Management of Cervical Cerclage after Premature Preterm Rupture of Membranes: An argument for retention: Retention vs Removal of Cerclage after Premature Preterm Rupture of Membranes.

Abstract

Preterm birth remains the leading cause of infant morbidity and mortality worldwide. Efforts aimed at reducing preterm birth rates have largely focused on mitigating risks in those who have already experienced a preterm delivery. One intervention, the placement of a cervical cerclage, has been shown to reduce the risk of subsequent preterm delivery in the appropriate candidate. However, a cerclage does not mitigate the risk of premature preterm rupture of membranes (PPROM). PPROM is a significant contributor to the incidence of preterm births and can occur with a cerclage in place. Many studies have examined the outcomes associated with immediate vs delayed cerclage removal following PPROM with inconsistent results. In this expert review, we summarize the characteristics of the studies examining timing of cerclage removal following PPROM (Table 1), and current international guidelines (Table 2). In the absence of labor, infection, cervical laceration or vaginal bleeding, we recommend that cervical cerclage remain in situ following PPROM until 32-34 weeks gestation.