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To compare the effectiveness of cervical pessary and vaginal progesterone in improving long-term development outcomes of children born to women with twin pregnancy and mid-trimester short cervix.
We followed children born to women randomized to pessary or progesterone at ≥24 months of age (NCT02623881; NCT04295187) (Dang et al. 2019)
We randomized 300 women to pessary or progesterone. In the pessary group (N=150), eight women had both twins died, five women had either twin died, and two women (2 sets of twins) were lost to follow-up. Corresponding figures in the progesterone group (N=150) were six, five, and one, respectively. Among women eligible for follow-up, response rates were 85.7% (120 women, 237 children) and 79.7% (114 women, 224 children). Mean age of children at follow-up was 37.7±3.9 months and 37.2±3.7 months. Mean height and weight of children were comparable. The composite of poor outcome was found in 10.5% children in the pessary group versus 15.8% in the progesterone group (relative risk 0.66; 95% confidence interval 0.43-1.01; Table 1). Among surviving children, mean ASQ-3 scores were not significantly different. In children born to women with CL ≤ 28 mm, pessary significantly reduced the poor composite outcome and the risk of abnormal ASQ-3 in the skill of communication, fine motor, problem solving, personal-social (Table 2).
We could not prove that pessary, compared to progesterone, reduces the risk of abnormal developmental outcomes in children born to women with twin pregnancies and mid-trimester short cervix. However, pessary substantially improves the development outcomes in children born to women with a CL ≤ 28 mm.