544: Indomethacin and Cerclage Placement: Are We Treating Ourselves?

To compare preterm delivery rates between women who received indomethacin and those who did not at the time of prophylactic cerclage placement. A retrospective, cohort study was performed on women with transvaginal cerclage from 2002-2012. The study cohort was gravidas who received indomethacin at the time of cerclage; the controls were those who received cerclage only. Exclusion criteria were delivery at another institution, multiple gestations and fetal or chromosomal anomalies. Demographic, antenatal and delivery information was obtained. Outcomes assessed included: delivery > 24, 32 and 37 weeks, mode of delivery, birthweight and development of chorioamnionitis. Chi square and t-test were used for categorical and continuous variables. 323 women were identified who met the inclusion criteria; 114 in the indomethacin cohort and 209 in the control cohort. Age, gravidity, prior term or preterm delivery, prior pregnancy with cerclage, cerclage type and vaginal progesterone were not significantly different. The mean gestational age at time of cerclage placement was different, 16.6 weeks in the indomethacin cohort and 15.0 weeks in the control cohort. More patients in the indomethacin cohort received antibiotics at the time of cerclage placement, 62% compared to 24%, and 17-OHP, 36% compared to 26%. There was no difference in delivery > 32 weeks, 67% in the indomethacin cohort, compared to 72% in the control cohort, OR 0.8 (0.5-1.3). There was no difference in delivery > 24 weeks, 83% in the indomethacin cohort and 87% in the control cohort, OR 0.7 (0.4-1.4), or > 37 weeks, 46% in the indomethacin cohort and 39% in the control cohort, OR 1.3 (0.8-2.1). Fewer patients in the indomethacin cohort had a C-section, 36% compared to 70%, OR 0.2 (0.1-0.4). There was no difference in birthweight or rate of chorioamnionitis between the groups. The empirical administration of indomethacin, while reassuring to the obstetrician, was not supported by evidence to be beneficial to the outcome of pregnancy with cerclage.