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

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