• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

How Effective is Cervical Pessary in Preventing Preterm Birth in Asymptomatic but High-Risk Pregnancies?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Conde-Agudelo et al. (AJOG, 2020) sought to determine the efficacy and safety of cervical pessary to prevent preterm birth and adverse perinatal outcomes in asymptomatic high-risk women

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • RCTs
    • Studies that compared cervical pessary with
      • Standard care (no pessary)
      • Alternative interventions (e.g., vaginal progesterone or cervical cerclage)  
  • Participants
    • Asymptomatic
    • High risk for preterm birth (e.g., midtrimester sonographic short cervix, history of preterm birth, multiple gestation, and uterine anomalies or excisional cervical procedures)
  • Study design and data analysis
    • Systematic review was conducted in accordance with Cochrane Handbook guidelines
    • Pooled relative risks with 95% confidence intervals were calculated
    • Quality of evidence was assessed using GRADE criteria
  • Primary outcome
    • Spontaneous preterm birth <34 weeks of gestation
  • Secondary outcomes
    • Adverse pregnancy, maternal, and perinatal outcomes

RESULTS:

  • 12 studies | 4687 women | 7167 fetuses/infants
    • 8 evaluated pessary vs no pessary in women with short cervix
    • 2 assessed pessary vs no pessary in unselected multiple gestations
    • 2 compared pessary vs vaginal progesterone in women with short cervix
  • No significant differences were observed between the pessary and no pessary groups in
    • Preterm birth <37, <32, and <28 weeks of gestation
    • Most adverse pregnancy, maternal, and perinatal outcomes
  • There were no significant differences between the pessary and no pessary groups for the following
    • Spontaneous preterm birth <34 weeks among singleton gestations with cervical length ≤ 25 mm
      • Relative risk (RR) 0.80 (95% CI, 0.43 to 1.49)
      • 6 trials | 1982 women
      • Low-quality evidence
    • Unselected twin gestations
      • RR 1.05 (95% CI, 0.79 to 1.41)
      • 1 trial | 1177 women
      • Moderate-quality evidence
    • Twin gestations with cervical length <38 mm
      • RR 0.75 (95% CI, 0.41 to 1.36)
      • 1 trial | 1177 women
      • Moderate-quality evidence
    • Twin gestations with cervical length ≤25 mm
      • RR 0.72 (95% Cl, 0.25 to 2.06)
      • 2 trials | 348 women
      • Low-quality evidence
  • There were also no significant differences in the risk of spontaneous preterm birth <34 weeks of gestation between pessary and vaginal progesterone
    • Singleton gestations with a cervical length ≤25 mm
      • RR 0.99 (95% CI, 0.54 to 1.83)
      • 1 trial | 246 women
      • Low-quality evidence
    • Twin gestations with a cervical length <38 mm
      • RR 0.73 (95% CI | 0.46 to 1.18)
      • 1 trial, 297 women
      • Very low-quality evidence
  • Pessary was associated with an increased risk for the following
    • Vaginal discharge: RR 2.15 (95% CI, 1.67 to 2.78)
    • Pelvic discomfort: RR 3.28 (95% CI, 1.96 to 5.50
    • High quality evidence

CONCLUSION:

  • Cervical pessary did not prevent preterm birth or improve perinatal outcomes in asymptomatic high-risk pregnancies
  • The authors point that there are ongoing studies that may impact the results of this current meta-analysis
  • The authors summarize the current available literature as follows

Current evidence does not support the use of cervical pessary to prevent preterm birth or to improve perinatal outcomes in singleton or twin gestations with a short cervix and in unselected twin gestations

Learn More – Primary Sources:

Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis


Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Does Cervical Pessary Benefit Women at risk for Preterm Birth due to Short Cervix?
Cervical Pessary or Vaginal Progesterone for Preterm Birth Prevention?
PoPPS Study: Does Pessary Use In Women with a Short Cervical Length Prevent Preterm Birth?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site