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Meta-Analysis
. 2017 Dec;30(24):2918-2925.
doi: 10.1080/14767058.2016.1268595. Epub 2017 Jan 12.

Cervical pessary for preventing preterm birth in twin pregnancies with short cervical length: a systematic review and meta-analysis

Gabriele Saccone  1   2 , Andrea Ciardulli  3 , Serena Xodo  4 , Lorraine Dugoff  5 , Jack Ludmir  6 , Francesco D'Antonio  2   7 , Simona Boito  2   8 , Elena Olearo  2   9 , Carmela Votino  2   10 , Giuseppe Maria Maruotti  1   2 , Giuseppe Rizzo  2   11 , Pasquale Martinelli  1   2 , Vincenzo Berghella  12
Affiliations
Meta-Analysis

Cervical pessary for preventing preterm birth in twin pregnancies with short cervical length: a systematic review and meta-analysis

Gabriele Saccone et al. J Matern Fetal Neonatal Med. 2017 Dec.

Abstract

Objective: To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in twin pregnancies with an asymptomatic transvaginal ultrasound cervical length (TVU CL) in the second trimester.

Methods: We performed a meta-analysis including all randomized clinical trials (RCTs) comparing the use of cervical pessary (i.e. intervention group) with expectant management (i.e. control group). The primary outcome was incidence of SPTB <34 weeks.

Results: Three trials, including 481 twin pregnancies with short cervix, were analyzed. Two RCTs defined short cervix as TVU CL ≤25 mm and one as TVU CL ≤38 mm. Pessary was not associated with prevention of SPTB, and the mean gestational age at delivery and the mean latency were similar in the pessary group compared to the control group. Moreover, no benefits were noticed in neonatal outcomes.

Conclusions: Use of the Arabin pessary in twin pregnancies with short TVU CL at 16-24 weeks does not prevent SPTB or improve perinatal outcome.

Keywords: Meta-analysis; cerclage; cervix; review; transvaginal ultrasound.

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