title: Poor perinatal outcome associated with retained cerclage in patients with premature rupture of membranes.
abstract: OBJECTIVE
  To evaluate the role of immediate cerclage removal versus retention in patients experiencing premature rupture of the membranes remote from term (PROM).
  
  
  METHODS
  Thirty patients with prophylactic cerclage experiencing PROM at 24-32 weeks were managed expectantly after either immediate removal in 20 (67%) or retention of the cerclage in ten (33%). Thirty-three patients without cerclage and with PROM at the same gestational age were used as controls.
  
  
  RESULTS
  More patients with retained cerclage (nine of ten, 90%) had delivery delayed for at least 48 hours after PROM compared to patients with immediate cerclage removal (ten of 20, 50%) (P < .05). Perinatal mortality was significantly higher for those with retained cerclage (seven of ten, 70%) than with immediate removal (two of 20, 10%) or in the control group (six of 33, 18%) (P < .001). Sepsis was responsible for most of the poor outcomes in the retained-cerclage group (71%).
  
  
  CONCLUSIONS
  Although retaining the cerclage prolonged the latency period between PROM and delivery, that benefit was more than offset by a greatly increased perinatal mortality rate. Our study supports immediate cerclage removal regardless of gestational age in cases of PROM.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Hospital, Boston, Massachusetts.
authors.forename: J
authors.initials: J
authors.lastname: Ludmir
authors.forename: T
authors.initials: T
authors.lastname: Bader
authors.forename: L
authors.initials: L
authors.lastname: Chen
authors.forename: C
authors.initials: C
authors.lastname: Lindenbaum
authors.forename: G
authors.initials: G
authors.lastname: Wong
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000401:mortality; D002584:Cervix Uteri / Q000601:surgery*; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000601:surgery*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors