Cervical pessaries for prevention of spontaneous preterm birth: past, present and future

Abstract

This Review describes the rationale for the use of cervical pessaries to prevent spontaneous preterm birth and their gradual introduction into clinical practice, discusses technical aspects of the more commonly used designs and provides guidance for their use and future evaluation. Possible advantages of cervical pessaries include the easy, ‘one-off’ application, good side-effect profile, good patient tolerance and relatively low cost compared with current alternatives. Use of transvaginal sonography to assess cervical length in the second trimester allows much better selection of patients who may benefit from the use of a cervical pessary, but future clinical trials are needed to establish clearly the role of pessaries as a preterm birth prevention strategy worldwide.

Anterior cervical angle as a new biophysical ultrasound marker for prediction of spontaneous preterm birth

“…rotate the cervix, shifting the weight of the uterus towards the anterior wall 3,4 , resulting in a more acute angle. The effectiveness of this approach was proven recently in an in-vivo magnetic resonance imaging study on pregnant women with inserted pessaries 5 .…”

Pessary versus cerclage versus expectant management for cervical dilation with visible membranes in the second trimester

“…We wanted to evaluate whether a cervical pessary, which has shown promise in women with a short cervix, could be beneficial to women with the more concerning diagnosis of advanced cervical dilation [15][16][17].…”

“…[3][4][5][6]8 The risk of PEIC placement includes: rupture of membranes (4% -19%), bleeding from cervical laceration and intrauterine infection [8][9][10][11][12][13]. Pessaries have been used to prevent preterm birth for over 50 years and have been evaluated for treatment of short cervix [14][15][16][17]. Mechanically, the pessary is thought to change the angle between the cervical canal and the uterus to help displace the uterine weight and block the internal os.…”

Prevention of Preterm Birth - What Works and What Doesn’t?

“…Pessaries designed for the treatment of prolapse were the first pessaries used for the purpose of preventing preterm birth. More recently, however, pessaries designed specifically for this purpose have been designed [22,23]. There are several hypotheses as to how pessaries may prevent preterm birth.…”