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Short cervix on ultrasound: Does indomethacin prevent preterm birth?

      Objective

      Our aim was to estimate if indomethacin therapy prevents preterm birth (PTB) in women with a short cervical length (CL) on transvaginal ultrasound (TVU).

      Study design

      Individual-level data from all randomized trials including asymptomatic women with a short CL on TVU were analyzed for use of indomethacin at the time of the short CL. The trials eligible would be ones that randomized women with a short CL <25 mm, identified between 14 and 27 weeks. The eligible trials randomized such women to receive either cerclage or no cerclage. Only women who did NOT receive cerclage were analyzed. Exclusion criteria were major fetal anomaly and cerclage. We compared demographics, risk factors, and outcomes in women who, at the time of the short CL, received indomethacin or not. Primary outcome was PTB <35 weeks.

      Results

      Three of the 4 randomized trials identified had databases which recorded indomethacin use at the time of the short CL. A total of 139 women with a short CL <25 mm identified at 14 to 27 weeks were identified. Of these women, 99 (71.2%) received indomethacin, and 40 (28.8%) did not. Demographics and risk factors, including previous PTB (45.5% vs 62.5%; P = .11), were similar in the 2 groups. The primary outcome of PTB <35 weeks occurred in 29.3% (29/99) of women who received indomethacin, and 42.5% (17/40) of women who did not receive indomethacin (RR 0.69, 95% CI 0.44-1.13). PTB <24 weeks occurred in 1.0% (1/99) versus 7.5% (3/40), respectively (RR 0.14; 95% CI 0.02-0.92). Incidence of perinatal death was similar in the 2 groups (6% vs 10%; RR 0.61, 95% CI 0.19-1.95).

      Conclusion

      Indomethacin therapy for asymptomatic women who have a short CL <25 mm on TVU at 14 to 27 weeks and do not receive a cerclage did not prevent spontaneous PTB <35 weeks, but did prevent PTB <24 weeks. Further research including larger numbers and a randomized trial design is necessary to further clarify the effectiveness as well as the risks of this therapy.

      Key words

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      References

        • Iams J.D.
        • Goldenberg R.L.
        • Meis P.J.
        • Mercer B.M.
        • Moawad A.
        • Das A.
        • et al.
        The length of the cervix and the risk of spontaneous premature delivery.
        N Engl J Med. 1996; 334: 567-572
        • Berghella V.
        • Daly S.F.
        • Tolosa J.E.
        • DiVito M.M.
        • Chalmers R.
        • Garg N.
        • et al.
        Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity.
        Am J Obstet Gynecol. 1999; 181: 809-815
        • Owen J.
        • Yost N.
        • Berghella V.
        • Thom E.
        • Swain M.
        • Dildy G.A.
        • et al.
        Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth.
        JAMA. 2001; 286: 1340-1348
        • Berghella V.
        • Iams J.D.
        • Newman R.B.
        • MacPherson C.
        • Goldenberg R.L.
        • Mueller-Heubach E.
        • et al.
        Frequency of uterine contractions in asymptomatic pregnant women with or without a short cervix on transvaginal ultrasound scan.
        Am J Obstet Gynecol. 2004; 191: 1253-1256
        • Lewis D.
        • Pelham J.J.
        • Done E.
        • Sawhney H.
        • Talucci M.
        • Berghella V.
        Uterine contractions in asymptomatic women with a short cervix on ultrasound.
        J Matern Fetal Neonatal Med. 2005; 18: 325-328
        • Rust O.A.
        • Atlas R.O.
        • Reed J.
        • van Gaalen J.
        • Balducci J.
        Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help.
        Am J Obstet Gynecol. 2001; 185: 1098-1105
        • Althuisius S.M.
        • Dekker G.A.
        • Hummel P.
        • Bekedam D.J.
        • van Geijn H.P.
        Final results of the cervical incompetence prevention randomized cerclage trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.
        Am J Obstet Gynecol. 2001; 185: 1106-1112
        • To M.S.
        • Alfirevic Z.
        • Heath V.C.F.
        • Cacho A.M.
        • Williamson P.R.
        • Nicolaides K.H.
        Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial.
        Lancet. 2004; 363: 1849-1853
        • Berghella V.
        • Odibo A.O.
        • Tolosa J.E.
        Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial.
        Am J Obstet Gynecol. 2004; 191: 1311-1317
        • Berghella V.
        • Obido A.O.
        • To M.S.
        • Rust O.A.
        • Althiusius S.M.
        Cerclage for short cervix on ultrasound: meta-analysis of trials using individual patient-level data.
        Obstet Gynecol. 2005; 106: 181-189
        • Iams J.D.
        • Johnson F.F.
        • Sonek J.
        • Sachs L.
        • Gebauer C.
        • Samuels P.
        Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance.
        Am J Obstet Gynecol. 1995; 172: 1097-1106
        • Guzman E.R.
        • Shen-Schwarz S.
        • Benito C.
        • Vintzileos A.M.
        • Lake M.
        • Lai Y.L.
        The relationship between placental histology and cervical ultrasongraphy in women at risk for pregnancy loss and spontaneous preterm birth.
        Am J Obstet Gynecol. 1999; 181: 793-797
      1. King J, Flenady V, Cole S, Thornton S. Cyclo-oxygenase (COX) inhibitors for treating preterm labour. Cochrane Database of Systematic Reviews 3; 2005.

        • Loe S.M.
        • Sanchez-Ramos L.
        • Kaunitz A.
        Assessing the neonatal safety of indomethacin tocolysis: a systematic review with meta-analysis.
        Obstet Gynecol. 2005; 106: 173-179