Perinatal outcome in preterm premature rupture of membranes at < or = 32 weeks with retained cerclage.
OBJECTIVE
To evaluate the risks of cerclage retention in the setting of preterm premature rupture of membranes (PPROM).


METHODS
Patients from 1995-2003 with PPROM at < or = 32 weeks and cerclage were studied via chart review. Only patients who received > 48 hours of antibiotics and a course of corticosteroids and who delivered after 24 weeks' gestation were included,


RESULTS
Of 23 cases, 17 (74%) had a retained cerclage (cerclage not removed within the first 24 hours of admission), and 6 (26%) had the cerclage removed within 24 hours of admission. Gestational age at PPROM was earlier in the retained cerclage group (26.1 +/- 3.3 vs. 29.3 +/- 2.9 weeks, p = 0.04). There was no difference in the rates of chorioamnionitis (50% vs. 52%, p = 0.9) or neonatal death due to sepsis (17% in each, p = 0.55) between the 2 groups.


CONCLUSIONS
Although this study did not have sufficient power to detect these differences, cerclage retention in patients with PPROM managed with both corticosteroids and antibiotics was not associated with either increased maternal morbidity or neonatal mortality. Severe prematurity and not a retained cerclage may be a greater contributor to neonatal mortality due to sepsis. Future research would require a multicenter, randomized trial that allows a greater sample size to elucidate optimal management in these patients.
Kominiarek
Michelle A
MA
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago Medical Center, Chicago, Illinois 60612, USA. mkomin1@uic.edu
Kemp
Andrea
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D023802:Cerclage, Cervical / Q000009:adverse effects*; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy* / Q000401:mortality; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents