Cervical Cerclage in the Setting of Preterm Premature Rupture of Membranes (PPROM)

Preterm Premature Rupture of Membranes occurs in a proportion of women with a cervical cerclage in situ and presents a significant clinical dilemma regarding optimal management. Retention of cerclage beyond 24 hours after PPROM has been associated with prolongation of pregnancy by more than 48 hours; however, it is also linked to increased risks of maternal chorioamnionitis and neonatal mortality due to sepsis. Therefore, immediate removal of cerclage is generally the preferred approach. Early removal of cerclage following PPROM reduces the risk of infection for both mother and foetus and lowers the incidence of neonatal complications such as respiratory distress syndrome, necrotising enterocolitis, and intraventricular haemorrhage. Importantly, cerclage does not prevent the occurrence of PPROM, which remains a major contributor to preterm birth and associated morbidity and mortality.