Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.

Max Mönckeberg; Rafael Valdés; Juan P. Kusanovic; Manuel Schepeler; Jyh K. Nien; Emiliano Pertossi; Pablo Silva; Karla Silva; Pía Venegas; Ulises Guajardo; Roberto Romero; Sebastián E. Illanes

doi:10.1515/jpm-2018-0388

Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.

Max Mönckeberg^*, Rafael Valdés, Juan P. Kusanovic, Manuel Schepeler, Jyh K. Nien, Emiliano Pertossi, Pablo Silva, Karla Silva, Pía Venegas, Ulises Guajardo, Roberto Romero, Sebastián E. Illanes

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm³; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.

Original language	English
Pages (from-to)	500-509
Number of pages	10
Journal	Journal of Perinatal Medicine
Volume	47
Issue number	5
DOIs	https://doi.org/10.1515/jpm-2018-0388
State	Published - 1 Jul 2019

Bibliographical note

Funding Information:
Research funding: This research was supported, in part, by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD, NIH under Contract No. HSN275201300006C. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Publisher Copyright:
© 2019 2019 Walter de Gruyter GmbH, Berlin/Boston.

Keywords

MIAC
amniotic fluid analysis
bulging membranes
cervical cerclage
cervical incompetence
cervical insufficiency
cervical stitch
intra-amniotic infection
intra-amniotic inflammation
microbial invasion of the amniotic cavity

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Mönckeberg, M., Valdés, R., Kusanovic, J. P., Schepeler, M., Nien, J. K., Pertossi, E., Silva, P., Silva, K., Venegas, P., Guajardo, U., Romero, R., & Illanes, S. E. (2019). Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis. Journal of Perinatal Medicine, 47(5), 500-509. https://doi.org/10.1515/jpm-2018-0388

@article{7fa094f7772642a698a99b135efb5732,

title = "Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.",

abstract = "The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.",

keywords = "MIAC, amniotic fluid analysis, bulging membranes, cervical cerclage, cervical incompetence, cervical insufficiency, cervical stitch, intra-amniotic infection, intra-amniotic inflammation, microbial invasion of the amniotic cavity",

author = "Max M{\"o}nckeberg and Rafael Vald{\'e}s and Kusanovic, {Juan P.} and Manuel Schepeler and Nien, {Jyh K.} and Emiliano Pertossi and Pablo Silva and Karla Silva and P{\'i}a Venegas and Ulises Guajardo and Roberto Romero and Illanes, {Sebasti{\'a}n E.}",

note = "Funding Information: Research funding: This research was supported, in part, by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD, NIH under Contract No. HSN275201300006C. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. Publisher Copyright: {\textcopyright} 2019 2019 Walter de Gruyter GmbH, Berlin/Boston.",

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language = "English",

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Mönckeberg, M, Valdés, R, Kusanovic, JP, Schepeler, M, Nien, JK, Pertossi, E, Silva, P, Silva, K, Venegas, P, Guajardo, U, Romero, R & Illanes, SE 2019, 'Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.', Journal of Perinatal Medicine, vol. 47, no. 5, pp. 500-509. https://doi.org/10.1515/jpm-2018-0388

TY - JOUR

T1 - Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.

AU - Mönckeberg, Max

AU - Valdés, Rafael

AU - Kusanovic, Juan P.

AU - Schepeler, Manuel

AU - Nien, Jyh K.

AU - Pertossi, Emiliano

AU - Silva, Pablo

AU - Silva, Karla

AU - Venegas, Pía

AU - Guajardo, Ulises

AU - Romero, Roberto

AU - Illanes, Sebastián E.

N1 - Funding Information: Research funding: This research was supported, in part, by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD, NIH under Contract No. HSN275201300006C. Employment or leadership: None declared. Honorarium: None declared. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. Publisher Copyright: © 2019 2019 Walter de Gruyter GmbH, Berlin/Boston.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.

AB - The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.

KW - MIAC

KW - amniotic fluid analysis

KW - bulging membranes

KW - cervical cerclage

KW - cervical incompetence

KW - cervical insufficiency

KW - cervical stitch

KW - intra-amniotic infection

KW - intra-amniotic inflammation

KW - microbial invasion of the amniotic cavity

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U2 - 10.1515/jpm-2018-0388

DO - 10.1515/jpm-2018-0388

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AN - SCOPUS:85062876012

SN - 0300-5577

VL - 47

SP - 500

EP - 509

JO - Journal of Perinatal Medicine

JF - Journal of Perinatal Medicine

IS - 5

ER -

Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.

Abstract

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Keywords

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