Management of cervical cerclage after preterm premature rupture of membranes: an argument for retention

Preterm birth remains the leading cause of infant morbidity and mortality worldwide. Efforts aimed at reducing preterm birth rates have largely focused on mitigating risks in those who have already experienced a preterm delivery. Of note, 1 intervention, the placement of a cervical cerclage, has been shown to reduce the risk of subsequent preterm delivery in appropriate candidates. However, a cerclage does not mitigate the risk of preterm premature rupture of membranes. Preterm premature rupture of membranes is a significant contributor to the incidence of preterm births and can occur with a cerclage in place. Many studies have examined the outcomes associated with immediate vs delayed cerclage removal after preterm premature rupture of membranes with inconsistent results. This expert review summarized the characteristics of the studies examining the timing of cerclage removal after preterm premature rupture of membranes (Table 1) and current international guidelines (Table 2). In the absence of labor, infection, cervical laceration, or vaginal bleeding, it is recommended that cervical cerclage remains in situ after preterm premature rupture of membranes until 32 to 34 weeks of gestation.