Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone.
OBJECTIVE
The purpose of this study was to compare preterm delivery rates and neonatal morbidity/mortality rates for women with cervical incompetence with membranes at or beyond a dilated external cervical os that was treated with emergency cerclage, bed rest plus indomethacin, versus just bed rest.


METHODS
Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27 weeks of gestation, were treated with antibiotics and bed rest and randomly assigned for emergency cerclage and indomethacin or bed rest only.


RESULTS
Twenty-three women were included; 13 women were allocated randomly to the emergency cerclage and indomethacin group, and 10 women were allocated randomly to the bed rest-only group. Gestational age at time of randomization was 22.2 weeks in the emergency cerclage and indomethacin group and 23.0 weeks in the bed rest-only group. Mean interval from randomization until delivery was 54 days in the emergency cerclage and indomethacin group and 20 days in the bed rest-only group (P=.046). Mean gestational age at delivery was 29.9 weeks in the emergency cerclage and indomethacin group and 25.9 weeks in the bed rest-only group. Preterm delivery before 34 weeks of gestation was significantly lower in the emergency cerclage and indomethacin group, with 7 of 13 deliveries versus all 10 deliveries in the bed rest-only group (P=.02).


CONCLUSIONS
Emergency cerclage, indomethacin, antibiotics, and bed rest reduce preterm delivery before 34 weeks compared with bed rest and antibiotics alone.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Sietske M
SM
Althuisius
Gustaaf A
GA
Dekker
Pieter
P
Hummel
Herman P
HP
van Geijn
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001510:Bed Rest; D023802:Cerclage, Cervical; D004630:Emergencies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D011247:Pregnancy; D015149:Tocolytic Agents / Q000627:therapeutic use; D002581:Uterine Cervical Incompetence / Q000628:therapy*
D000900:Anti-Bacterial Agents; D015149:Tocolytic Agents; D007213:Indomethacin