Amer J Perinatol 2007; 24: 413-416 DOI: 10.1055/s-2007-984405
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Good Pregnancy Outcome with Emergent Cerclage Placed in the Presence of Intra-Amniotic Microbial Invasion
Elisha Mvundura1, Alessandro Ghidini2, Sarah H. Poggi2
1 Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, District of Columbia 2 Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, Virginia

ABSTRACT

Cervical insufficiency with dilation can be associated with amniotic fluid microbial invasion. Cerclage placement in the presence of infection is contraindicated because it is associated with poor fetal and maternal outcome. A 30-year-old gravida 4 para 0 with cervical insufficiency had emergent cervical suture placement at 19 weeks. The patient underwent amniocentesis to screen for infection. After the screen for infection using amniotic fluid glucose and white blood cells had indicated negative results, the patient had cerclage placed. Post cerclage placement, amniotic culture results were positive for Klebsiella pneumoniae, Citrobacter freundii, and Staphylococcus coagulase negative. The patient was counseled about the need to remove the cerclage and she declined. She was treated with azithromycin and Unasyn and a repeat amniocentesis 7 days later indicated negative results. The patient had a 14 week cerclage to delivery interval, delivery at 33 2/7 weeks. Immediate evaluations of the newborn were negative for infection. Our satisfactory outcome with treatment of very early intra-amniotic infection suggests that this option may be considered in strictly selected patients in similar clinical scenarios as an alternative to cerclage removal and evacuation of the uterus.

KEYWORDS

Cervical insufficiency - intra-amniotic invasion - cerclage