Poster Session 1
Category: Prematurity
Poster Session 1
Shiran Bookstein Peretz, MD
Resident
Sheba Medical Center, Ramat Gan, Israel
Ramat Gan, HaMerkaz, Israel
Chen Lugacy, MD
Sheba medical center
Ramat Gan, Tel Aviv, Israel
Yossi Bart, MD
MFM fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sharon Amit, MD
Head of the Microbiology Laboratory
Sheba Medical Center
Tel HaShomer, HaMerkaz, Israel
Lital Shaham, MD, PhD (she/her/hers)
Resident Physician, Department of Obstetrics and Gynecology, Sheba Medical Center
Department of Obstetrics and Gynecology, Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
Avi Tsur, MD (he/him/his)
Director of The Women's Health Innovation Center
Department of Obstetrics and Gynecology, Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
Shali Mazaki Tovi, MD
Sheba Medical Center, Ramat Gan, Israel
ramat gan, HaMerkaz, Israel
Yoav Yinon, MD
Head of Fetal Medicine UnitChair of the Israeli Maternal Fetal Medicine Society
Sheba Medical Center, Ramat Gan, Israel
Ramat Gan, HaMerkaz, Israel
Michal Fishel Bartal, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Premature preterm rupture of membranes (PPROM) in patients with cerclage is associated with adverse outcomes. This study aimed to determine maternal and neonatal outcomes in individuals with cervical cerclage presenting with PPROM prior to 32 weeks, and to assess the yield of amniocentesis (AC) in identifying subclinical intra-amniotic infection
Study Design:
This single-center retrospective study included individuals with cerclage and PPROM < 32 weeks between 03/2010–06/2025. Exclusion criteria were clinical chorioamnionitis at presentation (fever, uterine tenderness, tachycardia, leukocytosis, or non-reassuring fetal monitoring) or active labor. Standard practice at our center for asymptomatic patients included AC; negative AC prompted expectant inpatient care, whereas positive AC led to delivery. Maternal and neonatal outcomes were compared according to AC results
Results:
Of 114 patients with cerclage and PPROM, 45 (39%) met eligibility criteria; 21 (47%) had positive AC. Baseline characteristics were comparable (Table 1). A wide variety of pathogens was identified, with some amniocentesis samples yielding multiple organisms. The most common organisms were Enterobacterales/other Gram-negatives (n=8), followed by Streptococcus anginosus/milleri (n=5), anaerobes (n=4), Candida (n=2), Staphylococcus aureus (n=2), Enterococci (n=2), and GBS (n=2). Positive AC was associated with higher rates of histologic chorioamnionitis (71.4% vs 33.3%, P=0.01). All intrapartum fetal deaths occurred in the positive AC group. Gestational age at delivery was similar, but birthweight and 1 and 5 minute Apgar scores were lower in the positive AC group. No differences were observed in composite adverse neonatal outcomes (Table 2)
Conclusion:
Nearly half of patients with cerclage and PPROM< 32 weeks without clinical signs of infection had intra-amniotic infection detected by AC. Despite longer latency in AC-negative individuals managed expectantly, adverse neonatal outcomes were similar to those with positive AC, highlighting the need for further research to clarify the impact of AC-guided management on perinatal outcomes