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.

Conclusion: Amniotic fluid levels of IL-6 and WBCs may be of clinical value for individualizing the management of patients with PPROM after cerclage.