnancy outcomes after the successful eradication of cultureproven intra-amniotic infections that were present at the time of emergency cerclage [25].…”

Prediction of spontaneous preterm birth in women with cervical insufficiency: Comprehensive analysis of multiple proteins in amniotic fluid

“…Moreover, http://www.unboundmedicine.com/medline/?st=M&author=Mvundura%20E et al . reported a satisfactory pregnancy outcome with antibiotic therapy and documented eradication of intra‐amniotic infection at the time of emergent cerclage placement . However, further prospective studies on the efficacy of these clinical management strategies according to the results of AF analysis may be needed.…”

Non-invasive emergent cerclage using a plastic sling: case series

“…Preterm rupture of membranes, preterm labour and chorioamnionitis were ruled out. Patients were admitted receiving indomethacin to prevent contraction and decrease fetal urine output as a theoretically way to decrease intra-amniotic pressure21 22 as well as ampicillin/sulbactan 1.5 g twice a day as prophylactic antibiotic therapy 21 23…”