(568) Should antenatal corticosteroids be considered in singletons undergoing cerclage at 22 0/7-23 6/7 weeks’ gestation?

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Moti Gulersen, MD, MSc

Assistant Professor, Obstetrics and Gynecology
Sidney Kimmel Medical College of Thomas Jefferson University
Philadelphia, Pennsylvania, United States

Coauthor(s)

Frank I. Jackson, DO (he/him/his)

Maternal Fetal Medicine Fellow
Northwell
New Hyde Park, New York, United States
Rupsa C. Boelig, MD, MS

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

Vice Chair of Obstetrics
Northwell Lenox Hill Hospital
New Hyde Park, New York, United States
Vincenzo Berghella, MD (he/him/his)

Professor, Director
Sidney Kimmel Medical College of Thomas Jefferson University
Philadelphia, Pennsylvania, United States
Matthew J. Blitz, MD

Director of Clinical Research, Maternal-Fetal Medicine, Northwell; Program Director, Maternal Fetal Medicine Fellowship, South Shore University Hospital
Northwell
Bay Shore, NY, United States

Objective: The American College of Obstetricians and Gynecologists (ACOG) suggests that antenatal corticosteroids (ACS) can be considered as early as 22 0/7 weeks’ gestation in patients at increased risk of preterm (PTB) within 7 days of presentation. We aimed to evaluate the likelihood of delivery within 7 days of cerclage placement to determine whether ACS should be considered in this high-risk population.

Study Design: Multicenter retrospective cohort of all singletons undergoing an ultrasound-indicated cerclage (UIC) or physical exam-indicated cerclage (PEIC) between 22 0/7-23 6/7 weeks’ gestation and delivered from 01/2018-06/2023. The primary outcome was delivery < 7 days after cerclage placement. Secondary outcomes included delivery < 14 days after cerclage placement and PTB. We planned to compare baseline characteristics at the time of cerclage placement between those who delivered < 7 days versus 7 days or later after cerclage. Statistical analysis included use of Pearson’s chi-square for categorical variables and Wilcoxon rank sum test for continuous variables. Statistical significance was set P < 0.05.

Results: Of the 83 patients included, 61 (73.5%) underwent an UIC and 22 (26.5%) underwent a PEIC. There were no patients who delivered < 7 days after cerclage placement; thus, we primarily compared those who delivered < 14 days versus 14 days or later. Three (3.6%) of patients delivered < 14 days after cerclage placement (12, 13, and 13 days). The prevalence of PTB < 37 weeks was 70.0%. Baseline characteristics compared between the two groups are displayed in the Table. Patients who delivered < 14 days after cerclage more commonly had a BMI > 40 kg/m² compared to those who delivered later (Table).

Conclusion: Although patients undergoing cerclage at 22 0/7-23 6/7 weeks’ gestation are at high risk of PTB, none of the patients in this cohort delivered < 7 day after placement. These data suggest that ACS administration may be deferred in this patient population unless additional indications are present.