Alternative Treatment for a Short Cervix: The Cervical Pessary
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
References (20)
Treatment of habitual abortion due to cervical incompetence
Lancet
(1959)Simple treatment of the incompetent cervical os
Am J Obstet Gynecol
(1961)- et al.
Births: final data for 2005
Natl Vital Stat Rep
(2007) - et al.
From concept to practice: the recent history of preterm delivery prevention. Part I: cervical competence
Am J Perinatol
(2006) - et al.
The length of the cervix and the risk of spontaneous premature delivery
N Engl J Med
(1996) A new method of operative treatment for habitual abortion in the second trimester of pregnancy
Antiseptic
(1955)Suture of the cervix for inevitable miscarriage
J Obstet Gynaecol Br Emp
(1957)Pessaries for the treatment of incompetent cervix and premature delivery
Obstet Gynecol Surv
(2000)The incompetent cervical os and the pessary
Am J Obstet Gynecol
(1963)Pessary treatment of the incompetent cervical os
Obstet Gynecol
(1968)
Cited by (37)
A finite porous-viscoelastic model capturing mechanical behavior of human cervix under multi-step spherical indentation
2023, Journal of the Mechanical Behavior of Biomedical MaterialsOBGYN practice patterns regarding combination therapy for prevention of preterm birth: A national survey
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyThe Short Cervix: A Critical Analysis of Diagnosis and Treatment
2020, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :The mechanism of action is thought to be its effect on the lower uterine segment angle.100 Initially, early studies in the United States suggested the benefit of lever-type pessaries placed in select patients with a history of previous sPTB/PPROM.99 Subsequent larger studies from Europe using a barrel-type pessary showed a promising potential benefit in both singleton and twin pregnancies with a short cervix.101,102
Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :On the other hand, the trials by Dugoff et al165 and Berghella et al170 reported negative results despite pessary insertion training that consisted of a didactic session and a hands-on session, and all staff were required to demonstrate competence in pessary placement on a live model. Finally, it has been repeatedly claimed that pessaries have advantages in that they are operator independent, noninvasive, and easy to place and remove when required.129–131,138,160,164,167,169 Third, the concomitant administration of vaginal progesterone to participants could have attenuated the benefits of the pessary.
N <sup>o</sup> 373 - Insuffisance cervicale et cerclage cervical
2019, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :L'utilisation de pessaires dans la prise en charge de l'insuffisance cervicale ou de l'accouchement prématuré n'est pas nouvelle, l'utilisation d'un pessaire de verre ayant été décrite pour la première fois en 1977124. Depuis, l'utilisation de divers modèles et matériaux a été rapportée125–131. Bien que de nombreux rapports et que de nombreuses analyses aient constaté qu'il s'agissait d'une approche prometteuse, une revue Cochrane n'a pas été en mesure de trouver des études pouvant être incluses dans une analyse des avantages de cette technique35.
No. 373-Cervical Insufficiency and Cervical Cerclage
2019, Journal of Obstetrics and Gynaecology Canada