692: Association of cerclage removal with maternal and neonatal outcomes in pregnancies complicated by preterm premature rupture of membranes

Abstract

To compare pregnancy outcomes between women with pPROM in the presence of cervical cerclage in whom the cerclage was removed within <48h and those in whom the cerclage was retained in situ. We conducted a retrospective cohort study of all women with a singleton pregnancy admitted with pPROM in the presence of cerclage to one of two tertiary referral centers in Toronto, Ontario between 2012-2016. The two centers differ in their approach with regard to the management of cerclage in the context of PPROM: in one center (SB) the common practice is to retain cerclage while in the second center (MSH) the common practice is to remove cerclage. Outcomes were compared between women in whom cerclage was removed within 48 hours and those in whom cerclage was retained until the onset of delivery. 1) Of a total of 79 women who met the study inclusion criteria, cerclage was removed in 44 (55.7%) and retained in 35 (44.3%). 2) There were no differences between the removal and retention groups in baseline characteristics, gestational age at cerclage placement (19.3±3.3 vs.18.0±4.1 weeks, p=0.1), cervical dilatation at cerclage, and gestational age at pPROM (28.3±2.9 vs. 28.0±2.6 weeks, p=0.7). 3) Women in the cerclage removal group had a lower pPROM to delivery interval (2.0±6.5 vs. 7.9±7.5 days, respectively, p<0.001) and were less likely to have a latency period of >7 days (4.5% vs. 37.1%, respectively, p<0.001) compared with women in whom cerclage was retained (Figure 1). 4) After adjustment for confounding factors, retention of cerclage was associated with higher odds for latency >7 days and lower odds for composite neonatal outcome (Figure 2). There were no differences between the groups in the odds for clinical chorioamnionitis and neonatal sepsis (Figure 2). In this multi-center retrospective study of women with pPROM and cervical cerclage, retention of cerclage was associated with longer latency period and lower rate of adverse neonatal outcome without increasing the risk of infection in the mother and newborn.