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Preterm Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
There are conflicting data regarding the effectiveness of a cervical pessary following an episode of arrested PTL to decrease the risk of PTB in singleton pregnancies. One RCT (n = 130) found that use of a cervical pessary did not reduce the risk of delivery <37 weeks or improve perinatal outcome. However, another RCT (n = 357) found no decrease in PTB <34 weeks with pessary use (RR 0.78; 95% CI 0.45–1.38) but did report a decrease in the rate of spontaneous PTB <37 weeks (RR 0.58; 95% CI 0.3–0.90; p = 0.01), threatened PTL recurrence (RR 0.23; 95% CI 0.11–0.47; p < 0.0001), and PPROM (RR 0.28; 95% CI 0.09–0.84; p = 0.01) [47].
Approach to one or more second-trimester painless abortions
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Indications for a cervical cerclage include clinical history of documented short cervix and/or dilated cervix in index pregnancy and can be allocated to a prophylactic cerclage group (history-indicated or ultrasound-indicated cerclage) and a therapeutic cerclage group (rescue cerclage). A cervical pessary is an alternative to a cerclage procedure; however, the data on pessary are limited with unproven results.
The Role of Cerclage and Pessaries
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Israel Hendler, Howard J.A. Carp
Another technique that has come into use for encircling the cervix is the cervical pessary. The Arabin pessary is the most commonly used such device. However, the idea of using a pessary is not new. In 1959, Cross described the use of a ring pessary in patients with cervical incompetence, lacerations, or uterine malformations [31]. Since then, other devices have been used, including the Hodge pessary and donut pessary (Figure 16.1 shows sonograms of the Hodge pessary in situ). The pessary has been described to act by pressing the internal os closed from behind, and by changing the inclination of the cervical canal. This change of position may prevent direct pressure on the membranes at the internal os and on the cervix itself. The weight of the uterus may therefore be directed toward the lower anterior uterine segment rather than the cervix. The pessary has been reported to protect the cervical mucus plug by compressing the attachment of the remaining cervical tissue. The cervical mucus plug may protect the intrauterine cavity from ascending infection and subsequent miscarriage or preterm labor [32,33]. Cervical elongation after pessary insertion has also been shown by TVU [34].
Prediction and prevention of preterm birth in pregnant women living with HIV on antiretroviral therapy
Published in Expert Review of Anti-infective Therapy, 2022
Amanda J. Jones, Uzoamaka A. Eke, Ahizechukwu C. Eke
Placement of a cervical pessary to prevent cervical shortening is not currently recommended for pregnant women with a short cervix [87]. Multiple RCTs have been published in the last several years, with conflicting results. As reported by Goya et al in 2012, in a RCT of cervical pessary use in pregnant women with a cervical length of 25 mm or less, spontaneous delivery before 34 weeks gestation was significantly less frequent in the pessary group than in the expectant management group [88]. However, as reported by Nicholaides et al. in 2016, in a RCT of cervical pessary use in pregnant women with a cervical length of 25 mm or less, cervical pessary did not result in a lower rate of spontaneous early preterm delivery than the rate with expectant management [89]. In meta-analyses of RCTs comparing the use of a cervical pessary with standard care in asymptomatic patients at high risk for preterm birth (CL ≤ 25 mm), pessary use did not reduce spontaneous preterm birth <28, 34, or 37 weeks or improve perinatal outcome [90,91]. However, these data cannot be extrapolated to women living with HIV, and the role of pessary for prevention of preterm birth in this population individually has not been studied.
Oral supplementation with arginine, willow bark, magnesium and calcium in prevention of preterm birth
Published in Journal of Obstetrics and Gynaecology, 2021
Pietro D’Alessandro, Bruno Arduino, Sonia Migliorini, Elena Cancellieri, Floriana Ilma Carbone, Gabriele Saccone
Preterm birth, defined as delivery before 37 weeks of gestation, is a major cause of perinatal morbidity and mortality (Depa and Gundabattula 2019). Different strategies have been adopted for prevention of preterm birth, including progesterone, cerclage, cervical pessary, as well lifestyle modifications (Matei 2019; Shaamash 2019). Recently, several studies have been published evaluating the efficacy of multiple micronutrient supplementation in prevention of preterm birth (Saccone and Berghella 2015, 2016).