B. Arabin, J. R. Halbesma, F. Vork, M. Hübener, J. van Eyck
Is treatment with vaginal pessaries an option in patients with a sonographically
detected short cervix?
Objective: The purpose was to determine the effect of
vaginal pessaries in patients at risk for spontaneous
preterm birth (SPB).
Study Design: Transvaginal sonography (TVS) was longitudinally
performed to measure cervical length (CL)
in 258 singleton at risk for SPB and 282 twin pregnancies.
Pairs with or without treatment were matched for gestational
age and the CL at examination.
Results: In 4 singleton and 7 twin pregnancies the CL
was < 15 mm before 24 weeks, the mean interval between
pessary insertion and delivery was 13+2 and
12+5 weeks respectively. For the matched control analysis,
12 pairs with singleton and 23 pairs with twin pregnancies
were compared. For singleton pregnancies, the
mean interval between TVS and delivery was 99
(70–134) days in the treatment and 67 (2–130) days in
the control group (p = 0.0184), the mean gestational age
at delivery was 38 (36+6–41) and 33+4 (26–38) weeks
respectively (p = 0.02). For twin pregnancies, the interval
was 85 (43–129) days in the treatment and 67 (21–100)
days in the control group (p = 0.001), gestational age at
delivery was 35+6 (33–37+4) and 33+2 (24+4–37+2)
respectively (p = 0.02). Within singleton pregnancies
with pessary, there was no SPB < 36 weeks compared to
6/12 cases in the control group (p < 0.001). Within twin
pregnancies, the rates were 8/23 cases with SPB
< 36 weeks but none < 32 weeks, compared to 12/23 cases
with SPB < 36 weeks and 7/23 cases < 32 weeks in the
control group (p < 0.001).
Conclusions: Insertion of a vaginal pessary may be a
cost-effective preventive treatment in patients at risk for
SPB. Prospective controlled trials are needed.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 31, 03/2003
Pages: 122 - 133
Show full article (external site)
Show all available items of this journal
Search
