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Arabin cerclage pessary in the management of cervical insufficiency
Yuen Ha Ting1, Terence T Lao, Lai Wa Law
1Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin, Hong Kong , Hong Kong.
Objective:
To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency.
Methods:
The pregnancy outcome of 20 women carrying singleton pregnancy referred for suspected cervical insufficiency and chose Arabin cerclage pessary for treatment from 2009-2011 were reviewed. Pregnancy outcome were analysed according to presence of risk factors, amniotic fluid sludge, cervical length and gestation at pessary insertion.
Results:
At presentation, mean cervical length was 1.17 cm (range 0-2.33 cm), mean gestation at pessary insertion and delivery was 20.6 (12.9-26.1) weeks and 32.1 (14.7-40.1) weeks, respectively, and mean prolongation of pregnancy was 11.5 (0.5-25.2) weeks. Overall, 5 (25%) had fetal loss between 14.7-23.1 weeks, while 3 (15%) and 12 (60%) delivered before and after 34 weeks gestation, respectively with no perinatal mortality. Compared with women with cervical length <1.5 cm, all those with cervical length ≥1.5 cm had pregnancy prolonged for ≥49 days (100 vs. 54% p = 0.032) and 86% delivered beyond 34 weeks (86 vs. 46% p = 0.085).
Conclusions:
Arabin cerclage pessary appears to be optimal for treating women at high risk of cervical insufficiency with a cervical length of 1.5-2.5 cm, while it is an acceptable option for high risk women with cervical length <1.5 cm.
