Good prognosis of cerclage in cases of cervical insufficiency when intra-amniotic inflammation/infection is ruled out

Abstract

IL-6 levels in amniotic fluid may be of clinical value for individualizing the management of patients with bulging membranes for placement of rescue cerclage.

Amniotic fluid proteomic signatures of cervical insufficiency and their association with length of latency

“…2 Spontaneous preterm birth is a multifactorial syndrome with numerous etiologies including inflammation, infection, excessive myometrial stretching, haemorrhage, cervical weakess or shortening and genetic factors. 5,[7][8][9] However, emergency cerclage is a potentially dangerous procedure because there may be pre-existing infection of the amniotic fluid or there may be bacteria coating the exposed membranes which are then pushed back into the uterus. This is almost always a precursor to delivery within 1 week, at a time when prospects of neonatal survival are poor.…”

“…3 Cervical insufficiency (CI) is the term for painless dilatation of the cervix between 15-26 weeks gestation. 4,7,[10][11][12][13] In either case, emergency cervical cerclage is contraindicated in the presence of intra-amniotic infection as it carries a significant risk of maternal sepsis and poor neonatal outcome. [4][5][6] One method of treatment is to put in a cervical suture to close the cervix (an emergency cervical cerclage) with the intent of prolonging the pregnancy and improving fetal outcome.…”

“…[4][5][6] One method of treatment is to put in a cervical suture to close the cervix (an emergency cervical cerclage) with the intent of prolonging the pregnancy and improving fetal outcome. 5,[7][8][9] However, emergency cerclage is a potentially dangerous procedure because there may be pre-existing infection of the amniotic fluid or there may be bacteria coating the exposed membranes which are then pushed back into the uterus. 4,7,[10][11][12][13] In either case, emergency cervical cerclage is contraindicated in the presence of intra-amniotic infection as it carries a significant risk of maternal sepsis and poor neonatal outcome.…”

“…5,[7][8][9] However, emergency cerclage is a potentially dangerous procedure because there may be pre-existing infection of the amniotic fluid or there may be bacteria coating the exposed membranes which are then pushed back into the uterus. 4,7,[10][11][12][13] In either case, emergency cervical cerclage is contraindicated in the presence of intra-amniotic infection as it carries a significant risk of maternal sepsis and poor neonatal outcome. [14][15][16][17][18][19] It is therefore essential to rule out infection before a cerclage is contemplated.…”

Amniotic immune biomarkers as risk factors in women with different symptoms of threatened late miscarriage

“…Although many immune biomarkers have been reported as risk factors for late miscarriage and preterm birth, there is still no consensus and few studies have focused on TLM patients with contractions 12,32 . Since amniocentesis was conducted prior to tocolytic therapy or cerclage to rule out intrauterine infections, we could exclude pregnancies with infection and thus add to the evidence from previous reports of worse perinatal outcomes for pregnancies with abnormal amniotic fluid markers indicative of inflammation or subclinical intra‐amniotic‐infection 33 . By conducting the analysis in each group separately, we ensured that patients were similar with respect to treatment: all patients in the no‐contractions group had cerclage, and no patient in the contractions groups had this procedure.…”