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Prematurity

Poster Session 4

(958) Pre-cerclage amniotic fluid glucose levels, white blood cell count and pregnancy outcomes

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Exam-indicated cerclage (EC) is an important treatment for cervical insufficiency, with the goal of preventing preterm birth (PTB). Given the risk of intra-amniotic infection (IAI) with cervical dilation, amniocentesis may be considered prior to EC to rule out IAI. In addition to bacterial culture, commonly tested amniotic fluid components include white blood cell count (WBC) and glucose. However, the utility of these tests in predicting pregnancy outcomes has not been demonstrated.

Study Design: A retrospective cohort study was conducted at a single academic center from 2015-2023. Patients undergoing amniocentesis prior to EC were identified. Multiples and patients with incomplete delivery data were excluded. Amniotic fluid was sent for gram stain, culture, WBC and glucose levels. Patients with positive culture did not proceed to cerclage. The primary outcome was gestational age (GA) at delivery. Spearman correlation was used to assess for correlation between amniotic fluid WBC or glucose and the primary outcome. WBC ( < 20, ≥ 20) and glucose (≤ 14, > 14) were also analyzed categorically by t-test or Wilcoxon rank sum test.

Results: 155 patients underwent EC. Of those, 77 proceeded with amniocentesis prior to EC. Median GA at diagnosis was 21.0 weeks (IQR 19.9-21.9). Median cervical dilation was 1.0cm (IQR 0.5-1.0). 21 patients (30.4%) had prolapsing membranes and 45 (61.6%) had intra-amniotic debris present prior to EC. Median amniotic WBC was 5.0 x103/uL (IQR 2.0-14.2) and mean glucose 36.5 mg/dL (SD 13.0). The median GA at delivery was 37.1 weeks (IQR 29.9-39.0). No correlation was found between either WBC (ρ=0.04, p=0.70) or glucose (ρ=-0.13, p=0.26) and GA at delivery. Assessed by group, patients with glucose ≤ 14 delivered later (p=0.03) than glucose > 14 (Table 1), though there was a limited number of patients in the ≤ 14 group.

Conclusion: In patients receiving EC, there is no statistically significant correlation between either amniotic WBC or glucose level and GA at delivery. In patients receiving cerclage, WBC and glucose may be of limited clinical utility in predicting pregnancy outcome.