Efficacy and Safety of Cervical Pessary in Decreasing the Preterm Labor in Symptomatic Pregnant Women: A Randomized Clinical Trial

Background & Objective: Pessary is a silicone, rubber or plastic device, available in different shapes and sizes, which may prevent preterm labor in some pregnant women. Materials & Methods: We enrolled >18-year-old women with gestational age between 24 weeks and 0 days to 34 weeks and 0 days, admitted to hospital with signs/symptoms of preterm labor (threatened preterm labor) and shortened cervical length (<25 mm in ultrasound measurement). Included subjects were randomly allocated to 2 groups. In first group a cervical pessary was placed for patient in lithotomy position. In second group no pessary was inserted and patients received only the routine standard institutional treatments. Results: Demographic characteristics, Body Mass Index, mean cervical length, parity status, fertilization type (natural, assisted) and route of delivery had no statistically significant difference in 2 studied groups. Although gestational age at which patient had experienced her first preterm labor episode was similar in 2 groups, gestational age at delivery was higher in pessary group compared with expectant management group (38.64 weeks versus 35.80 weeks which was statistically significant). Neonatal outcome measures (like rate of respiratory distress, orotracheal intubation, low birth weight, NICU admission, fetal death, etc.) were better (statistically significant) in pessary group. Conclusion: Using cervical pessary after successful control of a threatened preterm labor episode in women with short cervix can postpone the labor significantly, leading to increased gestational age and improved neonatal outcome.