The importance of experience in using cervical pessary for prevention of preterm birth

França, Marcelo Santucci; Hatanaka, Alan Roberto; Moron, Antônio Fernandes

doi:10.15406/ogij.2021.12.00558

Cited by 3 publications

(2 citation statements)

References 42 publications

(39 reference statements)

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“…However, no conclusive evidence exists so far for the effectiveness of pessary in women with a short cervix [12][13][14][15]. This latter observation is the result of conflicting findings in the international literature which may be attributed to the varying level of experience with the use of this technique [16]. Recently, FIGO has commissioned a good practice recommendation that suggests that current knowledge does not suffice to support the use of pessaries in current clinical practice [17].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

et al. 2022

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Purpose: In the present study we sought to compare the efficacy of cervical pessary to that of cerclage in terms of reducing preterm birth rates among women with a short (<25 mm) and ultra-short (<15 and <10 mm) cervix during the ultrasonographic second trimester assessment. Method: We retrospectively searched the hospital records for singleton pregnancies diagnosed with cervical insufficiency during the second trimester of pregnancy. The McDonald cerclage was used in all women with the use of a 5mm Mersilene tape. Arabin pessary was used uniformly. In all cases 80 mg of vaginal progesterone gel was administered daily, until 37 weeks of gestation. Results: Overall, 294 women were selected for analysis of whom 124 (42.2%) had a McDonald cerclage and 170 (57.8%) had placement of an Arabin pessary. Preterm birth rates <37 weeks were similar in both groups (C: 30/122 vs P: 35:165, p=.581) as well as PTB <34 weeks (C: 16/122 vs 15/150, p=.278). Admission to the NICU and need for CPAP were more prevalent in the cerclage group (p<.001). Analysis of cases with a cervix <15 mm and <10 mm indicated that preterm birth rates remained equal among groups whereas an increased risk of NICU admission in cases with cervical length <10 mm that were treated with cerclage. Discussion and conclusion: Cervical pessary may be an alternative to cervical cerclage for women with second trimester cervical shortening and its effect may persist even among cases with an ultra-short cervix. Future randomized trials are needed to ascertain these findings.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

et al. 2022

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“…27 However, what has been completely neglected up to now is that a clinical success also requires experience following a learning curve. 28 Up to now, there are incidental reports on side effects of the cervical pessary, but women's views and satisfaction rates have not yet been systematically investigated apart from the rates of early removal or discharge within randomized controlled trials (RCTs). 13,17 The discrepant rates of complaints, early removal, and success in preventing preterm birth within both singleton and twin pregnancies finally motivated us to investigate women's experience with the cervical pessary within our own cohort of 10 years and to compare the results with publications where the consideration of a learning curve was no issue.…”

Section: Introductionmentioning

confidence: 99%

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

Seravalli,

Strambi,

D’Arienzo

et al. 2024

Preprint

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Objective To investigate women’s experience with the cervical pessary for prevention of preterm birth. Design: Retrospecitve questionnaire study. Setting: Tertiary care hospital in Italy. Population: 166 pregnant women treated with Arabin cervical pessary within one center. Methods: A questionnaire was administered to all women after delivery. Main outcome measures: Data about patient’s experience before the insertion (adequacy of the information received), during treatment (follow-up, impact on daily life, perceived discomfort, side effects) and at the time of removal (pain, patient’s expectation met regarding the treatment) were analysed. Results: Information received before the insertion of Arabin pessary was considered adequate in 163/166 (98.2%). An increase of 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 suggesting that clinical experience of the health care specialists in charge may explain why the discrepancy of results. Conclusion: Although some trials report high rates of non-compliant patients, this could not be confirmed by our study. In contrast, most women reported a positive experience and were motivated to continue the treatment when they were continuously followed by experienced clinicians.

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

et al. 2022

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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.

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The importance of experience in using cervical pessary for prevention of preterm birth

Cited by 3 publications

References 42 publications

Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

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

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

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