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Cerclage retention versus removal following preterm premature rupture of membranes and association with amniotic fluid markers
Author(s) -
Aguin Eduardo,
Van De Ven Cosmas,
Cordoba Marcos,
Albayrak Samet,
BahadoSingh Ray
Publication year - 2014
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2013.10.005
Subject(s) - medicine , amniotic fluid , chorioamnionitis , cervical cerclage , amniocentesis , premature rupture of membranes , obstetrics , retrospective cohort study , cervical insufficiency , pregnancy , group b , gestational age , gynecology , surgery , fetus , prenatal diagnosis , cervix , genetics , cancer , biology
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.