Eur J Obstet Gynecol Reprod Biol. 2025 Aug 7;313:114634. doi: 10.1016/j.ejogrb.2025.114634. Online ahead of print.
ABSTRACT
INTRODUCTION: Cervical insufficiency is a known risk factor for preterm birth and miscarriage and is often associated with vaginal infections. For patients with a short cervix on sonography, the preferred treatments are vaginal progesterone administration and cervical cerclage. Although microbial imbalances are associated with negative pregnancy outcomes in cerclage-treated patients, the screening of infection before cerclage is not a standard practice. This study aimed to evaluate the preterm birth rate and adverse neonatal outcomes in pregnant women who underwent the screening of infection before cerclage.
METHODS: The data from 166 patients who underwent cerclage during pregnancy, with or without recurrent vaginal infections, were retrospectively collected between January 2005 and January 2021. The evaluation assessed the (recurrent) vaginal infections before cerclage, maternal characteristics, perinatal outcomes, and fetal complications.
RESULTS: The high-risk pregnant women who underwent cervical cerclage had a median gestational age at birth of 38 weeks, regardless of the infection status. However, those with prior vaginal infections delivered an offspring with lower birth weight percentiles (p < 0.05). Bacterial vaginosis (BV) was the most common infection before cerclage, with recurrent infections often being a combination of vulvovaginal candidosis and BV (p < 0.05).
CONCLUSION: Screening for vaginal infections represents an important aspect of managing high-risk pregnancies. Our findings suggest that, when appropriately treated, prior vaginal infections do not appear to increase the risk of PTB, provided that cerclage is placed only after confirmation of normal vaginal flora.
PMID:40784269 | DOI:10.1016/j.ejogrb.2025.114634
