Vaginal progesterone combined with cervical pessary in preventing preterm birth: a meta-analysis

Liu, Jing; Song, Guang; Meng, Ting; Zhao, Ge

doi:10.1080/14767058.2019.1677596

Cited by 17 publications

(10 citation statements)

References 35 publications

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“…There is one study showed that cervical pessary combined with vaginal progesterone could prolonged pregnancy, reduce prematurity rate and a low rate of perinatal complications [26]. However, a meta-analysis [27] and a RCT [28]in 2016 showed that combined treatment did not decrease the risk of preterm birth compared with cervical pessary in singletons with short CL. Therefore, it is not sure if vaginal progesterone could enhance or weaken the influence of cervical pessary to twin pregnancy.…”

Section: Sensitivity Analysismentioning

confidence: 99%

Effect of cervical pessary on pregnancy outcome in patients with twin pregnancies: a systematic review and meta-analysis

Wang

et al. 2022

Preprint

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Conclusion The cervical pessary can extend the gestational week of short-cervix twin pregnancy without clinical symptoms, reduce the premature birth rate before 34 weeks of gestation, improve pregnancy outcome, reduce neonatal mortality, reduce necrotizing enterocolitis incidence, neonatal sepsis incidence, and improve neonatal outcome. For patients with a cervical length less than 38mm, a cervical pessary can be performed to extend the gestational week. For patients with a cervical length less than 25mm, a cervical pessary can effectively prolong the gestational age and improve the maternal and fetal outcomes. The cervical pessary is safe for patients with twin pregnancies. Suggest that twin-preganct-patients with CL<38mm should consider take cervical pessary in advance. In terms of long-term efficacy, there is no evidence of cervical support placement on the long-term maternal prognosis. In terms of economic benefits, cervical support is better than vaginal progesterone, but this conclusion still needs more research to prov

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Section: Sensitivity Analysismentioning

confidence: 99%

Effect of cervical pessary on pregnancy outcome in patients with twin pregnancies: a systematic review and meta-analysis

Wang

et al. 2022

Preprint

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“…Current, only one retrospective cohort study of twin pregnancies draw a conclusion that cervical pessary combined with vaginal progesterone could prolonged pregnancy and reduce risk of adverse neonatal outcomes 22 . There is one study showed that cervical pessary combined with vaginal progesterone could prolonged pregnancy, reduce prematurity rate and a low rate of perinatal complications 23 .A metaanalysis 24 and a RCT in 2016 showed that combined treatment did not decrease the risk of preterm birth compared with cervical pessary in singletons with short CL 25 . Therefore, more clinical trials are needed.…”

Section: Sensitivity Analysismentioning

confidence: 99%

Effect of cervical pessary on pregnancy outcome in patients with twin pregnancies: a meta-analysis

Wang

et al. 2021

Preprint

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Background Preterm birth is the main cause of child death under 5years of age.The incidence of twin pregnancies is less than 2%, but the incidence of preterm delivery is 50% and the risk of neonatal death is 5 times higher in twin pregnancies than in singleton pregnancies.However,there is still no consensus on the effect of cervical pessary on preventing preterm delivery, prolonging the pregnancy cycle, and improving maternal and infant outcomes in patients with twin pregnancies. Objectives To explore the effect of cervical pessary on the pregnancy outcome of unselected twin pregnancy patients. Search Strategy Up to July 2021,researchers searched PubMed, EMBASE, COCHRANE, Web of Science, Wanfang, Weipu, and CNKI databases for research. Selection Criteria Randomized controlled trials that compared cervical pessary with standard care (no pessary) or alternative interventions(conventional and standard treatment (e.g.Atoxiban therapy) or vaginal progesterone) in patients with twin pregnancies. Data Collection and Analysis Two authors（W-Y and M-D）independently extracted information related to the study characteristics and test results from each of the included literature, and used Revman 5.3 to analyze the data. Conclusion The cervical pessary can extend the gestational week of short-cervix twin pregnancy without clinical symptoms, reduce the premature birth rate before 34 weeks of gestation, improve pregnancy outcome, reduce neonatal mortality, reduce necrotizing enterocolitis incidence, neonatal sepsis incidence, and improve neonatal outcome.

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“…Therefore, some scholars suggested to using a combined therapy [ 8 – 12 ]. Although there were systematic review and meta-analysis studies to assess the efficacy of a combined therapy for PTB prevention [ 13 , 14 ], the evidence available was extremely insufficient (only three studies published before 2018 were included in these two studies, respectively). Furthermore, unlike cervical pessary and progesterone, cervical cerclage is a surgical procedure that is invasive, high-cost [ 15 ], and causes adverse complications (i.e., bleeding, infection) [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis

Zhuang

et al. 2022

Reprod. Sci.

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This study was to assess the effectiveness of cervical pessary combined with vaginal progesterone for the prevention of preterm birth (PTB). Ten studies about singleton [five randomized controlled trials (RCTs), vs vaginal progesterone; four cohorts, vs vaginal progesterone; two cohorts, vs cervical cerclage + vaginal progesterone] and two cohort studies about multiple pregnancies (vs vaginal progesterone) were included after searching electronic databases. For singleton pregnancies, the meta-analysis of three non-RCTs [relative risk (RR) = 0.41, p = 0.001] or total trials in non-Asian country (RR = 0.56, p = 0.03) revealed that compared with vaginal progesterone alone, cervical pessary + vaginal progesterone treatment had significant effectiveness on preventing PTB < 34 weeks, but not for five RCTs; meta-analysis of two trials showed that cervical pessary + vaginal progesterone had no significant prevention effects of PTB compared with cervical cerclage + vaginal progesterone. For multiple pregnancies, meta-analysis of two trials showed that compared with vaginal progesterone, cervical pessary + vaginal progesterone treatment increased neonatal birth weight (standardized mean difference = 0.50, p = 0.01). Trial sequential analysis implied additional studies were required. Four studies vs other controls (pessary, three-combined, tocolysis, conservative or no treatment; one study, each) were selected for systematic review. In conclusion, cervical pessary combined with vaginal progesterone may be safe and effective to prevent PTB in singleton pregnancies and increase neonatal birth weight in the multiple pregnancies compared with vaginal progesterone alone.

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Vaginal progesterone combined with cervical pessary in preventing preterm birth: a meta-analysis

Cited by 17 publications

References 35 publications

Effect of cervical pessary on pregnancy outcome in patients with twin pregnancies: a systematic review and meta-analysis

Effect of cervical pessary on pregnancy outcome in patients with twin pregnancies: a systematic review and meta-analysis

Effect of cervical pessary on pregnancy outcome in patients with twin pregnancies: a meta-analysis

Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis

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