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

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.