title: Timing of cerclage removal after preterm premature rupture of membranes: maternal and neonatal outcomes.
abstract: OBJECTIVE
  Our aim was to evaluate immediate versus delayed removal of cerclage for women with preterm premature rupture of membranes with respect to maternal and neonatal outcomes.
  
  
  METHODS
  We retrospectively analyzed women with preterm premature rupture of membranes at <34 weeks' gestation with prior cerclage placement. Exclusion criteria included presentation with chorioamnionitis, active labor, or nonreassuring fetal status. Timing of cerclage removal, immediate (<24 hours) or delayed (>24 hours), was compared.
  
  
  RESULTS
  There were 25 women in the delayed-removal group and 37 in the immediate-removal group. Average times to removal were 206.8 +/- 7.4 and 5.4 +/- 0.2 hours, respectively. Use of betamethasone was similar for both groups; however, antenatal antibiotic use (100% vs 80%; P =.03) and short-term tocolytic use (20% vs 3%; P =.04) were higher in the delayed-removal group. Duration of latency was significantly longer with delayed removal (10.1 vs 5.0 days; P <. 001). Delivery occurred >48 hours from preterm premature rupture of membranes in 96% (24/25) versus 54% (20/37; P <.001) and >7 days from rupture in 56% (14/25) versus 24% (9/37; P =.02), respectively. Rates of neonatal sepsis (at <10 days) and maternal infection were not statistically different. Neonatal outcomes did not significantly differ regarding mortality, respiratory distress syndrome, birth weight, or duration of stay in the intensive care nursery.
  
  
  CONCLUSIONS
  With the current management scheme for preterm premature rupture of membranes, cerclage retention significantly increases duration of latency without significantly altering maternal or neonatal outcomes.
authors.affiliation: Divisions of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107-5083, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Jenkins
authors.forename: V
authors.initials: V
authors.lastname: Berghella
authors.forename: P A
authors.initials: PA
authors.lastname: Shlossman
authors.forename: C J
authors.initials: CJ
authors.lastname: McIntyre
authors.forename: B D
authors.initials: BD
authors.lastname: Maas
authors.forename: M A
authors.initials: MA
authors.lastname: Pollock
authors.forename: R J
authors.initials: RJ
authors.lastname: Wapner
mesh_terms: D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000601:surgery*; D006801:Humans; D013513:Obstetric Surgical Procedures; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors