Timing of cerclage removal after preterm premature rupture of membranes: Maternal and neonatal outcomes

Abstract

Objective: Our aim was to evaluate immediate versus delayed removal of cerclage for women with preterm premature rupture of membranes with respect to maternal and neonatal outcomes. Study Design: We retrospectively analyzed women with preterm premature rupture of membranes at <34 weeks’ gestation with prior cerclage placement. Exclusion criteria included presentation with chorioamnionitis, active labor, or nonreassuring fetal status. Timing of cerclage removal, immediate (<24 hours) or delayed (>24 hours), was compared. Results: There were 25 women in the delayed-removal group and 37 in the immediate-removal group. Average times to removal were 206.8 ± 7.4 and 5.4 ± 0.2 hours, respectively. Use of betamethasone was similar for both groups; however, antenatal antibiotic use (100% vs 80%; P = .03) and short-term tocolytic use (20% vs 3%; P = .04) were higher in the delayed-removal group. Duration of latency was significantly longer with delayed removal (10.1 vs 5.0 days; P < .001). Delivery occurred >48 hours from preterm premature rupture of membranes in 96% (24/25) versus 54% (20/37; P < .001) and >7 days from rupture in 56% (14/25) versus 24% (9/37; P = .02), respectively. Rates of neonatal sepsis (at <10 days) and maternal infection were not statistically different. Neonatal outcomes did not significantly differ regarding mortality, respiratory distress syndrome, birth weight, or duration of stay in the intensive care nursery. Conclusion: With the current management scheme for preterm premature rupture of membranes, cerclage retention significantly increases duration of latency without significantly altering maternal or neonatal outcomes. (Am J Obstet Gynecol 2000;183:847-52.)