The Role of Cerclage in Subsequent Pregnancy following Previable Prelabor Rupture of Membranes

Yossi Bart; Michal Fishel Bartal; Roni Plaschkes; Diklah Sebag; Suneet P Chauhan; Baha M Sibai; Raanan Meyer; Eran Kassif; Rakefet Yoeli; Shali Mazaki-Tovi

doi:10.1055/a-2028-7633

The Role of Cerclage in Subsequent Pregnancy following Previable Prelabor Rupture of Membranes

Am J Perinatol. 2023 Mar 17. doi: 10.1055/a-2028-7633. Online ahead of print.

Authors

Yossi Bart¹, Michal Fishel Bartal^{1

2}, Roni Plaschkes¹, Diklah Sebag¹, Suneet P Chauhan², Baha M Sibai², Raanan Meyer^{1

3}, Eran Kassif¹, Rakefet Yoeli^#¹, Shali Mazaki-Tovi^#^{1

3}

Affiliations

¹ Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
² Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
³ Department of Obstetrics and Gynecology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

^# Contributed equally.

PMID: 36746399
DOI: 10.1055/a-2028-7633

Abstract

Objective: This study aimed to ascertain the outcomes associated with a cervical cerclage among individuals with a history of previable prelabor rupture of membranes (PROM).

Study design: This study was a retrospective cohort study conducted at a single tertiary center between 2011 and 2021. We included individuals with a history of previable (before 24 weeks) PROM and the subsequent viable pregnancy. Women with multifetal gestation, preterm birth (PTB) or cerclage in previous gestation, or abdominal cerclage after trachelectomy were excluded. Primary outcome was PTB rate (delivery <37 weeks). Recurrence of preterm PROM and adverse composite maternal and neonatal outcomes (CMO and CNO) were evaluated as secondary outcomes. CMO included any of the following: suspected chorioamnionitis, endometritis, red blood cell transfusion, uterine rupture, unplanned hysterectomy, or death. CNO included any of the following: previable PTB (<24 weeks of gestation), bronchopulmonary dysplasia, grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, mechanical ventilation, seizures, hypoxic ischemic encephalopathy, or death.

Results: During the study period, 118 individuals had a history of previable PROM and a documented subsequent pregnancy, out of which 74 (62.7%) met inclusion criteria. Nineteen (25.7%) of eligible individuals underwent a cerclage for prior previable PROM and were compared with controls (n = 55, 74.3%). Women who underwent a cerclage had higher rates of PTB < 37 weeks (63.2 vs. 10.9%, p < 0.001; odds ratio [OR]: 14.00, 95% confidence interval [CI]: 3.97-49.35) and < 34 weeks (21.1 vs. 3.6%, p = 0.03; OR: 7.07, 95% CI: 1.18-42.39) compared with those without cerclage. Furthermore, recurrent preterm PROM and previable PTB rates were higher among patients who underwent cerclage. The survival curve further indicated that individuals with cerclage delivered earlier. CMO and CNO rates were similar in those with and without cerclage.

Conclusion: Cerclage placement in individuals with prior previable PROM was associated with higher rates of recurrent preterm PROM and PTB.

Key points: · The management of individuals in a subsequent pregnancy following previable PROM is a conundrum.. · Cerclage following previable PROM is associated with higher rates of recurrent preterm PROM and PTB.. · Composite maternal and neonatal outcome rates were similar in those with and without cerclage..