A silicone ring known as a cervical pessary could give hope to some expectant mothers at risk for pre-term birth.
Though studies have offered conflicting evidence as to the efficacy of the non-surgical device, a new report found that pregnant women who used the device to keep their cervix closed had a lower rate of pre-term birth at less than 34 weeks.
Women with a short cervix are often at risk for pre-term birth. This is similar to incompetent cervix, which happens when a woman has weaker cervical tissue
Neil Seligman, M.D., an OB/GYN at the University of Rochester Medical Center in New York, noted that preventing pre-term birth begins by modifying risk factors ideally before a woman conceives. Not all doctors screen for cervical length; some only offer it to women who have had a prior spontaneous pre-term birth.
Typically, women who have a shorter cervix and no pre-term birth history are given vaginal progesterone suppositories to help carry infants to term. Those who have had a previous pre-term birth are often candidates for a cerclage, a surgical procedure that involves suturing the cervix closed. A few women may actually benefit from cerclage even before measuring the cervical length depending on their birth history like women with a loss related painless dilation of the cervix, Seligman noted.
New Research on Cervical Pessaries
Gabriele Saccone, M.D., University of Naples Federico II in Italym led a team to conduct a randomized clinical trial on 300 pregnant women with short cervix who did not have a history of pre-term birth. Half of them had a cervical pessary inserted. Those who used the device had a lower rate of spontaneous pre-term birth compared to those who did not use the device.
The results have to be confirmed with more trials, the authors say.
Is There a Place for the Pessary?
Cervical pessaries are available in the U.S., though the one studied was available overseas.
Seligman said he isn’t sure about the future of pessaries to prevent pre-term birth. While the study was unique because it included a group of women that typically would only receive vaginal progesterone and required all of the investigators to be trained in pessary placement, it may not be enough for pessaries to gain traction because vaginal progesterone is shown to have more consistent benefits.
“Nonetheless, not all patients are willing to use vaginal progesterone and insurance coverage can be a significant hurdle,” he said. “The low one-time cost of a pessary (and potential benefit) makes this an excellent option for women who may otherwise go untreated.”