Cervical pessary in singleton gestations with arrested preterm labor: a randomized clinical trial

Area of Science:

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

Background:

• Cervical pessaries are effective for preventing preterm birth in asymptomatic women with short cervices.
• The efficacy of cervical pessaries in women with arrested preterm labor remains uncertain.

Purpose of the Study:

• To evaluate if a cervical pessary reduces preterm birth in singleton pregnancies with arrested preterm labor.
• To test the hypothesis that pessary use lowers the risk of delivery before 37 weeks gestation.

Main Methods:

• A randomized, nonblinded trial comparing cervical pessary use versus no pessary in women with arrested preterm labor.
• Participants were women with singleton gestations between 24 and 33 weeks.
• The primary outcome was preterm birth at less than 37 weeks gestation.

Main Results:

• The study was underpowered, enrolling 61 of a planned 120 participants.
• Preterm birth occurred in 43.8% of the pessary group versus 20.7% of the control group.
• The relative risk for preterm birth in the pessary group was 2.98 (95% CI, 0.96-9.30).

Conclusions:

• In this underpowered trial, cervical pessary use did not decrease the rate of preterm birth in women with arrested preterm labor.
• Further research is needed to confirm these findings in a larger, adequately powered study.