The role of cervical pessary and progesterone therapy in the phenomenon of placenta previa migration

Баринов, С. В.; Шамина, И. В.; Renzo, Gian Carlo Di; Lazareva, O. V.; Tirskaya, Yu. I.; Medjannikova, Irina V.; Ledovskikh, I.O.; Klementyeva, Lyudmila L; Dudkova, G.V.

doi:10.1080/14767058.2018.1509068

Cited by 11 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another area in which pessaries have recently been used is in the prevention of pre-term births. Studies are currently examining the efficacy of cervical pessaries with and without vaginal progesterone in women with placenta praevia, short cervix or twin gestation [219,220].…”

Section: Future Directionsmentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

View full text Add to dashboard Cite

Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.

show abstract

Section: Future Directionsmentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

View full text Add to dashboard Cite

show abstract

“…26 27 28 30 Our findings are similar to the single previous study evaluating the role of CP as a preterm birth prevention strategy, in that cervical cup pessary placement in women with a complete previa is associated with a reduction in admissions for vaginal bleeding leading to delivery. 32 In our study, the number of antepartum admissions for bleeding was twofold higher in women randomized to the EM group.…”

Section: Discussionmentioning

confidence: 44%

“…A recent randomized trial using a dome silicone pessary with vaginal progesterone in women with previa demonstrated that women in the pessary group were threefold less likely to experience vaginal bleeding prior to delivery and were less likely to deliver prior to 34 weeks' gestation. 32…”

mentioning

confidence: 99%

Cervical Pessary versus Expectant Management for the Prevention of Delivery Prior to 36 Weeks in Women with Placenta Previa: A Randomized Controlled Trial

Stafford

Garite

Maurel

et al. 2019

AJP Rep

View full text Add to dashboard Cite

Objective This multicenter randomized controlled trial compared cervical pessary (CP) versus expectant management (EM) in women with placenta previa between 22.0 and 32.0 in prolonging gestation until ≥ 36.0 weeks' gestation. Study Design This study took place from November 2016 to June 2018. Women were randomized to receive either the Bioteque CP or EM. The pessary was removed at ≥ 36.0 weeks unless indicated. The primary outcome was gestational age (GA) at delivery, with secondary outcomes including need for transfusion, number and duration of antepartum admissions, type of delivery, and neonatal outcomes. A total of 140 patients were needed to show a 3-week prolongation of pregnancy in the pessary group; however, the trial was stopped early due to budgetary issues. Results Of the 33 eligible women, 17 were enrolled. Although not statistically significant, the mean GA at delivery in the CP group was greater than women in the EM group (36.5 ± 1.23 vs. 36.0 ± 2.0; p = 0.1673). The number and duration of antepartum admissions was greater in the EM group (2.7 ± 0.58 vs. 16.0 ± 22.76 days; p = 0.1264) as well. Conclusion Although the study was underpowered to determine the primary outcome, safety and feasibility of CP in pregnancies complicated with previa were demonstrated.

show abstract

“…Of 16 studies, 12 studies [ 8 , 10 – 12 , 18 – 22 , 25 – 27 ] involved women with a singleton pregnancy and the other four [ 9 , 17 , 24 , 27 ] included women with multiple pregnancies. Five RCT [ 10 – 12 , 19 , 25 ] and four non-RCT [ 18 , 21 , 26 , 27 ] singleton studies included a control group receiving treatment with vaginal progesterone alone; two non-RCT singleton studies compared with a group receiving the combination of cervical cerclage and vaginal progesterone [ 18 , 20 ]; only one non-RCT singleton study used the group receiving vaginal progesterone + cervical cerclage + cervical pessary [ 18 ], tocolysis (ritodrine hydrochloride and magnesium sulfate) [ 22 ] or cervical pessary alone [ 8 ] as the control, respectively. Two non-RCT [ 9 , 23 ] multiple pregnancy studies included a control group receiving vaginal progesterone alone treatment; only one non-RCT multiple pregnancy used the group receiving conservative treatment [ 24 ] or no treatment [ 17 ] as the control, respectively.…”

Section: Resultsmentioning

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.

View full text Add to dashboard Cite

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.

show abstract

The role of cervical pessary and progesterone therapy in the phenomenon of placenta previa migration

Abstract: The use of the Arabin cervical pessary combined with progesterone in patients with placenta previa significantly reduced the rate of preterm delivery < 34 weeks and bleeding during pregnancy.

Cited by 11 publications

References 17 publications

Managing female pelvic floor disorders: a medical device review and appraisal

Managing female pelvic floor disorders: a medical device review and appraisal

Cervical Pessary versus Expectant Management for the Prevention of Delivery Prior to 36 Weeks in Women with Placenta Previa: A Randomized Controlled Trial

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

Contact Info

Product

Resources

About