Image: An example of a cervical pessary (Photo courtesy of VHIR).
A new study suggests that using a cervical pessary in pregnant women with short cervical length reduces the risk of spontaneous early birth.
Researchers at the University of Naples Federico II (Italy) conducted a randomized clinical trial of 300 women with singleton gestations, no previous spontaneous preterm births, and cervical lengths of 25 mm (or less) at 18-24 weeks of gestation, in order to test if use of a cervical pessary would reduce the rate of spontaneous preterm birth (less than 34 weeks of gestation). In the 150 women in the study group the pessary was removed at week 36-37, or earlier if indicated. The primary endpoint was spontaneous preterm birth at less than 34 weeks of gestation.
The results showed that the primary end point of pre-term birth occurred in 11 women (7.3%) in the pessary group, and 23 women (15.3%) in the control group. The majority of women in both the study and the control groups were also treated with vaginal progesterone. The researchers found that during follow-up, the women in the pessary group had a higher rate of increased or new vaginal discharge (86.7%) versus 46% in the control group. The study was published on December 19, 2017, in JAMA.
“Among women without prior spontaneous preterm birth who had asymptomatic singleton pregnancies and short transvaginal cervical length, use of a cervical pessary, compared with no pessary use, resulted in a lower rate of spontaneous preterm birth at less than 34 weeks of gestation,” concluded lead author Gabriele Saccone, MD, and colleagues. “The results of this single-center, non-blinded study among selected pregnant women require confirmation in multicenter clinical trials.”
“Based on these data, clinicians might contemplate recommending pessaries for all women with a short cervix identified on an antenatal sonogram,” wrote Robert Silver, MD, and D. Ware Branch, MD, of the University of Utah (Salt Lake City, USA), in an accompanying editorial. “Nonetheless, it is important to be cautious prior to universal adoption of pessaries. In contrast to the results of the current trial, another study conducted with equivalent scientific rigor found no benefit to use of a pessary in women with short cervixes.”
Pregnant women are at risk of preterm birth when the cervix begins to efface (shorten) and dilate earlier than necessary. One of the options to prevent a late miscarriage or preterm birth is the cervical pessary, a small silicone ring-shaped device placed around the incompetent cervix early in the pregnancy in order to close it; it is removed later on when the risk of a preterm birth has passed. Other options include a cerclage suture stitched around the opening of the cervix around 12–14 weeks into the pregnancy.
University of Naples Federico II