Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers.
OBJECTIVE
To evaluate whether amniotic fluid markers can aid the decision of whether to retain or remove a cervical cerclage after preterm premature rupture of membranes (PPROM).


METHODS
A retrospective cohort study included pregnancies involving PPROM after diagnostic amniocentesis and cerclage placement. Cerclage was retained for more than 12 hours after PPROM in the study group (n=18); the comparison group comprised women who underwent immediate cerclage removal after PPROM (n=22). Analyses were performed using concentrations of interleukin (IL)-6, glucose, and white blood cells (WBCs) in the amniotic fluid to measure relationships with adverse outcomes.


RESULTS
The latency period from PPROM to delivery was significantly shorter in the group that underwent immediate cerclage removal (P<0.005). Latency periods of more than 48 hours (P<0.001) and more than 7 days (P<0.01), and chorioamnionitis (P<0.05) were associated with cerclage retention. Neonatal outcomes were not significantly different between the study group and the comparison group. However, elevated IL-6 levels were associated with cumulative neonatal morbidity (P<0.05). Low IL-6 (P<0.001) and WBC (P<0.05) levels were significantly associated with a latency period of more than 7 days.


CONCLUSIONS
Amniotic fluid levels of IL-6 and WBCs may be of clinical value for individualizing the management of patients with PPROM after cerclage.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, USA. Electronic address: eaguin@med.umich.edu.
Eduardo
E
Aguin
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, USA.
Cosmas
C
Van De Ven
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York University, New York, USA.
Marcos
M
Cordoba
Department of Obstetrics and Gynecology, Wayne State University, Detroit, USA.
Samet
S
Albayrak
Department of Obstetrics and Gynecology, Oakland University - William Beaumont Hospital School of Medicine, Royal Oak, USA.
Ray
R
Bahado-Singh
D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D023802:Cerclage, Cervical; D002821:Chorioamnionitis / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000378:metabolism; D007962:Leukocytes / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D015850:Interleukin-6
Amniocentesis; Cerclage; Infection; Inflammation; Outcome; Prematurity; Preterm premature rupture of membranes; Ultrasound