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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(01): 053-058
DOI: 10.1055/s-0038-1676511
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Use of the Pessary in the Prevention of Preterm Delivery

Uso do pessário na prevenção de parto pretermo
Thayane Delazari Corrêa
1   Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Ester Gomes Amorim
1   Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Jade Aimée Guimarães Tomazelli
1   Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Mário Dias Corrêa  Júnior
1   Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
› Author Affiliations
Further Information

Publication History

15 August 2018

22 October 2018

Publication Date:
04 February 2019 (online)

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Abstract

Objective The gestational complication most associated with perinatal mortality and morbidity is spontaneous preterm birth with gestational age < 37 weeks. Therefore, it is necessary to identify its risk factors and attempt its prevention. The benefits of the pessary in prematurity are under investigation. Our objective was to analyze the use of the pessary in the prevention of preterm births in published studies, and to compare its efficacy with other methods.

Methods Randomized clinical trials published between 2010 and 2018 were selected from electronic databases. Studies on multiple gestations were excluded.

Results Two studies were in favor of the pessary as a preventive method, one study was contrary to the method and another two showed no statistically significant difference. The meta-analysis showed no statistical difference with the use of a cervical pessary in the reduction of births < 37 (odds ratio [OR]: 0.63; confidence interval [95% CI]: 0.38–1.06) and < 34 weeks (OR: 0.74; 95% CI: 0.35–1.57)

Conclusion The pooled data available to date seems to show a lack of efficacy of the cervical pessary in the prevention of preterm birth, although the heterogeneity of the studies made comparisons more difficult.

Resumo

Objetivo O parto com idade gestacional < 37 semanas é a complicação gestacional mais associada à mortalidade e morbidade perinatal, sendo necessária a identificação de seus fatores de risco e a tentativa de sua prevenção. Os benefícios do pessário na prematuridade estão sendo investigados. Nosso objetivo foi analisar os estudos publicados sobre uso do pessário na prevenção do parto pretermo e comparar sua eficácia perante outros métodos.

Métodos Foram selecionados estudos clínicos randomizados publicados entre 2010 e 2018, extraídos de bases eletrônicas de dados. Estudos de gestações múltiplas foram excluídos.

Resultados Dois estudos se mostraram a favor do pessário como método preventivo, um estudo foi contrário ao método, e outros dois não demonstraram diferença estatisticamente significativa. A meta-análise não mostrou diferença significativa no uso do pessário na redução de nascimentos < 37 (razão de chance [RC]: 0,63; intervalo de confiança [IC 95%]: 0,38–1,06) e < 34 semanas (RC: 0,74; IC 95%: 0,35–1,57).

Conclusão Os dados agrupados disponíveis até o momento parecem mostrar uma falta de eficácia do pessário cervical na prevenção do parto pretermo, embora a heterogeneidade dos estudos tenha dificultado as comparações.

Keywords

pessary - preterm birth - delivery - premature - short cervix

Palavras-chave

pessário - nascimento prematuro - parto - prematuridade - colo curto
 

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