Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial

Goya, María; Pratcorona, Laia; Merced, Carme; Rodó, Carlota; Valle, Leonor; Romero, Azahar; Juan, M.; Rodríguez, A.; Muñoz, Begoña; Santacruz, B.; Bello-Muñoz, J.; Llurba, Elisa; Higueras, Teresa; Cabero, L.; Carreras, Elena

doi:10.1016/s0140-6736(12)60030-0

Cited by 406 publications

(386 citation statements)

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“…In 2012, a randomized, controlled trial that investigated whether the insertion of the Arabin cervical pessary in singleton pregnant women with a TVU CL less than 25 mm at 20-23 weeks of gestation reduced the rate of early preterm delivery, showed a statistically significant reduction in spontaneous delivery before 34 weeks of gestation in the pessary compared with the expectant management groups, and no serious adverse effects associated with the use of a cervical pessary were reported. The authors suggested that although the mechanism of action of cervical pessary remains to be clarified, the positive effect of the use of a pessary relies on its mechanical ability to bend the cervix backwards, changing the uterocervical angle, which not only strengthens the cervical canal but also diminishes the contact of intact membranes with the vagina, somehow preserving its integrity [84]. More recently, the effectiveness of the use of Arabin cervical pessary in the reduction of the rate of sPTB has also been demonstrated in multiple pregnancy when the CL at 16-20 weeks is less than the 25th percentile, which corresponded to 38 mm [85].…”

Section: Cervical Pessarymentioning

confidence: 99%

Cervical length for the prediction and prevention of preterm birth

Di¹,

Berghella

2013

Expert Review of Obstetrics & Gynecology

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Section: Cervical Pessarymentioning

confidence: 99%

Cervical length for the prediction and prevention of preterm birth

Di¹,

Berghella

2013

Expert Review of Obstetrics & Gynecology

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“…However, the procedure is not without complications (6). Cervical pessaries have been shown to be efficacious in preventing preterm birth, especially in a high-risk population of women with a shortened cervical length (7)(8)(9)(10). On the other hand, a randomized controlled trial showed that the prophylactic use of cerclage pessaries did not reduce the rate of preterm delivery before 34 weeks (11).…”

Section: Discussionmentioning

confidence: 99%

Pessary use in pregnant women with short cervix

Konuralp

Kalafat

Söylemez

2016

J Turkish German Gynecol Assoc

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Case 3A 29-year-old, gravida 2, parity 0 woman was referred to our clinic for cervical insufficiency at 27 weeks and 4 days. Her initial assessment revealed a shortened cervix of 15 mm with a funneling sign. A cervical pessary was placed on the same day. She remained asymptomatic until term. The pessary was removed at the 39 th week of gestation due to the rupture of membranes. The cervical dilatation at admission was 5 cm, and 3300 g female baby was vaginally delivered with Apgar scores of 8 and 9. The time from pessary application to delivery was 76 days (Table 1). Case 4A 31-year-old, gravida 3, parity 2 woman was referred to our clinic for cervical insufficiency at 23 weeks and 4 days. Her initial assessment revealed a cervical dilatation of 5 cm and transvaginal measured cervical length of 15 mm. A cervical pessary was placed at 23 weeks and 4 days. She remained symptom free until the 37 th week of gestation. She was readmitted at 37 weeks and 3 days due to uterine contractions. The digital examination of her cervix revealed an unchanged dilatation of 5 cm, and the pessary was removed due to regular uterine contraction and also as the patient reached term. A 3200 g female baby was vaginally delivered with Apgar scores 8 and 9. The time from pessary application to delivery was 98 days (Table 1). DiscussionPreterm birth is a major cause of neonatal mortality and morbidity in developed countries. It is implicated as a cause of both short-and long-term morbidity in infants (1), and the prevention of preterm birth is the most effective way of decreasing morbidity rates. Shortened cervical length is an important predictor of spontaneous preterm birth, and several treatment strategies have been proposed. Alfirevic et al. (5) reported that cervical cerclage, vaginal progesterone, and cervical pessary appear to have a similar effectiveness as management strategies in women with singleton pregnancy, previous spontaneous preterm birth, and short cervix. Cervical cerclage is the most common mechanical prevention method for the prevention of preterm birth. However, the procedure is not without complications (6). Cervical pessaries have been shown to be efficacious in preventing preterm birth, especially in a high-risk population of women with a shortened cervical length (7-10). On the other hand, a randomized controlled trial showed that the prophylactic use of cerclage pessaries did not reduce the rate of preterm delivery before 34 weeks (11). Cervical pessary is an inexpensive and less invasive option to cervical cerclage. Pessary application and removal do not require anesthesia. Pessary use, instead of cervical suturing, can decrease hospital stays and reduce healthcare costs. In low-resource countries, cervical pessaries are an alternative method for the prevention of preterm birth. Few complications arising from pessary use have been reported, including increased vaginal discharge. However no major infectious morbidity, i.e., chorioamnionitis, has been reported. It appears to be cost effective with minima...

