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CC BY 4.0 · Rev Bras Ginecol Obstet 2023; 45(12): e764-e769
DOI: 10.1055/s-0043-1776033
Original Article
High Risk Pregnancy

Arabin-pessary or McDonald Cerclage in Cervical Shortening?

Pessário de Arabin ou cerclagem McDonald no encurtamento cervical?
Aytaj Jafarzade 
1   Obstetrics and Gynecology Department, Koru Hospital Ankara, Ankara, Turkey.
,
Sveta Aghayeva 
1   Obstetrics and Gynecology Department, Koru Hospital Ankara, Ankara, Turkey.
,
Tamer Mungan 
1   Obstetrics and Gynecology Department, Koru Hospital Ankara, Ankara, Turkey.
,
Aydan Biri 
1   Obstetrics and Gynecology Department, Koru Hospital Ankara, Ankara, Turkey.
,
Osman Ufuk Ekiz 
2   Statistic Department, Gazi University, Yenimahalle, Ankara, Turkey.
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Abstract

Objective The aim of the present study is to compare the effectiveness of Arabin pessary and McDonald cervical cerclage on preterm delivery.

Methods We conducted a retrospective analysis of data from patients who underwent either Arabin pessary or McDonald cerclage between January 1, 2019, and January 1, 2023. A total of 174 patients were included in the study, with 31 undergoing Arabin pessary and 143 receiving cervical cerclage using the McDonald technique in singleton pregnant women with cervical insufficiency, which applied between 14 and 22 gestational weeks. We included singleton pregnant women with normal morphology, and with normal combined test. The primary outcome was the impact of each method on preterm delivery (< 34 gestational weeks).

Results The weeks of cervical cerclage or pessary application were compatible with each other (p < 0.680). The pessary group had a statistically significant longer time to delivery compared with the Cerclage group (cerclage group mean 30.8 c 7.1 standard deviation [SD] versus pessary group mean 35.1 ± 4.4 SD; p < 0.002). A statistically significant difference was found between the pessary and cerclage groups in terms of delivery at < 34 weeks (p = 0.002). In patients with cervical length between 25 and 15mm and < 15mm, no significant difference was found between the pessary and cerclage groups in terms of delivery week (p < 0.212; p < 0.149). Regardless of the technique applied, no statistically significant difference was observed between cervical length and birth < 34 weeks.

Conclusion Our study found that pessary use for cervical insufficiency is statistically more effective than cervical cerclage surgery in preventing preterm births < 34 weeks in singleton pregnancy.

Keywords

cerclage - pessary - cervical insufficiency - McDonald cerclage

Contributions

Jafarzade A.: Conception, design, writer, supervision, data collection, literature review. Aghayeva S.: Data collection and/or processing. Munga T.: Critical review. Biri A.: Critical review. Ekiz O. U.: Analysis and/or interpretation.




