Amniocentesis for selection before rescue cerclage

Objective: To determine whether diagnostic amniocentesis should be part of evaluations of women under consideration for rescue cerclage. Methods: We reviewed the obstetric records of 25 candidates for rescue cerc lage seen between June 30, 1995, and July 1, 1997. Rescue cerclage was defi ned as a procedure on a cervix with an internal os dilated at least 2 cm an d 50% effaced, with membranes visible at the external os. Transabdominal am niocentesis was offered as part of the preoperative evaluation, and amnioti c fluid (AF) was sent for glucose and lactate dehydrogenase level determina tions, Gram staining, and culture for aerobic and anaerobic bacteria. Place ntas were examined for histopathologic evidence of inflammation. The women were divided into three groups. Eleven women had rescue cerclage after amni ocentesis, seven had rescue cerclage after declining amniocentesis, and sev en had amniocentesis but were treated conservatively because of AF markers of infection. Analysis of variance and chi(2) statistics were used. Results: The group that had rescue cerclage after amniocentesis had a signi ficantly longer mean admission-to-delivery interval, higher mean gestationa l age at delivery, higher mean birth weight, and higher neonatal survival r ate than did the group that had rescue cerclage without amniocentesis and t he group that had no cerclage after amniocentesis (P <.001). Conclusion: Amniocentesis before rescue cerclage placement identified women with subclinical chorioamnionitis who would not benefit from cerclage. (Ob stet Gynecol 2000;95:652-5. (C) 2000 by The American College of Obstetricia ns and Gynecologists.).