Photo Credit: Syahrir Maulana
The following is a summary of “Urogenital cultures and preterm birth in women with cervical cerclage: a single center retrospective cohort study,” published in the April 2024 issue of Obstetrics and Gynecology by Seys et al.
The prevailing hypothesis regarding the pathogenesis of cervical insufficiency implicates cervical inflammation as a pivotal factor. Urogenital tract infections potentially contribute to this inflammatory milieu, prompting the retrospective investigation into the association between gestational age (GA) at delivery and positive urogenital cultures among women who underwent cervical cerclage.
This single-center retrospective study scrutinized the records of 203 women with singleton pregnancies who received cervical cerclage between 2010 and 2020 at the University Hospital of Leuven, Belgium. Cervical cerclages were categorized as history-indicated (TVC I, n = 94), ultrasound-indicated (TVC II, n = 79), and clinically indicated (TVC III, n = 20), with an additional ten women undergoing transabdominal cerclage (TAC). Urogenital cultures, obtained from both vaginal and urine specimens, were assessed before and after cerclage placement at 4-week intervals. Cultures were deemed ‘positive’ if significant growth of microorganisms was detected in either urine or vaginal specimens. Treatment decisions were contingent upon culture results and clinical presentation. The primary objective was elucidating the relationship between urogenital culture results and GA at delivery across the cerclage groups. Additionally, the study aimed to explore the impact of antibiotic treatment for positive cultures on GA at delivery.
Findings revealed that positive pre-cerclage urogenital cultures were associated with earlier GA at delivery in TVC III cases (positive culture: 26w4d ± 40d vs. negative: 29w6d ± 54d, p = 0.036). Conversely, in TVC I cases, positive pre-cerclage urogenital cultures were correlated with later GA at delivery (positive culture: 38w0d ± 26d vs. negative: 35w4d ± 42d, p = 0.035). Notably, the status of the overall post-cerclage urogenital culture did not significantly affect GA at delivery. Furthermore, administering antibiotic treatment for positive pre- or post-cerclage urogenital cultures did not alter GA at delivery.
In conclusion, positive urogenital cultures obtained before clinically indicated cerclage intervention may be linked to earlier GA at delivery. However, the findings suggest that antibiotic treatment or routine urogenital cultures during follow-up of asymptomatic women after cerclage placement may not confer any demonstrable benefit.
Source: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06509-9