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Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies With Short Cervical Length: A Systematic
Gabriele Saccone1,2, Andrea Ciardulli3, Serena Xodo4
1Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Summary
The Arabin cervical pessary did not prevent spontaneous preterm birth in singleton pregnancies with a short cervix. This intervention also did not improve perinatal outcomes, despite risks of vaginal discharge.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Clinical Trials Research
Background:
- Spontaneous preterm birth (SPTB) is a leading cause of neonatal morbidity and mortality.
- A short cervix in the second trimester is a known risk factor for SPTB.
- Cervical pessaries have been investigated as a non-invasive method to prevent SPTB.
Purpose of the Study:
- To evaluate the effectiveness of the Arabin cervical pessary in preventing SPTB in singleton pregnancies with a second-trimester short cervix.
- To assess the impact of the cervical pessary on perinatal outcomes.
Main Methods:
- A systematic review and meta-analysis of three randomized clinical trials (RCTs) involving 1,420 participants.
- Included singleton pregnancies with transvaginal ultrasound cervical length (TVU CL) ≤25 mm.
- Primary outcome: incidence of SPTB <34 weeks. Secondary outcomes included various gestational age measures and neonatal outcomes.
Main Results:
- The Arabin cervical pessary was not associated with a reduction in SPTB at any gestational age threshold (<37, <34, <32, <28 weeks) compared to expectant management.
- No significant differences were observed in mean gestational age at delivery, interval from randomization to delivery, or rates of preterm premature rupture of membranes and cesarean delivery.
- Neonatal outcomes were similar between groups, but the pessary group had a significantly higher risk of vaginal discharge.
Conclusions:
- The Arabin cervical pessary does not effectively reduce spontaneous preterm delivery rates or improve perinatal outcomes in singleton pregnancies with a short cervix (TVU CL ≤25mm).
- Further research, potentially through individual patient data meta-analysis, is needed to identify potential subgroups who might benefit from cervical pessary use.
- Current evidence does not support the routine use of the Arabin pessary for preventing preterm birth in this specific obstetric population.