Elsevier

Seminars in Perinatology

Volume 33, Issue 5, October 2009, Pages 338-342
Seminars in Perinatology

Alternative Treatment for a Short Cervix: The Cervical Pessary

https://doi.org/10.1053/j.semperi.2009.06.008Get rights and content

Preterm birth is the leading cause of perinatal morbidity and mortality in the United States. The risk of preterm birth is inversely proportional to the length of the cervix on transvaginal sonography. The traditional treatment for a short cervix has been cerclage and recently there are newer trials using progesterone for this same indication. This manuscript reviews the published data regarding the use of an old method for the treatment of cervical insufficiency, “The Cervical Pessary.” A MEDLINE search was performed and articles published since 1959 regarding the use of pessary for cervical insufficiency were identified and reviewed. The pessary may represent an easy and safe intervention in the treatment of a short cervix diagnosed in the midtrimester. Further research is merited to evaluate the role of the cervical pessary as an alternative treatment for a short cervix or for women at high risk for preterm birth.

Section snippets

Pessary for Cervical Insufficiency

The first report on the use of a ring pessary, the Bakelite ring, for the treatment of incompetent cervix, was published in 1959 in the Lancet by Cross.7 A series of 13 patients is described, wherein the Bakelite ring is pushed up and around the cervix, to the level of the internal os. The indications for placement are noted as incompetent cervix (4 patients), history of cervical lacerations (8 patients), and a didelphys uterus (1 patient). The article describes a history of pregnancy loss

Guidelines for Pessary Placement

The following describes basic guidelines to be considered when offering placement of a pessary for prevention of spontaneous preterm birth.

  • 1

    Identify the population with a history of spontaneous preterm birth or cervical length shortening at <25 mm on transvaginal ultrasound.

  • 2

    Ensure that the patient does not have an infection or has signs or symptoms of active preterm labor.

  • 3

    Counsel and inform the patient that there is yet not strong evidence that a cervical pessary can prevent spontaneous preterm

Conclusions

Conventional cervical cerclage can be associated with complications and is not without risk.19 The cervical pessary may offer a safe and easy alternative to cerclage for the treatment of cervical insufficiency and prevention of preterm birth. Several types of pessaries have been used and shown to be effective in various observational trials. Cerclage pessary is a relatively noninvasive, operator-independent, cost-effective outpatient procedure. Although this modality has been described for 50

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There are more references available in the full text version of this article.

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