Cervical Pessary Reduces Preterm Births in Women with a Short Cervix

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Use of a cervical pessary may halve the incidence of spontaneous preterm birth in women with a short cervix, a JAMA study finds.

Some 300 women in Italy with a cervical length of 25 mm or less on transvaginal ultrasound at 18-24 weeks' gestation were randomized to receive a pessary or no pessary. Only asymptomatic women with singleton pregnancies and without prior preterm birth were included. Pessaries generally were removed during week 37 of gestation.

The primary outcome — spontaneous preterm birth before 34 weeks' gestation — was significantly lower in the pessary group (7% vs. 15%). Secondary outcomes, such as delivery before 37 weeks and neonatal ICU admission, also favored the pessary group.

Pessary recipients were more likely than controls to have increased vaginal discharge (87% vs. 46%), but pelvic discomfort didn't differ between the groups.

Editorialists, however, urge caution regarding widespread use of pessaries, given that prior research has yielded conflicting results.