Perinatal outcome in preterm premature rupture of membranes at ≤ 32 weeks with retained cerclage

OBJECTIVE: To evaluate the risks of cerclage retention in the setting of preterm premature rupture of membranes (PPROM). STUDY DESIGN: Patients from 1995-2003 with PPROM at ≤32 weeks and cerclage were studied via chart review. Only patients who received >48 hours of antibiotics and a course of corticosteroids and who delivered after 24 weeks' gestation were included. RESULTS: Of 23 cases, 17 (74%) had a retained cerclage (cerclage not removed within the first 24 hours of admission), and 6 (26%) had the cerclage removed within 24 hours of admission. Gestational age at PPROM was earlier in the retained cerclage group (26.1 ± 3.3 vs. 29.3 ± 2.9 weeks, p = 0.04). There was no difference in the rates of chorioamnionitis (50% vs. 52%, p = 0.9) or neonatal death due to sepsis (17% in each, p = 0.55) between the 2 groups. CONCLUSION: Although this study did not have sufficient power to detect these differences, cerclage retention in patients with PPROM managed with both corticosteroids and antibiotics was not associated with either increased maternal morbidity or neonatal mortality. Severe prematurity and not a retained cerclage may be a greater contributor to neonatal mortality due to sepsis. Future research would require a multicenter, randomized trial that allows a greater sample size to elucidate optimal management in these patients.