Poster Session 1
Maryama O. Ismail, MD (she/her/hers)
OBGYN Resident
Mass General Brigham
Boston, MA, United States
Taylor S. Freret, MD, MEd
Beth Israel Deaconess Medical Center
Brookline, MA, United States
Mark A. Clapp, MD, MPH (he/him/his)
Physician Investigator
Massachusetts General Hospital
Boston, MA, United States
Malavika Prabhu, MD (she/her/hers)
Assistant Professor, Division of Maternal Fetal Medicine
Massachusetts General Hospital
Boston, Massachusetts, United States
The use of perioperative antibiotics and indomethacin increase gestational latency (GL) for patients undergoing exam-indicated cerclage. We sought to determine if preoperative antibiotics for ultrasound-indicated cerclage (UIC) have similar benefits.
Study Design:
This was a retrospective cohort study of patients undergoing UIC per the operative report within a single healthcare system with a linked birth record ( >20 weeks’ gestation) from 2017 to 2023. Exclusion criteria included multiple gestation, multiple cerclages in the pregnancy, or receipt of postoperative antibiotics. Surgical case details, antibiotic administration, and delivery outcomes were abstracted from the electronic health record with chart review as required. The primary exposure was preoperative antibiotic administration. The primary outcome was GL, or the duration from cerclage placement to delivery. Secondary outcomes included gestational age (GA) at delivery and any preterm birth (PTB) < 28 or < 32 weeks. Multivariable linear and logistic regression analysis were used to control for prior preterm birth, vaginal progesterone use, and cervical length and GA at time of cerclage.
Results:
During the study period, 231 patients received an UIC, of whom 219 (94.8%) met inclusion criteria. 140 patients (63.9%) received preoperative antibiotics. The groups were similar on baseline characteristics (Table). There was no difference in GL (116 vs 113 days, p=0.46, Figure) or GA at delivery (37.0 vs 36.7 weeks, p=0.62) between those who did and did not receive antibiotics. The PTB rates before 28 and 32 weeks were also similar (3.6 vs 5.1%, p=0.59, and 10.1 vs 10.3%, p=0.97, respectively). Results were unchanged in the adjusted analyses and in sensitivity analyses considering patients with and without a prior preterm birth as separate cohorts.
Conclusion:
The use of preoperative antibiotics for UIC placement is not associated with increased GL or lower PTB rates compared to no antibiotics. Our findings may help promote antibiotic stewardship.
