(1027) Treating Vaginal Infections Prior to History-Indicated Cerclage and its Impact on PPROM and Pregnancy Prolongation

Objective:
To evaluate the effect of infectious vaginitis treatment in patients undergoing history-indicated cerclage. Gestational age at cerclage, preterm premature rupture of membranes (PPROM), gestational age at PPROM, time from cerclage to PPROM, gestational age at delivery, and time from cerclage to delivery were evaluated for patients who received treatment for bacterial vaginosis, chlamydia, trichomonas and yeast versus those who tested negative prior to cerclage.

Study Design:
A retrospective cohort study analyzing all history-indicated cerclages performed at a single institution between 2008-2020 (n = 333) was performed. Two-sample t-tests and ANOVA analyses were utilized to assess for statistical significance between the treated (n = 68) and control patient (n = 265) groups, and among the different vaginal infections for each study parameter, respectively.

Results:
There was no statistically significant difference in the timing of cerclage placement between the treated and negative group (15.2 weeks vs. 14.8 weeks, p = 0.06). Patients who were treated for vaginal infections prior to cerclage had a higher incidence of PPROM than those who tested negative (26.5% vs 17.4%, p = 0.04). Treatment of vaginal infections was associated with PPROM at a later gestational age (31.5 weeks vs. 27.7 weeks, p = 0.01) and a longer cerclage-to-PPROM interval than those who tested negative (15.8 weeks vs. 12.9 weeks, p = 0.04). There was no statistically significant difference between the treated and negative groups in gestational age at delivery (35.9 weeks vs. 36.1 weeks, p = 0.42) and time from cerclage to delivery (20.8 weeks vs. 21.3 weeks, p = 0.24). The type of infection and the presence of co-infection did not have any statistically significant influence on any variables in this study.

Conclusion:
Treating vaginal infections prior to placement of history-indicated cerclage is associated with a higher rate of PPROM, but is associated with an overall comparable or longer prolongation of pregnancy as well as reducing prematurity versus patients who tested negative for vaginal infection prior to cerclage placement.