Publication History

Received: 27 April 2023

Accepted: 24 July 2023

Article published online:
23 December 2023

© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606) 75-84
    CrossrefPubMedSearch in Google Scholar
  • 2 Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA, Aboelfadle Mohamed A. Cervical pessary for preventing preterm birth in singleton pregnancies. Cochrane Database Syst Rev 2022; 12 (12) CD014508
    PubMedSearch in Google Scholar
  • 3 Greco E, Gupta R, Syngelaki A, Poon LC, Nicolaides KH. First-trimester screening for spontaneous preterm delivery with maternal characteristics and cervical length. Fetal Diagn Ther 2012; 31 (03) 154-161
    CrossrefPubMedSearch in Google Scholar
  • 4 To MS, Skentou CA, Royston P, Yu CK, Nicolaides KH. Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study. Ultrasound Obstet Gynecol 2006; 27 (04) 362-367
    CrossrefPubMedSearch in Google Scholar
  • 5 Son M, Grobman WA, Ayala NK, Miller ES. A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate. Am J Obstet Gynecol 2016; 214 (03) 365.e1-365.e5
    CrossrefPubMedSearch in Google Scholar
  • 6 Rozenberg P. Universal cervical length screening for singleton pregnancies with no history of preterm delivery, or the inverse of the Pareto principle. BJOG 2017; 124 (07) 1038-1045
    CrossrefPubMedSearch in Google Scholar
  • 7 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol 2014; 123 (2 Pt 1): 372-379
    CrossrefPubMedSearch in Google Scholar
  • 8 Wood SL, Owen J. Cerclage: shirodkar, McDonald, and modifications. Clin Obstet Gynecol 2016; 59 (02) 302-310
    CrossrefPubMedSearch in Google Scholar
  • 9 Arabin B, Halbesma JR, Vork F, Hübener M, van Eyck J. Is treatment with vaginal pessaries an option in patients with a sonographically detected short cervix?. J Perinat Med 2003; 31 (02) 122-133
    CrossrefPubMedSearch in Google Scholar
  • 10 Cannie MM, Dobrescu O, Gucciardo L, Strizek B, Ziane S, Sakkas E. et al. Arabin cervical pessary in women at high risk of preterm birth: a magnetic resonance imaging observational follow-up study. Ultrasound Obstet Gynecol 2013; 42 (04) 426-433
    CrossrefPubMedSearch in Google Scholar
  • 11 Saccone G, Ciardulli A, Xodo S, Dugoff L, Ludmir J, Pagani G. et al. Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies With Short Cervical Length: A Systematic Review and Meta-analysis. J Ultrasound Med 2017; 36 (08) 1535-1543
    CrossrefPubMedSearch in Google Scholar
  • 12 Celik E, To M, Gajewska K, Smith GC, Nicolaides KH. Fetal Medicine Foundation Second Trimester Screening Group. Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet Gynecol 2008; 31 (05) 549-554
    CrossrefPubMedSearch in Google Scholar
  • 13 Acharya G, Eschler B, Grønberg M, Hentemann M, Ottersen T, Maltau JM. Noninvasive cerclage for the management of cervical incompetence: a prospective study. Arch Gynecol Obstet 2006; 273 (05) 283-287
    CrossrefPubMedSearch in Google Scholar
  • 14 Goya M, Pratcorona L, Merced C, Rodó C, Valle L, Romero A. et al; Pesario Cervical para Evitar Prematuridad (PECEP) Trial Group. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 2012; 379 (9828) 1800-1806
    CrossrefPubMedSearch in Google Scholar
  • 15 Hui SY, Chor CM, Lau TK, Lao TT, Leung TY. Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol 2013; 30 (04) 283-288
    PubMedSearch in Google Scholar
  • 16 Liem SM, van Pampus MG, Mol BW, Bekedam DJ. Cervical pessaries for the prevention of preterm birth: a systematic review. Obstet Gynecol Int 2013; 2013: 576723
    PubMedSearch in Google Scholar
  • 17 Melcer Y, Kovo M, Maymon R, Bar J, Wiener I, Neeman O. et al. Arabin cervical pessary with vaginal progesterone versus vaginal progesterone for preventing preterm delivery. J Matern Fetal Neonatal Med 2020; 33 (20) 3439-3444
    CrossrefPubMedSearch in Google Scholar
  • 18 Pekar-Zlotin M, Melcer Y, Kovo M, Wiener I, Neeman O, Zimerman A. et al. Arabin cervical pessary with vaginal progesterone versus vaginal progesterone for preventing preterm delivery. Am J Obstet Gynecol 2019; 220 (Suppl. 01) S236
    CrossrefPubMedSearch in Google Scholar
  • 19 Karbasian N, Sheikh M, Pirjani R, Hazrati S, Tara F, Hantoushzadeh S. Combined treatment with cervical pessary and vaginal progesterone for the prevention of preterm birth: A randomized clinical trial. J Obstet Gynaecol Res 2016; 42 (12) 1673-1679
    CrossrefPubMedSearch in Google Scholar
  • 20 Owen J, Hankins G, Iams JD, Berghella V, Sheffield JS, Perez-Delboy A. et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009; 201 (04) 375.e1-375.e8
    CrossrefPubMedSearch in Google Scholar
  • 21 Nicolaides KH, Syngelaki A, Poon LC, Picciarellli Gemma, Tul N, Zamprakou A. et al. A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth. N Engl J Med 2016; 374 (11) 1044-1052
    CrossrefPubMedSearch in Google Scholar
  • 22 Putora K, Hornung R, Kinkel J, Fischer T, Putora PM. Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines. BMC Pregnancy Childbirth 2022; 22 (01) 355
    CrossrefPubMedSearch in Google Scholar
  • 23 Alfirevic Z, Owen J, Carreras Moratonas E, Sharp AN, Szychowski JM, Goya M. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol 2013; 41 (02) 146-151
    CrossrefPubMedSearch in Google Scholar
  • 24 Mouzakiti N, Sierra F, Herzeg A, Naimi AA, Reising C, Bahlmann F. et al. The impact of a short cervix and funneling on the outcome in singleton pregnancies treated with an Arabin-pessary or a McDonald cerclage. J Matern Fetal Neonatal Med 2021; 34 (15) 2491-2497
    CrossrefPubMedSearch in Google Scholar