Spontaneous preterm birth (SPTB) is the leading cause of perinatal death in the United States and other countries. A short cervical length (CL) is a predictor of SPTB, and cervical pessaries have been found in some studies to decrease the rate of preterm birth. It is hypothesized that they do this by keeping the cervix closed or distributing weight off of the upper end of the cervix. The authors did a database search of randomized controlled trials that studied the use of cervical pessaries to judge whether they were able to prevent SPTB for women with short CL and singleton pregnancies. In the 3 randomized controlled trials included in this study, there were 1420women randomized at amean gestational age of 22 weeks. Overall, 49.8% were fitted with an Arabin pessary, and 50.2% comprised the control group and were managed expectantly. Pessaries were left in place until 37 weeks of gestation. The rate of spontaneous PTB at less than 37 was 20.2% in the pessary group versus 50.2% in control subjects (relative risk, 0.50; 95% confidence interval [CI], 0.23-1.09). There was also no decrease in the occurrence of SPTB between the 2 study groups at 28, 32, or 34 weeks' gestation. No differences in the incidence of cesarean delivery or premature membrane rupture, time to delivery, or neonatal data (birth weight, morbidity, mortality) were seen between the 2 groups. The authors concluded that the data do not support the use of pessaries in singleton pregnancies where the mother has a short CL. This is a population at risk of increased SPTB, yet neither the incidence of SPTB nor neonatal measures (eg, birth weight) were statistically different with use of a pessary. An increased vaginal discharge was noticed by pessary users (37.2% vs 18.0%). This study did not support an earlier review of a single study of 382 women. A strength of this study is that it includes data from 3 randomized clinical trials with 1420 women all with short CL. Aweakness of this study is that none of the 3 trials were double-blind, and one of the studies contains more than half of the participants (932/1420), so it dominates the results.
Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies with Short Cervical Length: A Systematic Review and Meta-analysis
Visentin S.Membro del Collaboration Group
;Gizzo S.Membro del Collaboration Group
;
2018
Abstract
Spontaneous preterm birth (SPTB) is the leading cause of perinatal death in the United States and other countries. A short cervical length (CL) is a predictor of SPTB, and cervical pessaries have been found in some studies to decrease the rate of preterm birth. It is hypothesized that they do this by keeping the cervix closed or distributing weight off of the upper end of the cervix. The authors did a database search of randomized controlled trials that studied the use of cervical pessaries to judge whether they were able to prevent SPTB for women with short CL and singleton pregnancies. In the 3 randomized controlled trials included in this study, there were 1420women randomized at amean gestational age of 22 weeks. Overall, 49.8% were fitted with an Arabin pessary, and 50.2% comprised the control group and were managed expectantly. Pessaries were left in place until 37 weeks of gestation. The rate of spontaneous PTB at less than 37 was 20.2% in the pessary group versus 50.2% in control subjects (relative risk, 0.50; 95% confidence interval [CI], 0.23-1.09). There was also no decrease in the occurrence of SPTB between the 2 study groups at 28, 32, or 34 weeks' gestation. No differences in the incidence of cesarean delivery or premature membrane rupture, time to delivery, or neonatal data (birth weight, morbidity, mortality) were seen between the 2 groups. The authors concluded that the data do not support the use of pessaries in singleton pregnancies where the mother has a short CL. This is a population at risk of increased SPTB, yet neither the incidence of SPTB nor neonatal measures (eg, birth weight) were statistically different with use of a pessary. An increased vaginal discharge was noticed by pessary users (37.2% vs 18.0%). This study did not support an earlier review of a single study of 382 women. A strength of this study is that it includes data from 3 randomized clinical trials with 1420 women all with short CL. Aweakness of this study is that none of the 3 trials were double-blind, and one of the studies contains more than half of the participants (932/1420), so it dominates the results.
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