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173: A comparison of cervical cerclage and vaginal pessaries in the prevention of spontaneous preterm birth in women with a short cervix

      Objective

      Cervical cerclage and vaginal pessaries are both used as treatment strategies for the prevention of spontaneous preterm birth. Our objective was to compare pregnancy and neonatal outcomes in women who had either an ultrasound or exam-indicated cervical cerclage or a vaginal pessary placed for the treatment of a short cervix (<25 mm).

      Study Design

      This was an IRB-approved retrospective study comparing women with singleton pregnancies who had either a cervical cerclage or a vaginal pessary placed for the treatment of a short cervix (<25 mm) between November 2009 through December 2013. Pregnancy and perinatal outcomes were compared, including risk of preterm delivery <34 weeks’ gestation or <37 weeks’ gestation, a composite of adverse neonatal outcomes, and other pregnancy complications.

      Results

      105 women were identified who received a cervical cerclage (n=55) or a vaginal pessary (n=50) for the treatment of a short cervix, of which delivery outcomes were available for 91 (50 in the cerclage group, 41 in the pessary group). Baseline demographic characteristics were similar between the two groups. There were no differences in preterm deliveries before 34 weeks’ gestation (RR 0.94; 95% CI 0.52-1.69) or 37 weeks’ gestation (RR 0.82; 95% CI 0.55-1.3). Median gestational age at placement was earlier for the cerclage group (20.3 vs 24.6 weeks, p<0.01). There were no differences in mode of delivery, birth weight, Apgar scores, or adverse perinatal outcomes. Chorioamnionitis and vaginal bleeding were higher in the cerclage group (table).

      Conclusion

      Vaginal pessaries appear to be equally efficacious to cervical cerclage in prevention of preterm deliveries and adverse neonatal outcomes in singleton pregnancies with a short cervix. They may be a more appealing option at later gestational ages and may be associated with fewer complications, such as chorioamnionitis and vaginal bleeding.
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      Characteristics and pregnancy outcomes in women who had a cervical cerclage or a vaginal pessary placed for the treatment of a short cervix in pregnancy
      Data are given as mean ± SD, median ± interquartile range, n (%) or relative risk (95%) CI. The composite of adverse neonatal outcomes included perinatal death, neonatal ICU stay >30 days, respiratory distress syndrome requiring intubation, sepsis, neonatal seizures, intraventricular hemorrhage, necrotizing enterocolitis, or 5 minute Apgar score <7.