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“…В 2012 г. испанские исследователи Goya et al [68] в проспективном открытом многоцен-тровом рандомизированном исследовании показали, что установка АП Arabin у женщин с одноплодной беременностью и короткой шейкой матки (по данным цервикометрии длина < 25 мм) в сроки гестации 18-22 не-дели позволила снизить частоту преждевре-менных родов в 3 раза. В работу были вклю-чены 385 беременных с короткой шейкой.…”

Section: акушерский пессарийunclassified

Selection of the method for correction of cervical incompetence

et al. 2017

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■ Истмико-цервикальная недостаточность (ИЦН) является одной из важных проблем современного акушерства.Перед практикующим акушером-гинекологом стоит сложная задача своевременной диагностики, выбора метода коррекции, сроков наложения и удаления серкляжа. Проблема несостоятельности шейки матки при беремен-ности известна с XIX в., но еще в XI в. выдающийся ученый Абу Али Ибн Сина (Авиценна) писал об этой пато-логии. Согласно классическому определению ИЦН -это размягчение, расширение и укорочение шейки матки до 37-й недели гестации при отсутствии угрозы прерывания. Для ИЦН характерна неспособность женщины доносить беременность до доношенного срока из-за функционального или структурного дефекта шейки матки. На настоящее время не существует объективных диагностических тестов для выявления пациенток высоко-го риска развития ИЦН ни до и ни во время беременности. Высокой диагностической значимостью во время беременности обладает трансвагинальное ультразвуковое исследование шейки матки. Разработанная ультра-звуковая шкала L.J. Salomon позволяет оценить длину шейки матки в зависимости от срока гестации и сделать врачу правильный выбор для коррекции короткой шейки. Выбор метода коррекции ИЦН зависит от клиниче-ской ситуации, анамнеза, сроков гестации, числа плодов, данных цервикометрии, гинекологического осмотра, угрозы прерывания беременности, опыта врача. Существует два основных метода коррекции ИЦН: консерва-тивный и хирургический. К хирургическим методам относятся трансвагинальный и трансабдоминальный сер-кляж, а к консервативным -соблюдение постельного режима, токолитическая, гормональная терапия, приме-нение акушерского пессария. Установка акушерских пессариев является перспективным безопасным простым методом лечения и профилактики ИЦН и угрозы прерывания беременности во II и III триместрах. Стратегия широкого использования пессариев у беременных из групп высокого риска позволяет снизить частоту прежде-временных родов и улучшить перинатальные исходы.■ Ключевые слова: истмико-цервикальная недостаточность (ИЦН); серкляж; трансвагинальный серкляж; трансабдоминальный серкляж; акушерский пессарий Arabin; трансвагинальное УЗИ; преждевременные роды. ■ Cervical incompetence (CI) is one of the challenges of modern obstetrics. The practicing obstetrician-gynecologist faces a complex task of timely diagnosis, selection of correction method, timing of application and removal of cerclage. The problem of CI in pregnancy is known from the XIX century, but in the XI century, the outstanding scientist Abu Ali Ibn Sina (Avicenna) wrote about this pathology. According to the classical definition, CI is the softening, widening and shortening of the cervix prior to the 37th week of gestation in the absence of thretening termination of pregnancy. CI is characterized by inability to carry a pregnancy to full-term due to functional or structural abnormalities of the uterine cervix. To date, no objective diagnostic tests exists to identify patients at high risk of developing CI, not before and not during pregnancy. A high diagnostic accuracy d...

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Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial

Cited by 406 publications

References 20 publications

Cervical length for the prediction and prevention of preterm birth

Cervical length for the prediction and prevention of preterm birth

Pessary use in pregnant women with short cervix

Selection of the method for correction of cervical incompetence

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