Skip to main content

Advertisement

SpringerLink
Log in

Removal vs. retention of cervical cerclage in pregnancies complicated by preterm premature rupture of membranes: a retrospective study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare pregnancy outcomes in women with pPROM and a cervical cerclage in whom the cerclage was removed within 24 h and those in whom the cerclage was retained in situ.

Methods

A two-center retrospective cohort study of women with a singleton gestation with pPROM at < 340/7 weeks of gestation in the presence of cervical cerclage (January 1, 2012–July 30, 2016). Maternal and perinatal outcomes were compared between women in whom cerclage was removed within 24 h from pPROM and those in whom cerclage was retained until the onset of delivery. The primary outcome was time from pPROM to delivery.

Results

Seventy women met inclusion criteria. Cerclage was left in situ in 47 (67.1%) and removed in 23 (32.9%) women. Women in the cerclage retention group had a higher pPROM-to-delivery interval (7.0 ± 7.2 vs. 6.0 ± 10.9 days, p = 0.03), and were more likely to have a latency period > 48 h (87.2% vs. 65.2%, p = 0.03; aOR 3.9, 95% CI 3.1–4.9) or > 7 days (29.8% vs. 8.7%, p = 0.04; aOR 7.0, 95% CI 2.5–19.6) compared with women in whom cerclage was removed. Furthermore, chorioamnionitis rate was lower in the cerclage retention group compared to cerclage removal group (aOR 0.7, 95% CI 0.5–1.0). There were no differences between the groups in early neonatal sepsis, severe brain injury, or composite neonatal outcome.

Conclusion

In women with pPROM and cervical cerclage, retention of cerclage may be associated with a longer latency period, and a lower chorioamnionitis rate, without an associated increase in the risk of neonatal infectious morbidity.

Presentation information: The abstract of this study was presented as a poster at the 38th SMFM (Society of Maternal and Fetal Medicine) annual meeting, February 2018, Dallas, Texas, USA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

Individual requests for sharing data and material will be considered.

References

  1. Martin JA, Hamilton BE, Osterman MJK (2018) Births in the United States, 2017. NCHS Data Brief 318:1–8

    Google Scholar 

  2. Berghella V et al (2009) Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev 3:CD007235. https://doi.org/10.1002/14651858.CD007235.pub2

    Google Scholar 

  3. Norwitz ER, CJL, Barss VA (2018) Transvaginal cervical cerclage. UpToDate. https://www-uptodate-com.myaccess.library.utoronto.ca/contents/transvaginal-cervical-cerclage?search=cerclage&source=search_result&selectedTitle=1~37&usage_type=default&display_rank=1. Accessed 27 Aug 2018

  4. Laskin D, Yinon Y, Whittle WL (2012) Preterm premature rupture of membranes in the presence of cerclage: is the risk for intra-uterine infection and adverse neonatal outcome increased? J Matern Fetal Neonatal Med 25(4):424–428

    Article  Google Scholar 

  5. Alfirevic Z, Stampalija T, Medley N (2017) Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev 6:Cd008991

    PubMed  Google Scholar 

  6. Jenkins TM, Berghella V, Shlossman PA et al (2000) Timing of cerclage removal after preterm premature rupture of membranes: maternal and neonatal outcomes. Am J Obstet Gynecol 183(4):847–852

    Article  CAS  Google Scholar 

  7. Ludmir J, Bader T, Chen L, Lindenbaum C, Wong G (1994) Poor perinatal outcome associated with retained cerclage in patients with premature rupture of membranes. Obstet Gynecol 84(5):823–826

    CAS  PubMed  Google Scholar 

  8. O'Connor S, Kuller JA, McMahon MJ (1999) Management of cervical cerclage after preterm premature rupture of membranes. Obstet Gynecol Surv 54(6):391–394

    Article  CAS  Google Scholar 

  9. Blickstein I, Katz Z, Lancet M, Molgilner BM (1989) The outcome of pregnancies complicated by preterm rupture of the membranes with and without cerclage. Int J Gynaecol Obstet 28(3):237–242

    Article  CAS  Google Scholar 

  10. Galyean A, Garite TJ, Maurel K et al (2014) Removal versus retention of cerclage in preterm premature rupture of membranes: a randomized controlled trial. Am J Obstet Gynecol 211(4):399.e1–7

    Article  Google Scholar 

  11. Kominiarek MA, Kemp A (2006) Perinatal outcome in preterm premature rupture of membranes at < or = 32 weeks with retained cerclage. J Reprod Med 51(7):533–538

