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Poster Session 1

(237) Safety of cerclage retention after PPROM: International Collaborative for Cerclage Longitudinal Evaluation And Research (IC-CLEAR)

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Joanne N. Quiñones, MD, MSCE (she/her/hers)

    Program Director, Maternal Fetal Medicine Fellowship; VC Research, Dept OBGYN
    Lehigh Valley Health Network
    Allentown, Pennsylvania, United States

    • Coauthor(s)

  • JB

    Joseph Bell, MD

    Associate Professor
    St. Luke’s University Health Network, Department of Obstetrics & Gynecology, Maternal Fetal Medicine, Bethlehem, PA, 18015
    Bethlehem, Pennsylvania, United States

  • Rupsa C. Boelig, MD, MS

    Assistant Professor
    Sidney Kimmel Medical College, Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • SA

    Shirin Azadi, MD

    Lehigh Valley Health Network, Department of Obstetrics & Gynecology
    Allentown, Pennsylvania, United States

  • OA

    Onyinyech Anosike, DO

    Resident Physician
    Lehigh Valley Health Network, Department of Obstetrics & Gynecology
    Allentown, Pennsylvania, United States

  • Dahiana M. Gallo, MD, PhD (she/her/hers)

    Program Director of Research and Education
    St. Lukes University Health Network
    Easton, PA, United States

  • AT

    Adam Taylor, MD

    Resident Physician
    St. Luke’s University Health Network, Department of Obstetrics & Gynecology
    Bethlehem, Pennsylvania, United States

  • Vincenzo Berghella, MD (he/him/his)

    Professor, Director
    Sidney Kimmel Medical College of Thomas Jefferson University
    Philadelphia, Pennsylvania, United States

  • LC

    Leah Carnick Ledford, MSN

    Atrium Health’s Women’s Institute
    Charlotte, North Carolina, United States

  • MR

    Monica Rincon, MD

    Coordinator MFM Research
    Oregon Health & Science University
    Portland, Oregon, United States

  • SV

    Susana Villegas-Sanchez

    Facultad de Medicina
    Department of Obstetrics & Gynecology, Universidad CES, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • Richard M. Burwick, MD, MPH

    Clinical Associate Professor, Western University of Health Sciences
    San Gabriel Valley Perinatal Medical Group; Pomona Valley Hospital Medical Center
    Pomona, California, United States

  • LL

    Luisa López-Torres, MD

    Fellow Medicina Materno Fetal
    Universidad Pontificia Bolivariana, Medicina Materno Fetal, Medellín, Colombia
    Medellin, Antioquia, Colombia

  • JT

    Jorge E. Tolosa, MD, MSCE

    Professor of Obstetrics & Gynecology
    St. Luke’s University Health Network
    Bethlehem, Pennsylvania, United States

Objective: Previous IC-CLEAR data suggested an increase in latency from PPROM to delivery with delayed cerclage removal (SMFM 2023). Our objective is to determine the safety of cerclage retention in women who experience PPROM before 34 weeks (w) gestation.

Study Design: Retrospective cohort study of singleton pregnancies with cerclage for history, ultrasound or physical exam indications between 6/2016-6/2020 at 8 sites across United States and Colombia. Primary exposure: time from PPROM to cerclage removal (CR) categorized as early < 48 hours (h)– or delayed (≥ 48 h). Maternal safety outcomes included clinical or histologic chorioamnionitis, postpartum endometritis, hemorrhage, sepsis, and ICU admission. Neonatal safety outcome was a composite of sepsis, prematurity complications and death. Statistical analysis included bivariate and multivariate techniques.

Results: Of 839 singleton pregnancies managed with cerclage, 128 (15.3%) experienced PPROM < 34w. 36 underwent immediate CR for labor, bleeding or chorioamnionitis. 92 patients included in final analysis – 60 early CR (65.2%) and 32 delayed CR (34.8%). Clinical chorioamnionitis and postpartum endometritis were higher in delayed CR vs. early CR (40.6% vs. 20.3%, P=0.04 and 15.6% vs 0%, P=0.002, respectively). Composite neonatal outcome was similar by CR timing when excluding PPROM < 24w (delayed 81.8% vs. early 64.9%, p=0.16). Neonatal mortality was higher in early CR, but similar when only including PPROM >24w (Table). In adjusted analyses, clinical chorioamnionitis was lower with early CR [AOR 0.36 (95% CI 0.14, 0.94), p=0.04), composite neonatal outcome was lower with early CR [AOR 0.34 (95% CI 0.12, 0.97), p=0.04] and neonatal mortality was lower with corticosteroid use [AOR 0.15 (95% CI 0.02, 0.94), p=0.04] and higher in PPROM< 24w [AOR 10.7 (95% CI 1.90, 60.0), p=0.007).

Conclusion: Delayed CR after PPROM increases maternal infectious morbidity and neonatal composite morbidity/mortality. Delaying cerclage removal requires careful counseling about maternal and neonatal risks.