(1156) PPROM after midtrimester cerclage placement: International Collaborative for Cerclage Longitudinal Evaluation and Research (IC-CLEAR)

To determine differences in latency from preterm rupture of membranes (PPROM) to delivery, chorioamnionitis and neonatal sepsis in pregnancies by cerclage removal (CR) timing. 

Study Design:

Retrospective cohort study of singleton pregnancies managed with cerclage for history, ultrasound or physical exam indications between June 2016-August 2020 at 10 sites across the United States and Colombia.  Exposure of interest was timing from PPROM to CR (immediate, delayed for 48 hours (h) and delayed > 48 h). Primary outcome of interest was latency from PPROM to delivery. Secondary outcomes included chorioamnionitis and neonatal sepsis. Statistical analysis included bivariate and multivariate techniques.

Results:

Of 842 pregnancies managed with cerclage, 165 (19.2%) experienced PPROM with cerclage in place.  48 records were excluded due to missing data on gestational age (GA) at CR and/or at time of PPROM. 117 records were included in final analysis. Over half of patients underwent immediate CR (54.7%, n=64), 17.1% delayed but removed within 48 h (n=20) and 28.2% delayed CR > 48 h (n=33).  Median delivery GA was similar between groups (26.0 wks [IQR 21.5-30.0] immediate, 27.5 wks [IQR 24.0-30.5] within 48 h, 28.0 wks [IQR 25.0-29.0] > 48 h group; p=0.45). In linear regression, there was a statistically significant relationship between days from PPROM to CR and latency to delivery (p < 0.0001). Number of days from PPROM to CR accounted for 79.8% of explained variability of latency to delivery.  Each additional day with cerclage in place was associated with average 0.82 days of latency. When comparing immediate vs. delayed CR (CR within 48 h or > 48 h as one group), histologic chorioamnionitis was higher in pregnancies with delayed CR (58.5% delayed vs. immediate CR 38.7%; p=0.03) and neonatal sepsis was similar between groups (7.3% delayed vs.13.9% immediate CR; p=0.46).

Conclusion:

Delayed cerclage removal after PPROM was associated with increased latency from PPROM to delivery but also with increased histologic chorioamnionitis. Further safety data are needed before recommending cerclage retention after PPROM.