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Removal vs. retention of cervical cerclage in pregnancies complicated by preterm premature rupture of membranes: a retrospective study

Abstract

Purpose

To compare pregnancy outcomes in women with pPROM and a cervical cerclage in whom the cerclage was removed within 24 h and those in whom the cerclage was retained in situ.

Methods

A two-center retrospective cohort study of women with a singleton gestation with pPROM at < 340/7 weeks of gestation in the presence of cervical cerclage (January 1, 2012–July 30, 2016). Maternal and perinatal outcomes were compared between women in whom cerclage was removed within 24 h from pPROM and those in whom cerclage was retained until the onset of delivery. The primary outcome was time from pPROM to delivery.

Results

Seventy women met inclusion criteria. Cerclage was left in situ in 47 (67.1%) and removed in 23 (32.9%) women. Women in the cerclage retention group had a higher pPROM-to-delivery interval (7.0 ± 7.2 vs. 6.0 ± 10.9 days, p = 0.03), and were more likely to have a latency period > 48 h (87.2% vs. 65.2%, p = 0.03; aOR 3.9, 95% CI 3.1–4.9) or > 7 days (29.8% vs. 8.7%, p = 0.04; aOR 7.0, 95% CI 2.5–19.6) compared with women in whom cerclage was removed. Furthermore, chorioamnionitis rate was lower in the cerclage retention group compared to cerclage removal group (aOR 0.7, 95% CI 0.5–1.0). There were no differences between the groups in early neonatal sepsis, severe brain injury, or composite neonatal outcome.

Conclusion

In women with pPROM and cervical cerclage, retention of cerclage may be associated with a longer latency period, and a lower chorioamnionitis rate, without an associated increase in the risk of neonatal infectious morbidity.

Presentation information: The abstract of this study was presented as a poster at the 38th SMFM (Society of Maternal and Fetal Medicine) annual meeting, February 2018, Dallas, Texas, USA.

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Authors and Affiliations

Authors

Contributions

DV—contribution to conception and design, planning, analyzing, drafting the article. NM—contribution to conception and design, planning, analyzing, revising the article critically, final approval of the version. DH—carrying out, contribution to analysis, revising the article critically, final approval of the version. MP—carrying out, contribution to analysis, revising the article critically, final approval of the version. MR—carrying out, contribution to analysis, revising the article critically, final approval of the version. EA—planning, analyzing, revising the article critically, final approval of the version. AZ—conception, planning, revising the article critically, final approval of the version. PS—planning, analyzing, writing up, revising the article critically, final approval of the version. JB—conception, planning, analyzing, revising the article critically, final approval of the version.

Corresponding author

Correspondence to Dana Vitner.

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The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Research Ethics Board at Sunnybrook Health Sciences Centre on December 8th, 2016. Project identification number 442-2016, and by the Research Ethics Board at Mount Sinai Hospital on July 12th, 2016. Project identification number 16-0142-C. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Vitner, D., Melamed, N., Elhadad, D. et al. Removal vs. retention of cervical cerclage in pregnancies complicated by preterm premature rupture of membranes: a retrospective study. Arch Gynecol Obstet 302, 603–609 (2020). https://doi.org/10.1007/s00404-020-05642-y

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  • DOI: https://doi.org/10.1007/s00404-020-05642-y

Keywords

  • Cervical cerclage
  • Chorioamnionitis
  • Latency
  • pPROM
  • Preterm premature rupture of membranes
  • Preterm birth
  • PTB
  • Neonatal sepsis