Highlights
- •Largest retrospective study evaluating woman following cerclage removal or retention after PPROM.
- •Cervical cerclage retention in women following PPROM was associated with a longer latency period to delivery.
- •Cervical cerclage retention in women following PPROM was associated with a non-significant trend towards chorioamnionitis.
Abstract
Objective
Preterm prelabour rupture of membranes occurs in over one third of pregnant women
with a cervical cerclage in situ. In the setting of preterm prelabour rupture of membranes,
clinicians are faced with the difficult decision of the optimal timing for removing
the cerclage. We compared the maternal and neonatal outcomes following immediate removal
or retention of the cervical cerclage.
Study design
Women were retrospectively identified from St Thomas’s Hospital Preterm Surveillance
clinic database. Asymptomatic women with preterm prelabour rupture of membranes were
identified and separated into those that had the cerclage removed and those that had
the cerclage retained within 24 h of presentation. Women who were symptomatic at presentation
and who delivered within 24 h of presentation were excluded from the analysis. Maternal
outcomes measured were latency between preterm prelabour rupture of membranes and
delivery, gestation at delivery and maternal chorioamnionitis and infection markers.
Neonatal outcomes including birthweight and Apgar scores were also measured.
Results
43 women with cerclage retained for over 24 h following preterm prelabour rupture
of membranes were compared to 25 women in whom the cerclage was removed. The latency
between preterm prelabour rupture of membranes and delivery was on average 70.4 h
longer in women who had their cerclage retained compared to the removed group (p =
0.009). Rates of chorioamnionitis, maternal blood results, neonatal birthweight and
Apgar scores did not differ significantly between the two groups, however a trend
towards higher rates of chorioamnionitis (60 % vs 45 %) were seen in the retained
group.
Conclusion
Cervical cerclage retention in women following preterm prelabour rupture of membranes
was associated with a longer latency period to delivery and was not significantly
associated with any adverse obstetric, maternal or neonatal outcomes. Therefore, in
women at risk of spontaneous preterm birth, cerclage retention may be beneficial,
however these women and their babies should be monitored closely for any signs of
infection. Further prospective randomised controlled studies assessing these outcomes
as well as longer-term outcomes in these women and their children are needed.
Abbreviations:
CRP (C-reactive protein), CS (caesarean section), EmCS (emergency caesarean section), PPROM (Preterm prelabour rupture of membranes), SVD (spontaneous vaginal delivery), WCC (white cell count)Keywords
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Article info
Publication history
Published online: February 06, 2021
Accepted:
February 1,
2021
Received in revised form:
January 26,
2021
Received:
December 13,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
