Cervical pessary for preterm twin pregnancy in women with a short cervix

Abstract

ObjectiveWe aimed to evaluate the effectiveness of cervical pessary for extending twin pregnancy in women with a shortcervix. MethodsBetween January 2014 and March 2019, the use of a cervical pessary for twin pregnancy in women with a cervicallength of ≤15 mm was investigated between 16 and 28 weeks of gestation. We included women with a shortenedcervix after a cerclage procedure and visible fetal membranes and cervical dilatation. Thirteen patients underwentpessary insertion and were matched with a control group of 15 patients. Pregnancy and neonatal outcomes werecompared between the groups. We excluded women with major fetal anomalies discovered before or after birth andknown placenta previa. ResultsWomen who underwent pessary insertion were diagnosed with a short cervix (0.65±0.47 vs. 0.66±0.51 cm in thepessary and control groups, respectively; P=0.957) at a gestational age similar to that of the controls (23.29 vs. 25.14weeks, P=0.294). There was no significant difference in gestational age at delivery between them (33.29 vs. 27.29weeks in the pessary and control groups, respectively, P=0.058). The pessary group had a longer interval betweenthe diagnosis and delivery than the control group (60.7±28.3 vs. 22.6±24.5 days, P=0.001). The number of adverseneonatal outcomes was significantly lower in the pessary group (n=7; 28.0%) than in the control group (n=14; 58.3%;P=0.032). ConclusionThe use of a cervical pessary may prolong gestation in twin pregnancies in women with an extremely short cervix untilviable gestational age.