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.
© 1994 The American College of Obstetricians and Gynecologists