Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

Abstract

Purpose In the present study we sought to compare the efficacy of cervical pessary to that of cerclage in terms of reducing preterm birth rates among women with a short (<25 mm) or ultra-short (<15 and <10 mm) cervix during the ultrasonographic second-trimester assessment.

Method We retrospectively searched the hospital records for singleton pregnancies diagnosed with cervical insufficiency during the second trimester of pregnancy. The McDonald cerclage using a 5mm Mersilene tape was used in all women. An Arabin pessary was used uniformly. In all cases 80 mg of vaginal progesterone gel were administered daily until 37 weeks of gestation.

Results Overall, 294 women (124 (42.2%) with a McDonald cerclage and 170 (57.8%) with placement of an Arabin pessary) were selected for analysis. Preterm birth rates <37 weeks were similar in both groups (C: 30/122 vs. P: 35:165, p=.581) as well as PTB <34 weeks (C: 16/122 vs. 15/150, p=.278). Admission to the NICU and need for CPAP were more prevalent in the cerclage group (p<.001). Analysis of cases with a cervix <15 mm and <10 mm indicated that preterm birth rates remained equal among the groups, while an increased risk of NICU admission was seen in cases with a cervical length <10 mm that were treated with cerclage.

Discussion and Conclusion Cervical pessary may be an alternative to cervical cerclage for women with second-trimester cervical shortening and its effect may persist even among cases with an ultra-short cervix. Future randomized trials are needed to ascertain these findings.

Zusammenfassung

Ziel In der vorliegenden Studie verglichen wir die Wirksamkeit eines Zervixpessars mit der einer Cerclage in Bezug auf die Verringerung der Frühgeburtenrate bei Frauen mit einer kurzen (<25 mm) oder ultrakurzen (<15 und <10 mm) Zervix bei der Zweittrimester-Ultraschalluntersuchung. Methode: Wir durchsuchten retrospektiv die Krankenhausakten nach Einlingsschwangerschaften, bei denen im zweiten Schwangerschaftstrimester eine Zervixinsuffizienz diagnostiziert wurde. Die Cerclage wurde nach McDonald mit einem 5 mm Mersilene-Band bei allen Frauen durchgeführt. Ein Arabin Pessar wurde durchgehend verwendet. In allen Fällen wurde täglich 80 mg vaginales Progesteron-Gel bis zur 37. Schwangerschaftswoche verabreicht.

Ergebnisse Insgesamt wurden 294 Frauen (124 (42,2%) mit einer Cerclage nach McDonald und 170 (57,8%) mit Arabin Pessar) für die Analyse ausgewählt. Die Frühgeburtenrate <37 Wochen war in beiden Gruppen ähnlich (C: 30/122 vs. P: 35/165, p=0,581), ebenso die PTB <34 Wochen (C: 16/122 vs. 15/150, p=0,278). Die Aufnahme in die Neugeborenen-Intensivstation und der Bedarf an CPAP waren in der Cerclage-Gruppe häufiger (p<0,001). Die Analyse von Fällen mit einer Zervixlänge <15 mm und <10 mm ergab, dass die Frühgeburtenraten in beiden Gruppen gleich hoch waren, während bei den Fällen mit einer Zervixlänge <10 mm, die mit einer Cerclage behandelt wurden, ein erhöhtes Risiko für die Aufnahme in die Neugeborenen-Intensivstation bestand.

Diskussion und Schlussfolgerung Das Zervixpessar kann bei Frauen mit einer Zervixverkürzung im zweiten Trimester eine Alternative zur Zervixcerclage sein, und seine Wirkung kann auch bei Fällen mit ultrakurzer Zervix anhalten. Zukünftige randomisierte Studien sind erforderlich, um diese Ergebnisse zu bestätigen.

Keywords

pessary - preterm birth - cervical insufficiency - Arabin - cervical length

Publication History

Received: 05 March 2022

Accepted after revision: 07 September 2022

Accepted Manuscript online:
07 September 2022

Article published online:
07 March 2023

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