Cervical Pessary Shows Promise for Delaying Preterm Births

Use of cervical pessary-a small, silicone, ring-shaped device inserted around the cervix-is a safe, inexpensive, and reliable alternative for preventing preterm delivery in women with a short cervix, according to the authors of a new study conducted in Spain.¹

This study is the first randomized controlled trial testing the usefulness of cervical pessary for preventing preterm births. Cervical pessaries, which have been used for about 50 years as an option for delaying preterm births, have been studied previously with favorable results, but the evidence comes from nonrandomized study designs.^2-4

The study involved 385 women aged 18 to 43 years identified as having a short cervix (25 millimeters or less) at a routine transvaginal ultrasound at 20 to 23 weeks of gestation. The women were randomly assigned to either the pessary group (n=192) or the expectant management group (n=193), and 190 women from each group were followed. The number of spontaneous deliveries before 34 weeks of gestation was significantly less in the pessary group than in the expectant management group (12 [6%] vs 51 [27%], respectively).

Although the findings are promising, additional larger studies are needed to ascertain whether eligibility for this intervention should be based solely on cervical length or other risk factors for preterm delivery. In addition, because of the small sample size of this study, there were very few adverse outcomes. Several larger studies are needed to determine possible risks of this intervention as well as the effectiveness of this intervention in routine practice. Currently, a randomized, multicenter study in England and other countries is underway to determine the usefulness of cervical pessary in twin pregnancies.⁵

Pertinent Points:

- With pessary use, a 21% absolute reduction of risk of preterm delivery was noted.
- Average gestation in the pessary group was 37.7 weeks, compared with 34.9 weeks in   the expectant management group-a statistically significant difference. Subsequently,  significantly fewer newborns from the pessary group had a birth weight of less than 2.5 kg (5.5 lb).
- There was a significantly higher need in the expectant management group to suppress labor using medication and to administer corticosteroids to accelerate fetal lung maturation.
- Although insertion and removal of the pessary was reported as painful, 95% of pessary recipients would recommend the intervention.

References:

References
1. Goya M, Pratcorona L, Merced C, et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomized controlled trial. Lancet. April 2, 2012. [Epub ahead of print.]
2. Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA. Cervical pessary for preventing preterm birth. Cochrane Database Syst Rev. 2010;(9):CD007873.

3. Kimber-Trojnar Z, Patro-Malysza J, Leszczynska-Gorzelak B, et al. Pessary use for the treatment of cervical incompetence and prevention of preterm labour. J Matern Fetal Neonatal Med. 2010;23:1493-1499.
4. Newcomer J. Pessaries for the treatment of incompetent cervix and premature delivery. ,i>Obstet Gynecol Surv. 2000;55:443-448.
5. The Fetal Medicine Foundation. . Accessed April 25, 2012.