The role of cervical cultures to guide perioperative antibiotics in cervical cerclage – a retrospective analysis of 65 consecutive cases

Abstract

Objective: The objective of this study is to examine results of bacterial cultures of the cervix prior to cerclage placement and how these may be used to guide prophylactic antibiotics.

Methods: All patients undergoing cerclage between 2000 and 2003 in a single, large community hospital were evaluated for indication for cerclage, signs and symptoms on presentation, transvaginal ultrasound cervical length findings, type of cerclage placed, type of anesthesia used, cervical culture taken, tocolytics given, gestational age at delivery, and complications surrounding delivery.

Results: Sixty-five cerclages were performed between 2000 and 2003, 13 (20%) prophylactic, 47 (72%) therapeutic, and five (8%) emergent. Cervical cultures were obtained in 85% of patients, of which 40% were negative resulting in no antibiotics given. In the remaining 45%, one or more pathogens were isolated and antibiotics were given according to sensitivities reported. Fifty-five of 65 patients (84%) delivered after 32 weeks gestation and a latency > 60 d was seen in 84%. The incidence of chorioamnionitis and PPROM was low.

Conclusion: Bacterial cultures of the cervix prior to cerclage show variable colonization and antibiotic sensitivities and, there is no single antibiotic, chosen empirically, that will cover all pathogens.

Keywords:

• Adjunctive therapy
• choriamnionitis
• incompetent cervix
• latency
• McDonald
• premature rupture of membranes
• preterm birth
• Shirodkar

Acknowledgements

The authors would like to thank the referring gynecologists in practice who provided follow-up data on their patients and Dr. Cornelia Englman for her assistance in the data collection and analysis.

Declaration of interest

The authors report that they have no conflicts of interest.