(1093) Exposed Fetal Membranes Prior to Physical Examination-Indicated Cervical Cerclage and Time to Delivery

Physical examination-indicated cerclage (PEIC) is considered in the setting of painless cervical dilation with or without exposed fetal membranes. We hypothesize that exposed fetal membranes is a poor prognostic sign and associated with shortened latency from cerclage to delivery.

Study Design:

This is a retrospective cohort study of all singleton pregnancies that underwent PEIC at a Level IV center between January 2015 and March 2024. Patients with no delivery records available for review were excluded. We compared demographic and clinical characteristics, latency from cerclage to delivery, and perinatal outcomes among patients with and without exposed fetal membranes at the time of surgery. 

Results:

Ninety-three cases of PEIC were analyzed: 56 (60%) had exposed fetal membranes and 37 (40%) did not. There were no significant differences in the distribution of age, race, parity, or medical comorbidities between groups. Latency period was significantly shortened in patients with exposed membranes compared to patients without (median 5 vs 16 weeks, P = 0.008) (Figure 1). Exposed membranes was associated with higher rates of preterm birth at < 24, < 28, < 32, and < 37 weeks gestation respectively (32 vs 11%, P= 0.02; 55 vs 22%, P= 0.001; 57 vs 27%, P= 0.004; and 73 vs 46%, P= 0.01). Exposed membranes was also associated with higher rates of prelabor premature rupture of membranes (PPROM) and intraamniotic infection (IAI) (27 vs 8%, P = 0.008; 12 vs 2%, P = 0.04) (Table 1).

Conclusion:

Sixty percent of patients with PEIC had exposed fetal membranes at the time of cerclage placement. Patients with exposed membranes had shortened latency periods and higher rates of preterm delivery < 24, < 28, < 32, and < 37 weeks. These data will inform provider counseling and patient expectations when considering PEIC.