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. 2013 May 31;2013(5):CD007873.
doi: 10.1002/14651858.CD007873.pub3.

Cervical pessary for preventing preterm birth

Hany Abdel-Aleem  1 , Omar M Shaaban, Mahmoud A Abdel-Aleem
Affiliations

Cervical pessary for preventing preterm birth

Hany Abdel-Aleem et al. Cochrane Database Syst Rev. .

Abstract

Background: Preterm birth is a major health problem and contributes to more than 50% of the overall perinatal mortality. Preterm birth has multiple risk factors including cervical incompetence and multiple pregnancy. Different management strategies have been tried to prevent preterm birth, including cervical cerclage. Cervical cerclage is an invasive technique that needs anaesthesia and may be associated with complications. Moreover, there is still controversy regarding the efficacy and the group of patients that could benefit from this operation. Cervical pessary has been tried as a simple, non-invasive alternative that might replace the above invasive cervical stitch operation to prevent preterm birth.

Objectives: To evaluate the efficacy of cervical pessary for the prevention of preterm birth in women with risk factors for cervical incompetence.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 September 2012), Current Controlled Trials and the Australian New Zealand Clinical Trials Registry (1 September 2012).

Selection criteria: We selected all published and unpublished randomised clinical trials comparing the use of cervical pessary with cervical cerclage or expectant management for prevention of preterm birth. We did not include quasi-randomised trials. Cluster-randomised or cross-over trials were not eligible for inclusion.

Data collection and analysis: Two review authors independently assessed trials for inclusion.

Main results: The review included one randomised controlled trial. The study included 385 pregnant women with a short cervix of 25 mm or less who were between 18 to 22 weeks of pregnancy. The use of cervical pessary (192 women) was associated with a statistically significantly decrease in the incidence of spontaneous preterm birth less than 37 weeks' gestation compared with expectant management (22% versus 59 %; respectively, risk ratio (RR) 0.36, 95% confidence interval (CI) 0.27 to 0.49). Spontaneous preterm birth before 34 weeks was statistically significantly reduced in the pessary group (6% and 27% respectively, RR 0.24; 95% CI 0.13 to 0.43). Mean gestational age at delivery was 37.7 + 2 weeks in the pessary group and 34.9 + 4 weeks in the expectant group. Women in the pessary group used less tocolytics (RR 0.63; 95% CI 0.50 to 0.81) and corticosteroids (RR 0.66; 95% CI 0.54 to 0.81) than the expectant group. Vaginal discharge was more common in the pessary group (RR 2.18; 95% CI 1.87 to 2.54). Among the pessary group, 27 women needed pessary repositioning without removal and there was one case of pessary removal. Ninety-five per cent of women in the pessary group would recommend this intervention to other people. Neonatal paediatric care admission was reduced in the pessary group in comparison to the expectant group (RR 0.17; 95% CI 0.07 to 0.42).

Authors' conclusions: The review included only one well-designed randomised clinical trial that showed beneficial effect of cervical pessary in reducing preterm birth in women with a short cervix. There is a need for more trials in different settings (developed and developing countries), and with different risk factors including multiple pregnancy.

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Conflict of interest statement

None known.

Figures

1
1
Cervical pessary in place. Images reproduced with the kind permission of Dr. Arabin GmbH & Co. KG
1.1
1.1. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 1 Spontaneous delivery at less than 37 weeks.
1.2
1.2. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 2 Spontaneous delivery at less than 34 weeks.
1.3
1.3. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 3 Mean gestational age at time of delivery.
1.4
1.4. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 4 Maternal medications.
1.5
1.5. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 5 Side effects of the intervention.
1.6
1.6. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 6 Neonatal paediatric care unit admission (composite adverse outcome).
1.7
1.7. Analysis
Comparison 1 Cervical pessary versus expectant management (singleton pregnancy), Outcome 7 Perinatal death.
See this image and copyright information in PMC

Update of

References

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Goya 2012 {published data only}
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References to other published versions of this review

Abdel‐Aleem 2009
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