Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers

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 cer...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2014-04, Vol.125 (1), p.37-40
Main Authors: Aguin, Eduardo, Van De Ven, Cosmas, Cordoba, Marcos, Albayrak, Samet, Bahado-Singh, Ray
Format: Article
Language:English
Subjects:
Adult
Amniocentesis
Amniotic Fluid - metabolism
Biomarkers - metabolism
Cerclage
Cerclage, Cervical
Chorioamnionitis - epidemiology
Cohort Studies
Female
Fetal Membranes, Premature Rupture - surgery
Humans
Infant, Newborn
Infection
Inflammation
Interleukin-6 - metabolism
Leukocytes - metabolism
Obstetrics and Gynecology
Outcome
Pregnancy
Pregnancy Outcome
Prematurity
Preterm premature rupture of membranes
Retrospective Studies
Time Factors
Ultrasound
Young Adult
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Summary: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.
ISSN:0020-7292
1879-3479
DOI:10.1016/j.ijgo.2013.10.005