Cervical Measurement and Pessary Application in Relation to Gestational Age at Delivery in Patients Treated with Fetoscopic Endotracheal Occlusion

Abstract

<b><i>Objective:</i></b> To evaluate the impact of cervical length and cervical pessary application in congenital diaphragmatic hernia (CDH) treated by the fetoscopic endotracheal occlusion (FETO) procedure. <b><i>Methods:</i></b> The study group consisted of 80 patients with severe CDH treated by FETO. Cervical length measurement was performed by transvaginal ultrasound in all patients within the 24 h prior to the FETO procedure. The study group (<i>n</i> = 44) had cervical pessaries applied routinely within the 24 h following the FETO procedure, whereas the control group (<i>n</i> = 36) were not offered pessaries and only had cervical length measurement performed. <b><i>Results:</i></b> The median cervical length was 31 (range 22–45) mm. The median gestational age at delivery was 34.7 (range 27.8–39.2) weeks. Gestational age at delivery correlated significantly with gestational age at balloon removal (<i>r</i> = 0.768; <i>p</i> < 0.0001) and premature rupture of membranes (<i>r</i> = 0.501; <i>p</i> = 0.003). There was no significant correlation between gestational age at delivery and cervical length before the procedure (<i>r</i> = 0.141; <i>p</i> = 0.26) or pessary application (<i>r</i> = 0.081; <i>p</i> = 0.51). In the multivariate linear regression model, the only factor independently associated with gestational age at delivery was gestational age at fetoscopic balloon removal (β = 0.713; <i>p</i> < 0.0001). <b><i>Conclusion:</i></b> In cases of severe CDH treated by the FETO procedure, neither cervical length before the procedure nor cervical pessary application was associated with gestational age at delivery.