Indomethacin as a diagnostic and therapeutic tool in the management of progressive cervical shortening diagnosed by trans-vaginal sonography

Abstract

Objective: To evaluate the role of indomethacin in discriminating between preterm labour and cervical insufficiency-related cervical shortening.

Methods: Retrospective analysis of all cases of cervical shortening on singleton gestations. All patients were treated according to our protocol with one or more of the following three modalities: (1) bed rest only, (2) bed rest and indomethacin and (3) cervical cerclage, bed rest, and indomethacin.

Outcomes: foetal loss <24 weeks, birth weight, delivery <34 weeks, and delivery <37 weeks.

Results: We treated 342 patients: 167 (48.8%) with bed rest only, 21 (6.1%) with cerclage, and 154 (45.1%) with indomethacin. By 28 weeks 56 (16.3%) remained stable or improved with bed rest only, 91 (26.6%) failed indomethacin and required cerclage, and the remaining 173 (50.6%) responded well to indomethacin and nifedipine. Birth weight was 3119 g ± 651 (SD) and GA at delivery 37.4 weeks ± 2.5 (SD). Of the 342 patients, 4 (1.2%) aborted <24 weeks, 1 was terminated (achondroplasia), 320 (93.6%) patients delivered >34 weeks and 301 (88.1%) >37 weeks.

Conclusions: Use of indomethacin in patients with cervical shortening discriminates patients with cervical insufficiency from those in premature labour and improves outcomes in comparison to existing published reports.