Cervical pessary for preventing preterm birth

Abdel‐Aleem, Hany; Shaaban, Omar M.; Abdel-Aleem, Mahmoud A

doi:10.1002/14651858.cd007873.pub2

Cited by 45 publications

(38 citation statements)

References 22 publications

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“…These reviews addressed highly relevant and sometimes routinely used interventions like cervical pessary for prevention [64] or risk scoring systems for predicting PTB [65], routine ultrasound in early pregnancy [66], or dietary advice for the prevention of [67] and screening for [68] gestational diabetes. In order to provide some information about potential effects on secondary outcomes considered in this overview, we prepared Table S4 as an additional file ([see Additional file 5]).…”

Section: Discussionmentioning

confidence: 99%

Antenatal interventions to reduce preterm birth: an overview of Cochrane systematic reviews

2014

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BackgroundSeveral factors are associated with an increased risk of preterm birth (PTB); therefore, various interventions might have the potential to influence it. Due to the large number of interventions that address PTB, the objective of this overview is to summarise evidence from Cochrane reviews regarding the effects and safety of these different interventions.MethodsWe conducted a systematic literature search in the Cochrane Database of Systematic Reviews. Included reviews should be based on randomised controlled trials comparing antenatal non-pharmacological and pharmacological interventions that directly or indirectly address PTB with placebo/no treatment or routine care in pregnant women at less than 37 completed weeks of gestation without signs of threatened preterm labour. We considered PTB at less than 37 completed weeks of gestation as the primary outcome.ResultsWe included 56 Cochrane systematic reviews. Three interventions increased PTB risk significantly. Twelve interventions led to a statistically significant lower incidence of PTBs. However, this reduction was mostly observed in defined at-risk subgroups of pregnant women. The remaining antenatal interventions failed to prove a significant effect on PTB < 37 weeks, but some of them at least showed a positive effect in secondary outcomes (e.g., reduction in early PTBs). As an unintended result of this review, we identified 28 additional Cochrane reviews which intended to report on PTB < 37 weeks, but were not able to find any RCTs reporting appropriate data.ConclusionsThe possible effects of a diverse range of interventions on PTB have been evaluated in Cochrane systematic reviews. Few interventions have been demonstrated to be effective and a small number have been found to be harmful. For around half of the interventions evaluated, the Cochrane review concluded that there was insufficient evidence to provide sound recommendations for clinical practice. No RCT evidence is available for a number of potentially relevant interventions.

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Section: Discussionmentioning

confidence: 99%

Antenatal interventions to reduce preterm birth: an overview of Cochrane systematic reviews

2014

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“…Physical interventions employed in women undergoing CL surveillance who demonstrate cervical shortening may include cervical cerclage or placement of a cervical pessary, although the role of the latter is likely to be limited, with a recent large randomized controlled trial identifying no reduction in early SPTB rates following pessary insertion. Total CL has been shown to predict SPTB < 34 weeks following both elective and emergency cerclage.…”

Section: Epidemiology and Definitionsmentioning

confidence: 99%

Cervical length as a predictor for spontaneous preterm birth in high-risk singleton pregnancy: current knowledge

Hughes

Kane

Júnior

et al. 2016

Ultrasound Obstet Gynecol

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“…In the fi rst trimester, as well as in asymptomatic patients in the second and third trimesters of pregnancy, identifying patients at risk of preterm delivery would enable an appropriate monitoring system to be set-up, and most importantly allow initiation of a preventive treatment such as progesterone Meis et al 2003;Romero et al 2012), cervical cerclage (Berghella et al 2005;Simcox et al 2009) or even cervical pessary (Abdel-Aleem et al 2010;Goya et al 2012). Furthermore, in patients with threatened preterm delivery, being able to identify those who are most likely to deliver early would assist in deciding whether to refer them to a higherlevel maternity unit, whether to modify tocolytic treatment and the length of hospital admission, and whether to administer a course of corticosteroids to allow fetal pulmonary maturation (ACOG 2011) or magnesium sulphate for neuroprotection (Bain et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Prediction of spontaneous preterm delivery in singleton pregnancies: Where are we and where are we going? A review of literature

Sananès

Langer

Gaudineau³

et al. 2014

Journal of Obstetrics and Gynaecology

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Prematurity is the chief cause of neonatal morbidity and mortality. The objective of this study is to review the different methods for predicting preterm delivery in asymptomatic pregnant women and in situations of threatened preterm delivery. A search of the PubMed/Medline database was carried out for the years 1980-2012. We included studies for predicting preterm birth in asymptomatic and symptomatic patients. Models for predicting preterm delivery based on maternal factors, cervical length and obstetric history in first trimester of pregnancy is a valuable avenue of research. Nevertheless, prediction accuracy still needs to be improved. In the second and third trimesters, routine digital vaginal examination is of no value in asymptomatic women. Echography of the cervix is not useful except in patients with a history of late miscarriage or preterm delivery in order to offer them a preventive treatment. In symptomatic women, the combination of digital vaginal examination, cervical echography and fibronectin gives the best predictive results. Electromyography of the uterus and elastography of the cervix are interesting avenues for future research. Identifying patients at risk of preterm delivery should be considered differently at each stage of pregnancy.

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Cervical pessary for preventing preterm birth

Cited by 45 publications

References 22 publications

Antenatal interventions to reduce preterm birth: an overview of Cochrane systematic reviews

Antenatal interventions to reduce preterm birth: an overview of Cochrane systematic reviews

Cervical length as a predictor for spontaneous preterm birth in high-risk singleton pregnancy: current knowledge

Prediction of spontaneous preterm delivery in singleton pregnancies: Where are we and where are we going? A review of literature

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