Poster Session 2
Daniel J. Martingano, DO, MBA, PhD
Clerkship Director, IRB Chair, Associate Program Director / Division Chair
St. John's Episcopal Hospital-South Shore and William Carey University College of Osteopathic Medicine
Far Rockaway, New York, United States
Marwah Al-Dulaimi, MD (she/her/hers)
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, NY, United States
Sandra Kumwong, MS
Medical Student
Touro College of Osteopathic Medicine-Harlem Campus
New York, New York, United States
Andrea Ouyang, MSc
Medical Student
William Carey University
Hattiesburg, Mississippi, United States
Lauren Cue, MD, BA (she/her/hers)
OB/GYN Resident
Rutgers University and the Jersey City Medical Center
Jersey City, New Jersey, United States
Ashley Nguyen, MD
OB/GYN Resident
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Francis X. Martingano, MD
Assistant Professor, Senior Minimally Invasive Surgeon
NYU Grossman School of Medicine - NYU Brooklyn
New York, New York, United States
Shailini Singh, MD
Director of Metabolic Syndrome
AtlantiCare Regional Medical Center
Pamona, New Jersey, United States
Alexander Ulfers, DO
Medical Director, Maternal Infant Care Center; Maj, USAF, MC
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
Mark Rebolos, MD
Director of Patient Safety, Labor & Delivery
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Kristin Cohen, CNM, DNP
Women's Health Care Practitioner
RWJBarnabas Health - Trinitas Regional Medical Center
Elizabeth, New Jersey, United States
Donald Morrish, MD
Chief Executive Officer
St. John's Episcopal Hospital-South Shore
Far Rockaway, New York, United States
Iffath A. Hoskins, MD
Former ACOG President, Director of Labor & Delivery, Chief Safety Officer
Albert Einstein College of Medicine - Montefiore Medical Center
New York, New York, United States
The effect of prophylactic antibiotics with or without tocolytic medications on gestational latency remains uncertain. This study sought to evaluate the effectiveness of adjunctive antibiotic regimens on increasing gestational latency for pregnancies complicated by cervical insufficiency requiring cervical cerclage.
Study Design:
We conducted a multi-center, prospective observational study from 7/2022 to 7/2024 comparing all pregnancies complicated by cervical insufficiency requiring cervical cerclage at a gestational age range of 16 0/7 to 23 6/7 weeks. History-indicated (HC) and physical-exam indicated (PC) cerclages were included. Antibiotic regimens used as covariates included cefazolin and/or azithromycin, and were determined based on physician preference. Each regimen received indomethacin and utilized a vaginal surgical approach. Each regimen was compared to the total patients receiving a different regimen. Patients with multiple gestations, additional tocolytic medication use, or prior vaginal progesterone use, were excluded. The primary outcomes included completed weeks gestation at time of delivery (CW), preterm and term deliveries, as respective, discrete events.
Results:
The study included 209 patients with 87 requiring a PC and 112 requiring HC. Demographic factors were not significantly different. In the PC group, 43 (49.4%) received cefazolin, 16 (18.4%) received azithromycin, 28 (32.2%) received both. In the HC group, 78 (70.0%) received cefazolin, 6 (5.4%) received azithromycin, and 28 (25%) received both. Kaplan-Meier survival analysis (Figure 1) noted significantly greater pregnancy latency when comparing cefazolin to azithromycin for PC (p=0.049). No significant differences in gestational latency or rates of preterm or term delivery were noted in the HC group for any regimen or when comparing other PC regimens.
Conclusion:
It is reasonable to administer cefazolin when performing a physical-exam indicated cervical cerclage with a vaginal approach and may offer greater pregnancy latency, with likely no additional benefit when using azithromycin alone or in combination with cefazolin.
