Does Indomethacin Prevent Preterm Birth in Women with Cervical Dilatation in the Second Trimester?

Berghella, Vincenzo; Prasertcharoensuk, Witoon; Cotter, Amanda; Räsänen, Juha; Mittal, Suneeta; Chaithongwongwatthana, Surasith; Gómez, Ricardo; Kearney, E.; Tolosa, Jorge E.; Pereira, Leonardo

doi:10.1055/s-0028-1091398

Cited by 32 publications

(42 citation statements)

References 10 publications

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“…A post hoc power analysis revealed that the study was underpowered to assess a benefit of indomethacin in addition to cerclage, if a benefit did exist. Berghella et al published a retrospective cohort study of women with ≥1 cm cervical dilation at the cervical os between 14 weeks and 25 weeks and 6 days [19]. The patients were not randomly assigned to receive indomethacin, but rather the decision for indomethacin treatment was made at the discretion of the managing physician during the observational period studied.…”

Section: Resultsmentioning

confidence: 99%

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

DeFranco

Valent

Newman

et al. 2013

Obstetrics and Gynecology International

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The aim of this paper is to provide a thorough summary of published studies that have assessed the efficacy of adjunctive therapies used in addition to cervical cerclage as a preventive measure for preterm birth. We limited our paper to patients treated with cerclage plus an additional prophylactic therapy compared to a reference group of women with cerclage alone. The specific adjunctive therapies included in this systematic review are progesterone, reinforcing or second cerclage placement, tocolytics, antibiotics, bedrest, and pessary. We searched PubMed and Cochrane databases without date criteria with restriction to English language and human studies and performed additional bibliographic review of selected articles and identified 305 total studies for review. Of those, only 12 studies compared the use of an adjunctive therapy with cerclage to a reference group of cerclage alone. None of the 12 were prospective randomized clinical trials. No comparative studies were identified addressing the issues of antibiotics, bedrest, or pessary as adjunctive treatments to cerclage. None of the 12 studies included in this paper demonstrated a clear benefit of any adjunctive therapy used in addition to cerclage over and above cerclage used alone; however, few studies with small numbers limited the strength of the conclusions.

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Section: Resultsmentioning

confidence: 99%

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

DeFranco

Valent

Newman

et al. 2013

Obstetrics and Gynecology International

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“…In the present study, the adverse effects of indomethacin were not serious. Indomethacin was not found to be effective for preventing preterm birth in women with cervical dilatation in the second trimester [23]; in addition, its administration in women who had an indication for cerclage on the basis of ultrasound examination did not reduce the incidence of spontaneous preterm birth [24].…”

Section: Discussionmentioning

confidence: 98%

Comparison of the efficacy and adverse effects of nifedipine and indomethacin for the treatment of preterm labor

Kashanian

Bahasadri

Zolali

2011

Intl J Gynecology & Obste

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“…There is no intervention proven to prevent preterm birth in women with second-trimester cervical dilation. Indomethacin therapy in women with dilated cervix at 14 0/7 to 25 6/7 weeks, regardless of cerclage or not, had no effect on pregnancy outcomes 2. Cerclage in women with cervical dilation has been studied in only one randomized trial of 23 women, including both singleton and twin gestations 3.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Significance of Digital Examination-Indicated Cerclage in Women with a Dilated Cervix at 14 0/7 - 29 6/7 Weeks

Ko¹,

Jo²,

Kil³

et al. 2011

Int. J. Med. Sci.

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Objective. This study was to compare pregnancy outcomes between cerclage and expectant management in wemen with a dilated cervix. Design. Retrospective multicenter cohort study. Setting. Five hospitals of Catholic University Medical Center Network in Korea. Population. A total of 173 women between 14 0/7 and 29 6/7 weeks' gestation with cervical dilation of 1 cm or greater by digital examination. Methods. Pregnancy outcomes were compared according to cerclage or expectant management, with the use of propensity-score matching. Main Outcome Measures. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were gestational age at delivery, neonatal survival, morbidity, preterm birth, and so on.Results. Of 173 women, 116 received a cerclage (cerclage group), and 57 were managed expectantly without cerclage (expectant group). Cervical dilation at presentation, and the use of amniocentesis performed to exclude subclinical chorioamnionitis differed between two groups. In the overall matched cohort, there was significant difference in the time from presentation until delivery (cerclage vs. expectant group, 10.6±6.2 vs. 2.9±3.2 weeks, p <0.0001). While there was no significant difference in the neonatal survival between two groups, there werelower neonatal morbidity as well as higher pregnancy maintenance rate at 28, 32, 34 and 37 weeks' gestation in the cerclage group, compared with the expectant group.Conclusion. This study suggests that digital examination-indicated cerclage appears to prolong gestation and decrease neonatal morbidity, compared with expectant management in women with cervical dilation between 14 0/7 and 29 6/7 weeks.

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Does Indomethacin Prevent Preterm Birth in Women with Cervical Dilatation in the Second Trimester?

Cited by 32 publications

References 10 publications

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

Comparison of the efficacy and adverse effects of nifedipine and indomethacin for the treatment of preterm labor

The Clinical Significance of Digital Examination-Indicated Cerclage in Women with a Dilated Cervix at 14 0/7 - 29 6/7 Weeks

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