(722) Cerclage in PPROM: should I stay or should I go?

The decision to remove or retain a cerclage in patients with preterm prelabor rupture of membranes (PPROM) without an active indication for delivery is controversial. We compared neonatal and maternal outcomes between patients with early (< = 24 hours) and deferred ( > 24 hours) removal of a cerclage.

Study Design:

Passive prospective cohort of 156 pregnancies with a cerclage in situ who presented between 24w0d and 34w0d with PPROM from 2009 to 2022, retrospectively analyzed. We assessed univariate associations of maternal and neonatal outcomes between those with early (< = 24 hours) and deferred ( > 24 hours) cerclage removal after PPROM.

Results:

66 patients (42.3%) were in the early cohort and 90 (57.7%) were in the deferred cohort. Both had similar demographics, history, indications for cerclage, type of cerclage, and suture. Both had similar gestational age (GA) at placement (18.3w vs 18.9w, p=0.27) and at the time of PPROM (28.9w vs 26.2w, p=0.13). The early removal cohort had a higher GA at delivery (29.3w vs 28.0w, p=0.029) and birthweight (1487g v 1202g, p=0.001). The deferred removal cohort was associated with a higher rate of pregnancy prolongation ≥48 hours (44% vs 100%, p< 0.001) and ≥7 days (11% vs 62%, p < 0.001). The deferred cohort had a higher incidence of neonatal sepsis (16% vs 33%, p=0.029) and bronchopulmonary dysplasia (16% vs 37%, p=0.009). The rates of clinical chorioamnionitis (32 vs 43%, p=0.18) and histopathologic chorioamnionitis (35% vs 52%, p=0.60) were similar.

Conclusion:

Management of PPROM with cerclage in situ is individualized depending on gestational age and specific patient factors with no consensus on optimal management. Our data suggest that while early removal was associated with a higher GA and birthweight at delivery, as well as a lower rate of neonatal sepsis and bronchopulmonary dysplasia, deferred removal was associated with a higher rate of pregnancy duration ≥ 48 hours and 7 days.