The effectiveness of the Dr. Arabin cervical pessary in the prevention of extreme preterm birth and very preterm birth in twins

Abstract

BACKGROUND: Multiple pregnancy remains a serious obstetrical problem, as it is a high risk factor for miscarriage/preterm birth at any gestational age. On average, in 54% of patients with twins, pregnancy ends in preterm birth, regardless of the economic situation and the level of perinatal care in the state, and is characterized by high childhood morbidity and mortality.
 AIM: The aim of this study was to identify risk factors for spontaneous preterm birth and to evaluate the effectiveness of a cervical pessary in pregnant women with twins and a short cervix.
 MATERIALS AND METHODS: This prospective, open, randomized cohort study included 91 women with twins, a short cervix (25 according to the L.J. Salomon scale) and a threatened miscarriage / preterm birth in the second and third trimesters of pregnancy, who received the Dr. Arabin cervical pessary. We analyzed pregnancy outcomes and identified risk factors for spontaneous preterm birth.
 RESULTS: Based on the pregnancy outcomes, all patients were categorized into two main groups after 16 pregnant women with induced preterm birth were excluded from further study. The study was continued by 75 pregnant women, with term birth in 40 (53.3%) women in group I and spontaneous preterm birth in 35 (46.7%) women in group II.
 The average period of pregnancy prolongation was statistically different between groups II and I (8.86 4.86 and 12.32 4.38 weeks, p 0.01). The average gestational age of labor initiation was 37.73 0.62 weeks in group I and 34.24 2.08 weeks in group II (p 0.001). We found no extreme preterm birth (22-27 6/7 weeks) in group II, the perinatal mortality of newborns being the highest at this gestational age. Labor at a gestational age of 28-33 6/7 weeks was in 14 (18.67%) women and of 34-36 6/7 weeks in 21 (28.00%) women. The detailed analysis of the course and outcomes of pregnancy and labor in high-risk groups identified two factors that affect the occurrence of spontaneous preterm birth in twin pregnancies: the Bishop score 5 points (p = 0.03579; odds ratio 4.93, 95% confidence interval 1.2319.74) and cervical length on bimanual vaginal examination 20 mm (p = 0.014; odds ratio 4.67, 95% confidence interval 1.4714.82).
 CONCLUSIONS: The use of a cervical pessary in the group of pregnant women with twins and at a high risk of spontaneous preterm birth not only allows for prolonging pregnancy and excluding the birth of extremely premature babies, but also reduces the number of spontaneous extreme and very preterm births.