Cervical pessary for preventing preterm birth in singletons and twin pregnancies: an update systematic review and...

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatal Research

Background:

• Preterm birth (PTB) is a significant cause of perinatal mortality and morbidity.
• Cervical pessaries are devices used to support the cervix, potentially preventing PTB.
• Evidence on the effectiveness of cervical pessaries, particularly in diverse pregnancy types, requires synthesis.

Purpose of the Study:

• To systematically evaluate the efficacy of cervical pessary use in preventing PTB.
• To assess the impact of cervical pessary on perinatal outcomes in singleton and twin pregnancies.
• To compare cervical pessary intervention against expectant management strategies.

Main Methods:

• A systematic review and meta-analysis of randomized clinical trials (RCTs) were conducted.
• Studies were searched from inception until March 14, 2019, across electronic databases.
• The primary outcome measure was the incidence of PTB before 34 weeks gestation.

Main Results:

• Thirteen studies (8 singleton, 6 twin pregnancies) were included.
• Cervical pessaries showed no significant effectiveness in preventing PTB at various gestational ages (<28, <34, <37 weeks) for singleton pregnancies with short cervix.
• For twin pregnancies with short cervix, cervical pessaries did not reduce PTB rates but showed potential to decrease spontaneous PTB before 28 weeks and low birth weight (<1500g). Vaginal discharge increased, and overall perinatal outcomes did not improve.

Conclusions:

• The effectiveness of cervical pessary in reducing PTB risk compared to expectant management is currently uncertain.
• Further high-quality randomized controlled trials are necessary to definitively establish the role of cervical pessaries.
• Cervical pessaries may offer specific benefits for certain subgroups, such as reducing spontaneous PTB in twin pregnancies, warranting further investigation.