Grand Rounds

Remove or Retain Cervical Cerclage After PPROM?

BACKGROUND AND PURPOSE:

Vitner et al. (Archives of Gynecology and Obstetrics, 2020) compared PPROM pregnancy outcomes when cerclage was removed vs when it was retained

Two-center retrospective cohort study
Participants
- Singleton pregnancy
- PPROM at < 34w0d
- Cervical cerclage in situ
Exposures
- Retention of cerclage until onset of delivery
- Removal of cerclage within 24 hours of PPROM
Primary outcome
- Time from PPROM to delivery

70 women included
- Cerclage retained in situ: 67.1% (47 women)
- Cerclage removed: 32.9% (23 women)
Women in the cerclage retention group had a higher PPROM-to-delivery interval (p = 0.03)
- Retained: 7.0 ± 7.2 days
- Removed: 6.0 ± 10.9 days
Women in the retention group were more likely to have a longer latency period
- > 48 h (p = 0.03)
  - Retain: 87.2%
  - Remove: 65.2%
  - Adjusted odds ratio (aOR) 3.9 (95% CI, 3.1 to 4.9)
- > 7 days (p = 0.04)
  - Retain: 29.8%
  - Remove: 8.7%
  - aOR 7.0 (95% CI, 2.5 to 19.6)
Chorioamnionitis rate was lower in the retention group
- aOR 0.7 (95% CI, 0.5 to 1.0)
No differences found for the following
- Early neonatal sepsis
- Sever brain injury
- Composite neonatal outcome

Retention of cerclage in situ vs removal
- May increase the latency between rupture and delivery in pregnancies <34 weeks
- May be associated with lower rates of chorioamnionitis
- Increase in neonatal morbidity was not evident
There were no differences in risk of neonatal morbidities associated with either removal or retention
The authors state that

Further research on how best to address this clinical scenario is needed which could include a randomized clinical trial

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