Allen A. Ghareeb MD , Alisa Kachikis MD, MSc , Vy Nguyen BS , Amanda Roman MD, MPH
{"title":"Management of cervical cerclage after preterm premature rupture of membranes: an argument for retention","authors":"Allen A. Ghareeb MD , Alisa Kachikis MD, MSc , Vy Nguyen BS , Amanda Roman MD, MPH","doi":"10.1016/j.ajogmf.2024.101569","DOIUrl":null,"url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 1","pages":"Article 101569"},"PeriodicalIF":3.8000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Obstetrics & Gynecology Mfm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589933324002957","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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.
期刊介绍:
The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including:
Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women.
Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health.
Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child.
Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby.
Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.