Infectious complications of cervical cerclage.

A study of 115 gravid patients who required cervical cerclage indicated that the optimum time to perform the surgical procedure was between the fourteenth and eighteenth weeks. If the operation is delayed until later in the second trimester, the incidence of chorioamnionitis is increased 2.6-fold, and premature rupture of the membranes prior to the thirty-second week of gestation is trebled. Amniocentesis performed in nine patients with chorioamnionitis and intact membranes after cerclage demonstrated the polymicrobial nature of the amniotic fluid infection. The isolation of such organisms at Bacteroides bivius, Eubacterium lentum, and Staphylococcus epidermidis indicates their potential importance in chorioamnionitis. Early recourse to amniocentesis is recommended when chorioamnionitis is suspected, and, moreover, prophylactic antibiotics should be used when cerclage is performed after the eighteenth week of pregnancy.