title: Retention of cervical cerclage after preterm premature rupture of the membranes: a critical appraisal.
abstract: OBJECTIVE
  The present meta-analysis aims to assess the efficacy of cervical cerclage retention after the occurrence of preterm premature rupture of the membranes by analyzing the observed maternal and neonatal perinatal outcomes.
  
  
  METHODS
  We searched Medline (1966-2014), Scopus (2004-2014), Clinicaltrials.org (1997-2014), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2014) and Google Scholar (2004-2014) search engines, as well as reference lists from all included studies. The statistical analysis was performed using the RevMan software.
  
  
  RESULTS
  Six studies were finally included in the present review, involving 293 parturient. Cerclage retention did not significantly prolong the gestational latency period (MD 2.56 days, 95% CI - 1.06, 6.71). It did, however, increased the rates of delivery after the first 48 h (OR 6.27, 95% CI 1.08, 36.24). As a technique, it did not significantly increase the rates of neonatal sepsis (OR 1.42, 95% CI 0.65, 3.12) or the neonatal death rates (OR 1.09, 95% CI 0.48, 2.47).Maternal chorioamnionitis was, however, significantly more prevalent among women offered cerclage retention (OR 1.78, 95% CI 1.02, 3.12), although the same was not observed in the case of postpartum endometritis (REM OR 4.73, 95 % CI 0.74, 30.09).
  
  
  CONCLUSIONS
  Current evidence is insufficient to support the retention of cervical cerclage after the occurrence of PPROM, therefore, its implementation should be exceptionally instituted in everyday clinical practice, until further evidence becomes available.
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, 15B Ag. Thoma str, 115 27, Athens, Greece, pergialiotis@yahoo.com.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Pergialiotis
authors.forename: Eleana
authors.initials: E
authors.lastname: Gkioka
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bakoyiannis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Mastroleon
authors.forename: Anastasia
authors.initials: A
authors.lastname: Prodromidou
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
mesh_terms: D023802:Cerclage, Cervical; D002821:Chorioamnionitis / Q000453:epidemiology; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D066087:Perinatal Death; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control; D014599:Uterus / Q000503:physiopathology