Antibiotics and indomethacin as perioperative management for cerclage: A systematic review and meta-analysis

•Systematic review and random-effects meta-analysis of observational studies and randomized clinical trials;•No association was found between antibiotics and indomethacin and their combination for cerclage and perinatal mortality;•No association between antibiotics and indomethacin and their combina...

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Published in:European journal of obstetrics & gynecology and reproductive biology 2025-01, Vol.304, p.104-108
Main Authors: Delatorre, Erica, Provinciatto, Henrique, Rolo, Liliam Cristine, Araujo Júnior, Edward
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotics
Cerclage
Cerclage, Cervical
Cervical stitch
Female
Humans
Indomethacin
Indomethacin - therapeutic use
Perioperative Care - methods
Pregnancy
Premature Birth - prevention & control
Prematurity
Preterm birth
Tocolysis
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Summary:•Systematic review and random-effects meta-analysis of observational studies and randomized clinical trials;•No association was found between antibiotics and indomethacin and their combination for cerclage and perinatal mortality;•No association between antibiotics and indomethacin and their combination for cerclage and preterm birth. Prematurity complications remain the leading cause of perinatal morbidity and mortality. Although cerclage shows promise in preventing preterm birth, it remains unclear whether perioperative management, such as the use of antibiotics or indomethacin, offers any additional benefit. We conducted a systematic review and random-effects meta-analysis comparing the use of indomethacin, antibiotics, and their combination as perioperative management for cerclage versus cerclage alone. Our research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on June 9, 2024 (ID CRD42024552516). Our systematic review encompassed ten studies, and 838 pregnant women submitted to cerclage for prevention of preterm birth. We found no association between perioperative management and preterm birth before 28 weeks (RR 1.03; 95 % CI 0.76–1.39; p = 0.86), or perinatal mortality (RR 0.81; 95 % CI 0.54–1.22; p = 0.32). Antibiotics, indomethacin, and their combination may have no additional benefit to cerclage in risk reduction of preterm birth or perinatal mortality.
ISSN:0301-2115
1872-7654
1872-7654
DOI:10.1016/j.ejogrb.2024.11.036