Short Cervix and Risk for Preterm Birth: Do Pessaries Work?
This study by Xin-Hang et al. (Scientific Reports, 2017) sought to explore the effectiveness of using cervical pessaries to prevent preterm birth and perinatal morbidity and mortality in asymptomatic women with a singleton pregnancy and a short cervix (length ≤25 mm).
Systematic Review and Meta-Analysis
A total of 1,412 women were analyzed. Cervical pessary placement was not shown to reduce the risk of spontaneous preterm birth <34 weeks’ gestation (RR 0.71; 95%CI, 0.21–2.43, P = 0.59). Cervical pessary placement was not associated with any maternal or neonatal adverse effects. The authors concluded that although analysis of these trials did not indicate that cervical pessaries decrease the risk of spontaneous preterm birth, large randomized controlled trials are needed to confirm the findings due to study limitations. Such limitations include the potential bias due to inability to blind researchers and providers. Furthermore, only 3 studies could be included and therefore the sample size does not allow for proper analysis of cofounding variable (for example BMI and varying cervical lengths). Finally, the use of progestogens in combination with pessaries remains to be determined.
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