Cervical pessary to reduce preterm birth <34 weeks of gestation after an episode of preterm labor and a short cervix: a randomized controlled trial

Laia Pratcorona, Maria Goya, Carme Merced, Carlota Rodó, Elisa Llurba, Teresa Higueras, Luis Cabero, Elena Carreras, Silvia Arévalo, Mayte Avilés, Inés Calero, Manel Casellas, Marina Folch, Andrea Gascón, Manel Mendoza, Mª Angeles Sanchez, Anna Suy

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Abstract

© 2018 Elsevier Inc. Background: To date, no intervention has proved effective in reducing the spontaneous preterm birth rate in singleton pregnancies following an episode of threatened preterm labor and short cervix remaining. Objective: This study was designed to ascertain whether cervical pessaries could be useful in preventing spontaneous preterm birth in women with singleton pregnancies and a short cervix after a threatened preterm labor episode. Study Design: This open randomized controlled trial was conducted in 357 pregnant women (between 240–336 weeks) who had not delivered 48 hours after a threatened preterm labor episode and had a short cervix remaining (≤25 mm at 240–296 weeks; ≤15 mm at 300–336 weeks). Patients were randomly assigned to cervical pessary (179) or routine management (178). The primary outcome was the spontaneous preterm birth rate <34 weeks. Spontaneous preterm birth <28 and 37 weeks and neonatal morbidity and mortality were also evaluated in an intention-to-treat analysis. Results: No significant differences between the pessary and routine management groups were observed in the spontaneous preterm birth rate <34 weeks (19/177 [10.7%] in the pessary group vs 24/175 [13.7%] in the control group; relative risk, 0.78; 95% confidence interval, 0.45–1.38). Spontaneous preterm birth <37 weeks occurred less frequently in the pessary group (26/175 [14.7%] vs 44/175 [25.1%]; relative risk, 0.58; 95% confidence interval, 0.38–0.90; P =.01). Preterm premature rupture of membranes rate was significantly lower in pessary carriers (4/177 [2.3%] vs 14/175 [8.0%]; relative risk, 0.28; 95% confidence interval, 0.09–0.84; P =.01). The pessary group less frequently required readmission for new threatened preterm labor episodes (8/177 [4.5%] vs 35/175 [20.0%]; relative risk, 0.23; 95% confidence interval, 0.11–0.47; P <.0001). No serious adverse maternal events occurred; neonatal morbidity and mortality were similar in both groups. Conclusion: Pessary use did not significantly lower the spontaneous preterm birth rate <34 weeks in women with a short cervix remaining after a threatened preterm labor episode but did significantly reduce the spontaneous preterm birth rate <37 weeks, threatened preterm labor recurrence, and the preterm premature rupture of membranes rate.
Original languageEnglish
Pages (from-to)99.e1-99.e16
JournalAmerican Journal of Obstetrics and Gynecology
Volume219
Issue number1
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • arabin pessary
  • arrested preterm labor
  • cervical pessary
  • fetal maturation
  • high-risk pregnancy
  • neonatal morbidity
  • preterm birth
  • preterm birth prevention
  • respiratory distress syndrome
  • short cervical length
  • short cervix
  • singleton pregnancy
  • threatened preterm labor
  • tocolysis
  • tocolytic treatment

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    Pratcorona, L., Goya, M., Merced, C., Rodó, C., Llurba, E., Higueras, T., Cabero, L., Carreras, E., Arévalo, S., Avilés, M., Calero, I., Casellas, M., Folch, M., Gascón, A., Mendoza, M., Sanchez, M. A., & Suy, A. (2018). Cervical pessary to reduce preterm birth <34 weeks of gestation after an episode of preterm labor and a short cervix: a randomized controlled trial. American Journal of Obstetrics and Gynecology, 219(1), 99.e1-99.e16. https://doi.org/10.1016/j.ajog.2018.04.031