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CME Credit Offered
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Abstract Award
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Poster Session 1

(321) Amniocentesis prior to mid-trimester cerclage: practice patterns and obstetric outcomes

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Rachel A. Madding, MD (she/her/hers)

    Physician resident
    Oregon Health and Science University
    Portland, Oregon, United States

    • Coauthor(s)

  • MR

    Monica Rincon, MD

    Coordinator MFM Research
    Oregon Health & Science University
    Portland, Oregon, United States

  • LW

    Lucy Ward, MS

    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
    Oregon Health & Science University
    Portland, Oregon, United States

  • Rupsa C. Boelig, MD, MS

    Assistant Professor
    Sidney Kimmel Medical College, Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • JT

    Jorge E. Tolosa, MD, MSCE

    Professor of Obstetrics & Gynecology
    St. Luke’s University Health Network
    Bethlehem, Pennsylvania, United States

  • Joanne N. Quiñones, MD, MSCE (she/her/hers)

    Program Director, Maternal Fetal Medicine Fellowship; VC Research, Dept OBGYN
    Lehigh Valley Health Network
    Allentown, Pennsylvania, United States

  • Vincenzo Berghella, MD (he/him/his)

    Professor, Director
    Sidney Kimmel Medical College of Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • NR

    Nicole D. Rojas

    Resident
    Departamento de Obstetricia y Ginecología, Corporación Universitaria Remington, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • LL

    Luisa López-Torres, MD

    Fellow Medicina Materno Fetal
    Universidad Pontificia Bolivariana, Medicina Materno Fetal, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • Richard M. Burwick, MD, MPH

    Clinical Associate Professor, Western University of Health Sciences
    San Gabriel Valley Perinatal Medical Group; Pomona Valley Hospital Medical Center
    Pomona, California, United States

  • JM

    Julio Mateus Nino, MD, PhD

    Atrium Health, Wake Forest University School of Medicine
    Charlotte, North Carolina, United States

  • Dahiana M. Gallo, MD, PhD (she/her/hers)

    Program Director of Research and Education
    St. Lukes University Health Network
    Easton, PA, United States

  • Leonardo Pereira, MD

    Professor, Division Director Maternal Fetal Medicine
    Oregon Health & Science University
    Portland, Oregon, United States

Objective: Intraamniotic infection (IAI) is a contraindication to cerclage placement. However, the benefit of amniocentesis to diagnose subclinical IAI must be weighed against the risks of the procedure and the limited accuracy of rapid amniotic fluid test results. We aimed to determine perinatal outcomes associated with amniocentesis compared to no amniocentesis before mid-trimester cerclage.

Study Design: This is a secondary analysis of the international collaborative for cerclage longitudinal evaluation and research (IC-CLEAR), a study that included singleton pregnancies without major anomaly and with mid-trimester cerclage placed at eight different institutions in the United States and Colombia from June 1st, 2016 to June 1st, 2020. Inclusion criteria were ultrasound- or exam-indicated cervical cerclage at gestational age (GA) >16 weeks. The comparison group consisted of those who did not undergo amniocentesis. The primary outcome was latency to delivery following cerclage. Cerclage indication, maternal baseline characteristics, and maternal/neonatal outcomes were compared between groups in a multivariable analysis.

Results: In this study, a total of 468 participants who had a cerclage placed during pregnancy met inclusion criteria: 119 had an amniocentesis and no evidence of IAI before cerclage placement. Those who underwent amniocentesis had a mean latency to delivery of 12.5 weeks compared to 13.7 weeks without amniocentesis (p=0.087). In a multivariable regression analysis, amniocentesis was not an independent contributor to decreased latency to delivery after accounting for cerclage indication, GA at cerclage placement, and cervical length at cerclage placement. The rate of premature rupture of membranes < 34 weeks was not significantly different between the two groups (21.2.% vs 21.0%, p=0.853).

Conclusion: In this analysis, we did not find that amniocentesis before cerclage impacted latency to delivery compared to patients who do not undergo amniocentesis. These findings can be used to guide clinical counseling regarding amniocentesis before cerclage placement.