Position Paper of the Task Force for Obstetrics and Prenatal Medicine (AGG – Section Preterm Birth) on the Placement, Removal and Surveillance of the Arabin Cervical Pessary in Patients at Risk for Spontaneous Preterm Birth

Abstract

This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

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

“…The fact that the majority of patients have reported positive changes in their lives during treatment may be in part related to the decreased concern about the risk of preterm birth. In addition, the presence of the pessary supporting the cervix may give relief of pressure sensations while walking or standing in some patients [ 26 ].…”

“…During the past decade, the cervical pessary has been investigated in different settings in both singleton [ 12 – 17 ] and twin pregnancies [ 18 – 24 ]. It promotes an inclination of the uterocervical angle as visualized by MRI or clinically [ 25 , 26 ]. This mechanism is supposed to reduce the pressure on the lower uterine segment at the level of the internal cervical os and the cervix as studied in vivo by a change in maternal position [ 27 , 28 ], or in vitro by biomechanical engineering [ 29 ].…”

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

“…14,15 After that presentation, the hospital included CP in the non-standard medication of our pharmacy and supported all of our cases and research with this device, based on just the economic aspect. Some information about cervical pessary has been already published for new users, [16][17][18] but many other aspects need to be pointed out about this subject.…”

Letter to the Editor: FIGO good practice recommendations on the use of pessary for reducing the frequency and improving outcomes of preterm birth

“…9 As part of the German task force to prevent preterm birth we have published guidelines about cervical pessary treatment based on approximately 1000 treated cases of the first author. 10 The complaints described by Norman et al 8 were never reported and may rather reflect lack of clinical expertise during insertion, continuity of care, reassurance, or removal and lack of audit. Biomechanical remodeling suggested that a relief of pressure to the lower uterine segment requires accurate positioning, i.e.…”

“…In the STOPPIT‐2 trial, 8 the average treatment/center was three—leading to patient complaints as compared to centers with experience 9 . As part of the German task force to prevent preterm birth we have published guidelines about cervical pessary treatment based on approximately 1000 treated cases of the first author 10 . The complaints described by Norman et al 8 were never reported and may rather reflect lack of clinical expertise during insertion, continuity of care, reassurance, or removal and lack of audit.…”