Interventions
All the patients were informed of the potential benefits and risks of ECC, signed informed consent. The attending physicians were senior obstetricians and their fixed team. The preoperative evaluation included assessment of vaginal bleeding or discharge, serum white blood cell (WBC) count and C-reactive protein level, intra-amniotic infection, and uterine contractions. The degree of cervical dilation was determined by pelvic exam and/or speculum exam and specimens for mycoplasma, chlamydia, bacterial vaginosis, candidiasis and trichomonas’s were collected at the time of exam. An isolated finding of vaginal discharge was evaluated for a definitive diagnosis and antibiotics were used for at least 48 hours empirically according to a drug sensitivity test. Patients tested positive for chlamydia and their sexual partners were treated. Clinical chorioamnionitis was defined as maternal fever of ≥38° C with one of the following conditions: maternal tachycardia (>100 beats/minute), fetal tachycardia, (>160 beats/minute), WBC >15 × 103/L, or uterine tenderness. Evidence of intra-amniotic infection was a contraindication for ECC. Preoperative prophylactic antibiotics was offered to all patients, and perioperative indomethacin and nifedipine were administered and continued 48 hours postoperatively.