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Grand Rounds

Remove or Retain Cervical Cerclage After PPROM?

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

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


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Related ObG Topics:

ACOG Guidance Update: Diagnosis and Management of PROM (Prelabor Rupture of Membranes)
Cervical Cerclage for a Progressively Shortening Cervix or Very Short Cervix
Progesterone or Cerclage in Preterm Prevention in Women with Previous Preterm Birth and Short Cervix?
What is the Best Course of Action Following PPROM Between 24 and 37 Weeks?

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