P18.11: Microbial invasion of the amniotic cavity as precursor of incompetent cervix

Abstract

Background: Preterm asymptomatic cervical dilatation or ‘‘cervical incompetency’’ has been associated with microbial invasion of the amniotic cavity (MIAC). It remains unclear if MIAC is a cause or a consequence in this situation. We are reporting a case of a 34 y.o.woman who had 3 pregnancies complicated with asymptomatic cervical dilatation and MIAC. Case: The first pregnancy, she presented with few abdominal cramps at 20 weeks’ gestation. A dilated cervix with bulging amniotic membranes was found and MIAC with Mycoplasma hominis was diagnosed. She was treated with antibiotics and cerclage and delivered at 35 weeks’. The second pregnancy, she underwent a prophylactic cervical cerclage at 14 weeks’, without antibiotics and ended up with a PROM at 24 weeks’ followed by clinical chorioamnionitis and delivery at 26 weeks’. For the third pregnancy, transvaginal ultrasound performed at 15 weeks’ showed normal cervical length but the presence of intra-amniotic sludge. An amniocentesis revealed MIAC with Mycoplasma hominis and she was treated with IV antibiotics. At 19 weeks, she presented with asymptomatic cervical dilatation and transvaginal ultrasound showed an important accumulation of amniotic sludge. She was admitted for IV antibiotics and cervical cerclage on the next day. Unfortunately, she reached complete cervical dilatation without evidence of regular uterine contractions. Vaginal misoprostol was given and she delivered at 19 weeks. For the fourth pregnancy, she had a cervical cerclage placed at 12 weeks’ gestation and she received daily prophylactic erythromycin from 12 to 34 weeks’ gestation. She delivered at 38 weeks’ of a healthy boy. Discussion: In this case, we found MIAC that was present several days before the first signs of cervical changes in a woman with a diagnosis of incompetent cervix. This case also confirms that mid-trimester intra-amniotic sludge is predictive of MIAC in asymptomatic woman. Prophylactic antibiotics should be considered in women at high-risk of MIAC in combination with cervical cerclage.