Indomethacin administration at the time of ultrasound-indicated cerclage: is there an association with a reduction in spontaneous preterm birth?
OBJECTIVE
The purpose of this study was to estimate the effect of indomethacin on the prevention of preterm birth (PTB) in women with an ultrasound-indicated cerclage.


METHODS
We performed a retrospective cohort study from 1995-2006. Asymptomatic women with a cerclage for a short cervical length (CL), which was defined as <25 mm, between 14-23 weeks 6 days of gestation were included. Women who received indomethacin therapy at the time of ultrasound-indicated cerclage for a short CL were compared with those women who did not. Our primary outcome was spontaneous PTB at <35 weeks of gestation.


RESULTS
Fifty-one women received indomethacin, and 50 women did not. There were no differences between groups regarding previous PTB, gestational age, or CL at time of cerclage. The rate of spontaneous PTB at <35 weeks of gestation was similar between those who received indomethacin (20/51 [39%]) and those who did not (17/50 [34%]; relative risk, 1.15 [95% CI 0.69-1.93]). In our post hoc power analysis, 190 patients would have been needed to detect a 50% reduction in the rate of PTB.


CONCLUSIONS
Administration of indomethacin around the time of ultrasound-indicated cerclage was not associated with a decrease in spontaneous PTB.
Visintine
John
J
Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA.
Airoldi
James
J
Berghella
Vincenzo
V
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D023802:Cerclage, Cervical; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000517:prevention & control; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage*; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin