Abstract
In 2014, we introduced cervical pessary as an optional treatment for patients with twin pregnancies and a short cervical length. The objective of this study was to evaluate cervical pessary as an intervention to prevent preterm birth in twin pregnancies with a short cervix. Retrospective cohort study of twin pregnancies with a short cervical length (<20mm) at 22-29 weeks. We compared outcomes between patients who received a pessary and controls matched 3:1 according to cervical length (within 5mm) and gestational age (within 1 week). The primary outcome was preterm birth <32 weeks. We also examined gestational age at delivery and days from pessary placement to delivery. Patients with cerclage were excluded. All patients received vaginal progesterone. Sample size was calculated to have 80% power to detect a difference in preterm birth <32 weeks from 33% to 16.5%. 19 patients received a cervical pessary and they were compared to 57 matched controls. As expected (due to matching), baseline gestational age (25.5 +/- 2.2 vs. 25.8 +/- 2.2 weeks, p=0.626) and cervical length (10.6 +/- 3.6 vs. 11.8 +/- 4.6 mm, p=0.240) were similar between the groups. Outcome data from 2 ongoing pregnancies with pessaries and their 6 controls were limited to information available at time of submission (preterm birth <32 weeks). The incidence of spontaneous preterm birth <32 weeks was significantly lower in the pessary group (1/19, 5.3% vs. 17/57, 31.5%, p=0.032), and the time from pessary placement to delivery was significantly longer by 12.5 days (66.2 +/- 18.4 vs. 53.7 +/- 26.2 days, p=0.036). Gestational age at delivery was 1.6 weeks later in the pessary group, but this did not reach statistical significance (34.7 +/- 2.8 vs. 33.1 +/- 4.2 weeks, p=0.095). For twin pregnancies with a short cervix, cervical pessary appears to prolong pregnancy and reduce the risk of preterm birth <32 weeks. A large randomized trial should be performed to verify these exciting retrospective findings.
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