The cervical cap: Reaccumulation of amniotic fluid does not improve perinatal outcome

Objectives: We investigated the safety and efficacy of the cervical cap in restoring amniotic fluid volume in previable pregnancies complicated by premature rupture of membranes and oligohydramnios. Methods: Patients with premature rupture of membranes <24 weeks' gestation and an amniotic fluid index <5 cm were candidates for cap placement if they desired expectant management and had no clinical signs of intrauterine infection or vaginal bleeding. Results: The cervical cap was applied in four pregnancies. Amniotic fluid reaccumulated in all pregnancies and the mean amniotic fluid index increased from 0 to 5.8 ± 2.8 cm. The first two pregnancies, however, resulted in neonates that expired from pulmonary hypoplasia. The third pregnancy was electively terminated because of our inability to assure prevention of pulmonary hypoplasia. The fourth pregnancy was terminated secondary to an intrauterine fetal demise. Conclusion: These observations disappointingly suggest that in spite of modest reaccumulation of amniotic fluid after midtrimester premature rupture of membranes, perinatal outcome may not be improved.