Cervical pessary does not prevent preterm birth in high-risk women
Detroit, MI: The current evidence does not support cervical pessary use for the prevention of preterm birth (PTB) in women at high risk for PTB, according to a recent study in the American Journal of Obstetrics and Gynecology.
Randomized controlled trials have reported conflicting results on the efficacy of cervical pessary for preventing preterm birth in asymptomatic women. AgustinConde-Agudelo, Wayne State University School of Medicine, Detroit, MI, and colleagues evaluated the efficacy and safety of cervical pessary to prevent preterm birth and adverse perinatal outcomes in asymptomatic high-risk women.
The researchers searched the online databases for randomized controlled trials that compared cervical pessary with standard care (no pessary) or alternative interventions in asymptomatic women at high risk for preterm birth. The systematic review was conducted according to the Cochrane Handbook guidelines. The primary outcome was spontaneous preterm birth <34 weeks of gestation.
The study included 12 studies involving 4687 women and 7167 fetuses/infants. Out of those 12 studies, 8 evaluated pessary vs no pessary in women with a short cervix, 2 assessed pessary vs no pessary in unselected multiple gestations, and 2 compared pessary vs vaginal progesterone in women with a short cervix.
Key findings of the study include:
- There were no significant differences between the pessary and no pessary groups in the risk of spontaneous preterm birth <34 weeks of gestation among singleton gestations with a cervical length ≤25 mm (relative risk, 0.80; 6 trials, 1982 women; low-quality evidence), unselected twin gestations (relative risk, 1.05; 1 trial, 1177 women; moderate-quality evidence), twin gestations with a cervical length <38 mm (relative risk, 0.75; 3 trials, 1128 women; low-quality evidence), and twin gestations with a cervical length ≤25 mm (relative risk; 0.72, 2 trials, 348 women; low-quality evidence).
- No significant differences were observed between the pessary and no pessary groups in preterm birth <37, <32, and <28 weeks of gestation, and most adverse pregnancy, maternal, and perinatal outcomes (low- to moderate-quality evidence for most outcomes).
- There were no significant differences in the risk of spontaneous preterm birth <34 weeks of gestation between pessary and vaginal progesterone in singleton gestations with a cervical length ≤25 mm (relative risk, 0.99; 1 trial, 246 women; low-quality evidence) and twin gestations with a cervical length <38 mm (relative risk, 0.73; very low-quality evidence).
- Vaginal discharge was significantly more frequent in the pessary group than in the no pessary and vaginal progesterone groups (relative risks, ∼2.20; high-quality evidence).
"Current evidence does not support the use of cervical pessary to prevent preterm birth or to improve perinatal outcomes in singleton or twin gestations with a short cervix and in unselected twin gestations," concluded the authors.
The study, "Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis," was published in the American Journal of Obstetrics and Gynecology.
DOI: https://doi.org/10.1016/j.ajog.2019.12.266
