P34.16: Indomethacin: A diagnostic and therapeutic tool in the management of progressive cervical shortening diagnosed by trans‐vaginal sonography

To evaluate the role of Indomethacin in discriminating between preterm labor and cervical insufficiency in progressive premature cervical shortening. Retrospective analysis of singleton gestations with progressive cervical shortening detected by vaginal ultrasound. Depending on cervical length, patients were treated as follows: (1) bed rest only, (2) bed rest and Indomethacin and (3) cervical cerclage, bed rest, and Indomethacin as needed. Maintenance tocolysis was achieved with Nifedipine. We used Indomethacin more than once during the course of the pregnancy. After 32 wks gestation we only used Nifedipine. Exclusion criteria: multiple gestation, pPROM, oligohydramnios, and growth failure. Outcomes included: fetal loss prior to 24 wks, birth weight, delivery prior to 34 wks, and delivery prior to 37 wks. Of the 342 patients, 167 (48.8%) were treated with bed rest only, 21 (6.1%) with cerclage, and 154 (45.1%) with Indomethacin. By 28 wks gestation only 56 (16.3%) of the patients remained stable or improved with bed rest only, an additional 91 (26.6%) patients failed Indomethacin and required cerclage, 112 patients in total (33.1%), and the remaining 173 (50.6%) responded to Indomethacin and Nifedipine with improved or stable cervix. Mean birth weight was 3119g ± 651 (SD) and GA at delivery 37.4 wks ± 2.5 (SD). Of the 342 patients 4 (1.2%) experienced pPROM and spontaneous abortion prior to 24 wks, 1 terminated electively (achondroplasia), 22 (6.4%) patients delivered < 34 wks and 41 (11.9%) < 37 wks. Indomethacin in patients with progressive premature cervical shortening discriminates patients with cervical insufficiency from those in premature labor. Such diagnostic stratification reduces the need for cerclage and improves outcomes significantly in comparison to existing published outcomes in similar patients.