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Cerclage may exacerbate complications of PPROM

Cerclage is associated with higher rates of chorioamnionitis after preterm premature rupture of membranes.

Incidence of chorioamnionitis in women with cerclage is almost twice that of those without.

Significantly higher rates of sepsis, anemia, and respiratory distress were seen in neonates delivered after PPROM in women with cerclage.

Women treated with cerclage have higher rates of chorioamnionitis and adverse perinatal outcomes after preterm premature rupture of membranes (PPROM) than women without cerclage.

The findings come from a Canadian retrospective observational cohort study published in the Journal of Maternal-Fetal and Neonatal Medicine (2012;25[4]:424-428). Of a total of 668 women diagnosed with PPROM between 24 and 34 weeks of pregnancy, 64 who had cerclage were matched with 170 controls without cerclage.

Pregnancy latency period did not differ significantly between the groups; average time to delivery was 7 to 10 days with or without cerclage. However, the rate of clinical chorioamnionitis among women with cerclage was almost twice that of controls (26.6% vs 13.5%; histological rates were 92.6% vs 65.4%).

Rates were particularly high in women diagnosed with PPROM <28 weeks’ gestation. With cerclage in situ and a diagnosis of PPROM <28 weeks, more than one-third of women delivered because of clinical chorioamnionitis, and more than 90% had histological chorioamnionitis at delivery.

In addition, significantly greater rates of sepsis (P=0.05), neonatal respiratory distress (P=0.003), and neonatal anemia (P=0.002) were found among the neonates delivered after PPROM in women with cerclage versus those without.

The authors note that previous studies about acute management of PPROM in the presence of cerclage predate the use of erythromycin.

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