Management of Cerclage in Patients With Preterm Prelabor Rupture of Membranes

摘要

Women undergoing cerclage placement remain at high risk for preterm labor and preterm prelabor rupture of membranes (PPROMs). The management of cervical cerclage after PPROM is controversial given the potential for prolonged latency when the cerclage is kept in place balanced with a potential increased risk of maternal infectious morbidity. In this review, we compared studies that examined maternal, fetal, and neonatal outcomes in women with cerclage at the time of PPROM. We evaluated latency after PPROM and maternal and neonatal complications in the setting of PPROM with cervical cerclage. Original research articles, review articles, and guidelines on cerclage removal were reviewed. Nine studies comparing cerclage retention versus removal were examined with mixed results, in particular between studies before the routine use of latency antibiotics and corticosteroid administration. There was an associated increase in latency to delivery with retention of cerclage, with a potential increase in maternal infectious morbidity. No significant differences were noted for neonatal mortality, neonatal sepsis, or other neonatal morbidity outcomes. The majority of studies were limited by their retrospective nature and small sample sizes. Cerclage removal at the time of diagnosis of PPROM can be considered due to the concern for increased risk of maternal morbidity without definitive benefit in latency to delivery or neonatal outcomes. However, data are limited, and clinicians should engage in shared decision-making with patients in this setting. Obstetricians and gynecologists, pediatricians After participating in this activity, the provider should be better able to summarize the current evidence regarding maternal, obstetric, and neonatal outcomes for women with PPROM in the setting of cervical cerclage; describe clinical evaluation for women who present with cerclage at the time of PPROM; and evaluate management considerations for women who present with cerclage at the time of PPROM.