Patient’s experience with the Arabin cervical pessary during pregnancy: A questionnaire survey

Abstract

Introduction The cervical pessary is used in women with precocious cervical ripening to prevent preterm birth. Up to now however, there have been no systematic studies on compliance and tolerance, which vary among different study cohorts. Material and methods A questionnaire was administered to 166 women treated with the Arabin cervical pessary in one center. Data were analysed about the patient’s experience before insertion (adequacy of information received), during treatment (follow-up, impact on daily life, perceived discomfort, side effects) and at the time of removal (pain, if the patient’s expectations had been met regarding the treatment). Results Information received before the insertion of the Arabin cervical pessary was considered adequate in 163/166 (98.2%) women. An increase in vaginal discharge was experienced by 70/166 (42.2%) women. Discomfort or other side effects were reported in 13.8% and 16.3% of cases, respectively. Overall, 77% of women reported an improved quality of life and 94% considered the follow-up during pregnancy adequate. Removal was moderately painful for 58/166 (35%) of women. Patient’s expectations regarding the treatment were exceeded in the majority of cases (75.3%). In a final step, we compared our results to previous studies regarding the use of the pessary in singleton and twin pregnancies. Conclusion Although some trials report high rates of non-compliant patients, this could not be confirmed by our study. In contrast, most women reported having a positive experience and that they were motivated to continue the treatment when they were continuously followed by experienced clinicians.

Evaluation of patient preferences for treatments to prevent preterm births in singleton and twin pregnancies with a short cervix.

“…The only characteristic that showed a signi cant association with method preference was the higher number of working hours in women with twin pregnancies, who preferred the pessary and P + P than ovules, with nine hours (9-10 h), nine hours (8-11 h), and eight hours (8-10 h), respectively (P = 0.02). 19.1 [17][18][19][20][21][22][23][24] 0.96…”

“…The study also reported that the positive changes during the pessary treatment seemed to be related to a decreased concern about the risk of premature birth and to the relief of intrauterine pressure during daily activities. 17 The QoL may also play a role in the choice of treatment methods, particularly in cases of increased gestational risk resulting in unfavorable outcomes for both mother and fetus. [18][19][20] In singleton pregnancies, patients with a preference for the pessary over progesterone had higher scores in the environment domain.…”

Cervical pessary to prevent preterm birth and poor neonatal outcome: An integrity meta‐analysis of randomized controlled trials focusing on adherence to the European Medical Device Regulation

“…It is not surprising that authors of trials with recruitment below five patients per center 24 reported on high rates of patient discomfort, suggesting suboptimal application or reassurance. 40 Nicolaides and coworkers 22,23 determined that vaginal discharge following pessary placement was not due to bacterial pathogens as more than 40% of patients received essentially unindicated antibiotic therapy. Notably, antibiotics may have an impact on the vaginal microbiome and even induce PTB.…”

“…Technical properties of different pessary types, (low) experience, and (insufficient) learning curves as reflected by the number of recruitments per center for the complete management were not reported in trials, a trend that has continued in a current “network meta‐analysis” (Mol et al submitted). It is not surprising that authors of trials with recruitment below five patients per center 24 reported on high rates of patient discomfort, suggesting suboptimal application or reassurance 40 . Nicolaides and coworkers 22,23 determined that vaginal discharge following pessary placement was not due to bacterial pathogens as more than 40% of patients received essentially unindicated antibiotic therapy.…”