The Mechanical “Fix” of the Pessary May Not Solve the Problem of Preterm Birth

Summary and Comment |
March 16, 2016

The Mechanical “Fix” of the Pessary May Not Solve the Problem of Preterm Birth

  1. Allison Bryant, MD, MPH

Placement of a cervical pessary did not lower rates of preterm delivery among at-risk women with singleton pregnancies.

  1. Allison Bryant, MD, MPH

As preterm birth is the leading cause of infant morbidity and mortality, interest is focused on interventions to lower its incidence. Although cervical cerclage has not proven effective for women at excess risk for preterm delivery due to a short cervix, placement of a silicone ring pessary has held early promise for such women; however, trial results have been inconsistent. In an international study, U.K. investigators sought additional evidence that pessary placement can reduce risk for early preterm birth.

A total of 935 women with singleton pregnancies at 20 to 25 weeks' gestation and cervical lengths <25 mm were randomized to pessary placement or expectant management (control group). All women with cervical lengths <15 mm were additionally treated with vaginal progesterone. Rates of spontaneous delivery before 34 weeks' gestation were similar in the pessary and control groups (12.0% and 10.8%, respectively; P=0.57).

Comment

A previous trial of cervical pessaries generated excitement that this relatively inexpensive, low-tech, well-tolerated intervention might reduce the burden of preterm birth among women with a short cervix. However, the present trial (the largest to date) lends credence to the axiom that a single positive study should not drive a practice change. Perhaps it's too much to expect that a mechanical “fix” can substantially diminish the risk inherent in a multifactorial process like preterm birth. Hopefully, other potential solutions are in the clinical and translational research pipeline.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Nothing to disclose

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