Empiric Indomethacin Use With Cerclage Placement [29L

Abstract

INTRODUCTION: Cerclage placement is often performed for cervical incompetency to prevent preterm birth. However, it is unknown if empiric Indomethacin provides additional benefits. The objective is to investigate whether Indomethacin use with cerclage decreases the number of preterm births. METHODS: A chart review of patients who received a cerclage with and without indomethacin at SUNY Downstate Medical Center from January 2013 to August 2015. The inclusion criteria included singleton pregnancies requiring cerclage, age ≥18, cerclage and delivery at same hospital, and delivery by the time of chart review. The main outcomes were term at time of delivery and birth weight. A negative outcome was defined as a pregnancy that resulted in fetal demise or only reached preterm or late preterm. RESULTS: A total of 130 patients (Control: n=39, Indomethacin: n=91) were included. The groups were demographically similar. Results in the Control and Indomethacin group were respectively: Fetal demise: 12.82% vs 9.89% (P=.77), Early Preterm (GA<34w0d): 15.38% vs 9.89% (P=.53), Late Preterm (34w0d to 36w6d): 15.38% vs 14.29% (P=.55), Early Term (GA 37w0d to 38w6d): 46.16% vs 53.85% (P=.58) and Full Term (GA 39w0d to 40w6d): 10.26% vs 12.09% (P=.60). The risk ratio of a negative outcome during pregnancy is 0.995 (CI=0.76–1.30). A majority of patients in both groups delivered infants with normal birth weights (53.84% vs 61.53%, P=.41). The risk ratio of delivering a baby that is less than 2500 g is 1.46 (CI=0.86–2.47). CONCLUSION: There is no association between empiric indomethacin use with cerclage and prolonging gestation or increasing birth weight.