    PubMed  Google Scholar 

  12. McElrath TF, Norwitz ER, Lieberman ES, Heffner LJ (2002) Perinatal outcome after preterm premature rupture of membranes with in situ cervical cerclage. Am J Obstet Gynecol 187(5):1147–1152

    Article  Google Scholar 

  13. Yeast JD, Garite TR (1988) The role of cervical cerclage in the management of preterm premature rupture of the membranes. Am J Obstet Gynecol 158(1):106–110

    Article  CAS  Google Scholar 

  14. Sperling JD, Dahlke JD, Gonzalez JM (2017) Cerclage use: a review of 3 national guidelines. Obstet Gynecol Surv 72(4):235–241

    Article  Google Scholar 

  15. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM (1988) Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 82(4):527–532

    CAS  PubMed  Google Scholar 

  16. Bell MJ, Ternberg JL, Feigin RD et al (1978) Neonatal necrotizing enterocolitis Therapeutic decisions based upon clinical staging. Ann Surg 187(1):1–7

    Article  CAS  Google Scholar 

  17. Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92(4):529–534

    Article  CAS  Google Scholar 

  18. Aguin E, Van De Ven C, Cordoba M, Albayrak S, Bahado-Singh R (2014) Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers. Int J Gynaecol Obstet 125(1):37–40

    Article  CAS  Google Scholar 

  19. Kuhn RJP, Pepperell RJ (1977) Cervical ligation: a review of 242 pregnancies. Aust N Zeal J Obstet Gynaecol 17(2):79–83

    Article  Google Scholar 

  20. McElrath TF, Norwitz ER, Lieberman ES, Heffner LJ (2000) Management of cervical cerclage and preterm premature rupture of the membranes: should the stitch be removed? Am J Obstet Gynecol 183(4):840–846

    Article  CAS  Google Scholar 

  21. Giraldo-Isaza MA, Berghella V (2011) Cervical cerclage and preterm PROM. Clin Obstet Gynecol 54(2):313–320

    Article  Google Scholar 

  22. Pergialiotis V, Gkioka E, Bakoyiannis I, Mastroleon I, Prodromidou A, Perrea D (2015) Retention of cervical cerclage after preterm premature rupture of the membranes: a critical appraisal. Arch Gynecol Obstet 291(4):745–753

    Article  Google Scholar 

  23. Walsh J, Allen VM, Colford D, Allen AC (2010) Preterm prelabour rupture of membranes with cervical cerclage: a review of perinatal outcomes with cerclage retention. J Obstet Gynaecol Can 32(5):448–452

    Article  Google Scholar 

Download references

Funding

There was no funding of any kind.

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Dana Vitner, Nir Melamed, David Elhadad, Michael Phang, Maya Ram, Arthur Zaltz & Jon Barrett

  2. Rambam HealthCare Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Dana Vitner

  3. Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Elizabeth Asztalos

  4. Departments of Paediatrics and HPME, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah

Authors
  1. Dana Vitner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nir Melamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Elhadad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Phang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maya Ram
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizabeth Asztalos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Arthur Zaltz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Prakesh S. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jon Barrett
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DV—contribution to conception and design, planning, analyzing, drafting the article. NM—contribution to conception and design, planning, analyzing, revising the article critically, final approval of the version. DH—carrying out, contribution to analysis, revising the article critically, final approval of the version. MP—carrying out, contribution to analysis, revising the article critically, final approval of the version. MR—carrying out, contribution to analysis, revising the article critically, final approval of the version. EA—planning, analyzing, revising the article critically, final approval of the version. AZ—conception, planning, revising the article critically, final approval of the version. PS—planning, analyzing, writing up, revising the article critically, final approval of the version. JB—conception, planning, analyzing, revising the article critically, final approval of the version.

Corresponding author

Correspondence to Dana Vitner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Research Ethics Board at Sunnybrook Health Sciences Centre on December 8th, 2016. Project identification number 442-2016, and by the Research Ethics Board at Mount Sinai Hospital on July 12th, 2016. Project identification number 16-0142-C. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

N/A.

Consent for publication

N/A.

Code availability

N/A.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vitner, D., Melamed, N., Elhadad, D. et al. Removal vs. retention of cervical cerclage in pregnancies complicated by preterm premature rupture of membranes: a retrospective study. Arch Gynecol Obstet 302, 603–609 (2020). https://doi.org/10.1007/s00404-020-05642-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05642-y

Keywords

Search

Navigation