Cerclage in PPROM may be safe if no infection. (No Data to Show if Latency is Lengthened).

BIG SKY, MONT. - Prolene cerclages can safely be left in place in a woman who has preterm premature rupture of membranes and no sign of infection, said Dr. Lynn Montgomery, director of obstetrics and maternal-fetal medicine at Rocky Mountain Perinatal Center in Missoula, Mont.

Still, the practice has not been shown to lengthen latency in a formal study, but theoretically one would expect this to be the case, he said at an obstetrics conference sponsored by Symposia Medicus.

And one audience member at the meeting urged caution in retaining the cerclage in women with preterm premature rupture of membranes (PPROM), noting that his institution had been sued by a woman who delivered a baby with cerebral palsy after this practice was followed.

Dr. Montgomery, on the other hand, has had better experiences with the procedure, which he now does routinely and had been doing selectively since the mid-1990s.

"I think there are now data that would. support leaving a Prolene cerclage in place in a patient that has no clinical signs of infection and has good maternal and fetal surveillance ongoing. It's reasonable to expectantly manage them," he said.

His observations are supported by a study of 81 women with a cerclage who had PPROM. Retention of the cerclage after PPROM before 34 weeks' gestation was associated with similar results in terms of latency and perinatal outcomes, reported Dr. Thomas F. McElrath and his associates at Harvard Medical School, Boston (Am. J. Obstet. Gynecol. 183[4]:840-46, 2000).

Another study by the same authors, which was presented at this year's annual meeting of the Society for Maternal Fetal Medicine, found similar rates of maternal and neonatal morbidity between a group of patients who had their cerclages removed and another group who ...