Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Obstet Gynecol. 2020 Jun;135(6):1409-1416. doi: 10.1097/AOG.0000000000003874.
To evaluate gestational latency in individuals who did and did not receive perioperative cefazolin and indomethacin after physical examination-indicated cerclage.
This is a retrospective cohort study of all pregnant women with a singleton gestation who underwent physical examination-indicated cerclage placement and delivered at Northwestern Memorial Hospital from 2009 to 2018. Physical examination-indicated cerclage was performed in the setting of painless cervical dilation of at least 1 cm between 16 0/7 and 23 6/7 weeks of gestation. After 2014, our practice universally implemented perioperative prophylaxis of cefazolin and indomethacin. Individuals were categorized based on exposure to perioperative prophylaxis. The primary outcome was pregnancy latency at least 28 days after cerclage placement. Secondary outcomes included median latency; median gestational age at delivery; preterm birth before 28 weeks of gestation; preterm prelabor rupture of membranes; chorioamnionitis; and median birth weight. Multivariable analyses were performed, as well as a sensitivity analysis using propensity score matching.
Cerclages were placed in 142 people: 72 (50.7%) received perioperative prophylaxis. Baseline demographics were not significantly different between groups. On multivariable analyses, individuals who received perioperative prophylaxis had a higher incidence of achieving a pregnancy latency at 28 days or more (adjusted relative risk [aRR] 1.21, 95% CI 1.05-1.40). Individuals who received perioperative prophylaxis had a significant improvement in gestational latency (+17.8 days, 95% CI 1.4-34.2 days) and birth weight (+489.8 g, 95% CI 64.6-915.0 g), with no differences in other outcomes. On sensitivity analysis, individuals receiving perioperative prophylaxis had a higher incidence of achieving a pregnancy latency at 28 days or more, (aRR 1.17, 95% CI 1.01-1.36) with no differences in other outcomes.
Perioperative use of cefazolin and indomethacin prophylaxis during physical examination-indicated cerclage placement is associated with a significant prolongation in gestational latency without an increase in incidence of chorioamnionitis.
评估体格检查指示宫颈环扎术后接受围手术期头孢唑林和吲哚美辛与未接受者的妊娠潜伏期。
这是一项回顾性队列研究，纳入了 2009 年至 2018 年在西北纪念医院接受体格检查指示宫颈环扎术并分娩的单胎妊娠孕妇。体格检查指示宫颈环扎术在妊娠 16 0/7 至 23 6/7 周之间出现无痛性宫颈扩张至少 1cm 时进行。2014 年后，我们的实践普遍采用围手术期头孢唑林和吲哚美辛预防。根据围手术期预防措施的暴露情况对个体进行分类。主要结局是宫颈环扎术后至少 28 天的妊娠潜伏期。次要结局包括中位潜伏期；分娩时的中位孕龄；28 周前早产；早产胎膜早破；绒毛膜羊膜炎；和中位出生体重。进行了多变量分析，以及使用倾向评分匹配的敏感性分析。
共进行了 142 例宫颈环扎术：72 例（50.7%）接受围手术期预防。两组间的基线人口统计学特征无显著差异。多变量分析显示，接受围手术期预防的个体发生妊娠潜伏期达到 28 天或更长的发生率更高（调整后的相对风险 [aRR] 1.21，95%CI 1.05-1.40）。接受围手术期预防的个体妊娠潜伏期显著延长（+17.8 天，95%CI 1.4-34.2 天）和出生体重增加（+489.8g，95%CI 64.6-915.0g），其他结局无差异。敏感性分析显示，接受围手术期预防的个体发生妊娠潜伏期达到 28 天或更长的发生率更高（aRR 1.17，95%CI 1.01-1.36），其他结局无差异。
体格检查指示宫颈环扎术时使用围手术期头孢唑林和吲哚美辛预防与妊娠潜伏期显著延长相关，而绒毛膜羊膜炎的发生率无增加。
