(465) Evaluation of prophylactic antibiotic use in ultrasound-indicated cerclage placement in a large US hospital system

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

David M. Esterquest, MD, MS

OB/GYN Resident
Advocate Lutheran General Hospital
Advocate Lutheran General Hospital, Illinois, United States

Coauthor(s)

Rachel K. Harrison, MD (she/her/hers)

Clinical Professor Maternal-Fetal Medicine
Advocate Health Care
Advocate Health Care, Illinois, United States
CH

Calla Holmgren, MD

Clinical Professor Maternal-Fetal Medicine
Advocate Health Care
Advocate Health Care, Illinois, United States

Objective: Compare pregnancy outcomes in patients that did and did not receive antibiotic prophylaxis for ultrasound-indicated cerclage placement

Study Design: Retrospective cohort study of singleton pregnancies undergoing ultrasound-indicated (US) cerclage at multiple hospitals within a large US hospital system between 2020-2023. Subjects were included if they met criteria for US-indicated cerclage. They were excluded if they did not have detailed operative notes and pre- and post-op documentation, or if the maternal and neonatal outcomes were not available. Patients were separated into two groups: those who received antibiotics at the time of cerclage placement and those that did not. Patient demographics, socio-economic factors, and medical co-morbidities were compared as well as operative findings and use of indomethacin. The primary outcome was gestational age at delivery. Secondary outcomes included rates of cesarean section and p</span>reterm delivery at < 37 weeks (w), < 32 w, and < 28 w. Student’s t-test, chi-squared, and logistic and linear regression were used for statistical analysis, and p-value < 0.05 was considered statistically significant.

Results: 127 singleton pregnancies were analyzed, with 97 receiving antibiotics. Patients across both cohorts were similar in terms of age, parity, BMI, race, ethnicity, marital status, and type of insurance. Additionally, patients did not differ significantly regarding their medical co-morbidities. Those who received antibiotics were more likely to have a dilated cervix at the time of cerclage placement (53.6% vs 26.7%, p</span>=0.010) as well as prolapsed membranes (17.5% vs 0%, p</span>=0.014). Indomethacin use did not vary significantly between groups. Gestational age at delivery as well as incidence of delivery at < 37 w, < 32 w, and < 28 w did not vary significantly between the two groups, even when adjusting for confounding factors (table). There was no difference in rate of cesarean between the groups.

Conclusion: Antibiotic use at the time of ultrasound-indicated cerclage is not associated with a decreased risk for preterm delivery.