Removal versus retention of cervical cerclage with preterm prelabor rupture of membranes: Systematic review and meta-analysis

•Removal of cervical cerclage after pPROM significantly decreases the chances of prolongating pregnancy for >48 h and 7 days.•Retention of cerclage significantly increases the risk of chorioamnionitis and Apgar 7 days from pPROM and pregnancy latency >48 h from pPROM. Random effect head to‐head meta‐analyses were performed to directly compare each outcome, expressing the results as summary odds ratio (OR) for dichotomous outcomes and as mean difference (MD) for continuous outcomes, plus relative 95% confidence interval (CI). Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale. Six studies involving a total of 377 women (169 in the “removal” and 208 in the “retention” group) were included. The rate of pregnancy prolongation >48 h was significantly lower in the removal compared to retention group (OR 0.15, 95% CI 0.07–0.31; p 7 days (OR 0.30 95% CI 0.11–0.83; p = 0.02) and pregnancy latency expressed in days (MD −2.84 days, 95% CI −5.40 to −0.29; p = 0.03). The rate of chorioamnionitis was significantly lower in the removal compared to the retention group (OR 0.57 95% CI 0.34–0.96p = 0.03) as was the rate of Apgar score