OBJECTIVE: To describe our protocol that recommends amniocentesis for intraamniotic infection or inflammation (IAI) screening to guide rescue cerclage decision-making. METHODS: We implemented a novel protocol at our centre in 2021, which recommends performing amniocentesis when exam-indicated cerclage is recommended (singleton or multiple pregnancies between 14 and 23 RESULTS: From 25 patients included, 12 had low IL-6 (<
3000 pg/mL) (11 received rescue cerclage), while 13 had high IL-6 (≥3000 pg/mL) and were managed with antibiotics and progesterone. The low IL-6 group showed a significantly longer mean ADI (85 CONCLUSION: Amniocentesis before cerclage, particularly IL-6 screening, is a valuable tool in guiding the decision to perform rescue cerclage in selected patients. IL-6 is a strong predictor of both the likelihood of successful cerclage and perinatal outcomes. More studies are needed to optimize management for patients with high risk of IAI.