Prolonged Indomethacin Therapy Following Cervical Cerclage Is Not Associated With Improved Pregnancy Latency: A Retrospective Cohort Study
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Abstract
Background: Cervical cerclage is an established intervention for the prevention of spontaneous preterm birth (sPTB) in selected high-risk pregnancies. Indomethacin is frequently administered perioperatively because of its anti-inflammatory and tocolytic properties; however, evidence regarding the benefit of prolonged administration following cerclage placement remains limited.
Objective: To evaluate the association between prolonged indomethacin therapy following cervical cerclage and pregnancy latency, spontaneous preterm birth, and maternal outcomes.
Methods: This retrospective cohort study included women who underwent transvaginal cervical cerclage at a tertiary referral center between 2018 and 2022. All patients received perioperative indomethacin therapy and were categorized according to treatment duration as standard-duration (≤48 hours) or prolonged-duration (>48 hours) therapy. The primary outcome was latency from cerclage placement to delivery. Secondary outcomes included spontaneous preterm birth before 34 and 28 weeks of gestation, gestational age at delivery, and clinical chorioamnionitis. Kaplan–Meier survival analysis and multivariable Cox proportional hazards regression were performed to evaluate factors associated with pregnancy latency.
Results: A total of 131 women were included, of whom 54 received prolonged indomethacin therapy and 77 received standard-duration treatment. Baseline maternal characteristics, previous preterm birth history, gestational age at cerclage placement, cervical findings at presentation, and rates of clinical chorioamnionitis were comparable between groups. Women receiving prolonged indomethacin delivered at a lower gestational age than those receiving standard-duration therapy (median 34.0 vs. 37.0 weeks, p=0.009) and experienced higher rates of spontaneous preterm birth before 37 weeks (57.4% vs. 36.4%, p=0.017). Kaplan–Meier analysis demonstrated a significantly shorter latency period in the prolonged-treatment group (median 94.0 vs. 123.0 days; log-rank p<0.001). The rate of spontaneous preterm birth before 34 weeks was not significantly different between groups (27.8% vs. 18.2%, p=0.193). In multivariable Cox regression analysis, prolonged indomethacin administration remained independently associated with an increased hazard of earlier delivery (adjusted hazard ratio 1.728, 95% CI 1.116–2.677, p=0.014).
Conclusions: Prolonged indomethacin administration following cervical cerclage was not associated with improved pregnancy prolongation and was independently associated with a shorter latency period from cerclage placement to delivery. These findings do not support the routine extension of indomethacin therapy beyond the immediate perioperative period after cervical cerclage. Prospective studies are needed to clarify the role of prolonged indomethacin treatment in this population.
