The role of cervical cerclage in the management of preterm premature rupture of the membranes.

The presence of a cervical cerclage at the time of preterm premature rupture of the membranes potentially complicates this already difficult management problem. An analysis of 44 patients presenting with preterm premature rupture of the membranes and cervical cerclage was conducted. Twelve patients were immediately delivered because of fetal distress, labor, or mature fetal pulmonary studies. Thirty-two patients entered an expectant management protocol. The cervical cerclage was removed on admission to the study. These patients were compared with 32 matched control subjects. There appears to be no difference in neonatal or maternal outcome between the study and control groups. The latency period from premature rupture of the membranes until delivery was not affected by the presence or removal of the cerclage. There was no difference in infectious complications. These data suggest that the presence of a cervical cerclage at the time of preterm premature rupture of the membranes does not increase the risk of delivery or infectious morbidity as long as the cerclage is removed early in the management protocol.