Position Paper of the Task Force for Obstetrics and Prenatal Medicine (AGG – Section Preterm Birth) on the Placement, Removal and Surveillance of the Arabin Cervical Pessary in Patients at Risk for Spontaneous Preterm Birth

Ioannis Kyvernitakis; Holger Maul; Werner Rath; Katrina Kraft; Ruben Kuon; Amr Hamza; Edith Reuschel; Barbara Filsinger; Harald Abele; Yves Garnier; Franz Bahlmann; Ekkehard Schleußner; Richard Berger

doi:10.1055/a-1007-8613

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(11): 1171-1175
DOI: 10.1055/a-1007-8613

GebFra Science

Statement

Georg Thieme Verlag KG Stuttgart · New York

Position Paper of the Task Force for Obstetrics and Prenatal Medicine (AGG – Section Preterm Birth) on the Placement, Removal and Surveillance of the Arabin Cervical Pessary in Patients at Risk for Spontaneous Preterm Birth

Positionspapier der Arbeitsgemeinschaft Geburtshilfe und Pränatalmedizin (AGG – Sektion Frühgeburt) zur Platzierung, Entfernung und Überwachung von Arabin-Zervixpessaren bei Patientinnen mit erhöhtem Frühgeburtsrisiko

Ioannis Kyvernitakis

¹Section of Prenatal Diagnostics and Therapy, Dept. of Obstetrics and Prenatal Medicine, Asklepios Center of Excellence Hamburg, Campus Barmbek, Heidberg-Nord and Wandbek, Hamburg, Germany

,

Holger Maul

²Dept. of Obstetrics and Prenatal Medicine, Asklepios Center of Excellence Hamburg, Campus Barmbek, Heidberg-Nord and Wandbek, Hamburg, Germany

,

Werner Rath

³Dept. of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

,

Katrina Kraft

⁴Dept. of Obstetrics and Gynecology, Harlaching Hospital Munich, Munich, Germany

,

Ruben Kuon

⁵Dept. of Gynecological Endocrinology and Fertility Disorders, University Hospital of Heidelberg, Heidelberg, Germany

,

Amr Hamza

⁶Dept. of Obstetrics and Gynecology, University Hospital Saarland, Homburg, Germany

,

Edith Reuschel

⁷Dept. of Obstetrics and Gynecology, University of Regensburg, Hospital of the Barmherzige Brueder, Clinic St Hedwig, Regensburg, Germany

,

Barbara Filsinger

⁸Dept. of Obstetrics and Gynecology, Diakonissen Hospital Speyer, Speyer, Germany

,

Harald Abele

⁹Center for Mother and Child, University-Hospital Tübingen, Tübingen, Germany

,

Yves Garnier

¹⁰Dept. of Obstetrics and Gynecology, Osnabrück Hospital, Osnabrück, Germany

,

Franz Bahlmann

¹¹Dept. of Obstetrics and Gynecology, Buergerhospital and Clementine Childrenʼs Hospital Frankfurt a. M., Frankfurt a. M., Germany

,

Ekkehard Schleußner

¹²Dept. Of Obstetrics and Prenatal Medicine, University of Jena, Jena, Germany

,

Richard Berger

¹³Dept. of Obstetrics and Gynecology, Marienhospital Neuwied, Neuwied, Germany

› Author Affiliations

Abstract

This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

Zusammenfassung

Dieses Positionspapier beschreibt klinisch wichtige praktische Aspekte der Zervixpessartherapie. Zur Beurteilung der Zervixlänge und um Patientinnen auszuwählen, die von einer Pessartherapie profitieren könnten, wird standardmäßig transvaginaler Ultraschall eingesetzt. Wie bei anderen Behandlungsmodalitäten auch, ist es wichtig, regelmäßig Schulungen zum klinischen Einsatz und zur Pessarplatzierung durchzuführen. Diese Schulungen sind unerlässlich, um eine korrekte Platzierung von Pessaren im Notfall zu gewährleisten, Frühgeburten zu verhindern und die neonatale Ausgangssituation zu optimieren. Pessare sollten nur von medizinischen Fachleuten eingesetzt werden, die nicht nur mit den klinischen Implikationen einer Frühgeburt als Syndrom vertraut sind, sondern auch in der praktischen Anwendung von Pessaren geschult sind. Die folgenden Aussagen zum klinischen Einsatz von Pessaren und deren Entfernung dienen als Ergänzung der vor Kurzem veröffentlichten deutschen S2-Richtlinie zur Prävention und Therapie der Frühgeburt.

Key words

Arabin pessary - preterm birth - prevention - recommendations - placement - removal - surveillance

Schlüsselwörter

Arabin-Pessar - Frühgeburt - Prävention - Empfehlungen - Platzierung - Entfernung - Überwachung

Full Text

References

References
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