Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers. Issue 1 (2nd January 2014)

• Record Type: Journal Article
• Authors: Aguin, Eduardo; Van De Ven, Cosmas; Cordoba, Marcos; Albayrak, Samet; Bahado‐Singh, Ray
• Is Part Of: International journal of gynaecology and obstetrics. Volume 125:Issue 1(2014)
• Page Start: 37
• Page End: 40
• Publication Date: 2014-01-02
• Subjects: Amniocentesis -- Cerclage -- Infection -- Inflammation -- Outcome -- Prematurity -- Preterm premature rupture of membranes -- Ultrasound; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1016/j.ijgo.2013.10.005
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: 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.