337: Arabin cervical pessary with vaginal progesterone versus vaginal progesterone for preventing preterm delivery

Abstract

Preterm birth is the leading cause of perinatal morbidity and mortality. Vaginal progesterone and Arabin cervical pessary are both considered as preventive treatments in women at risk for preterm birth. However, there is little evidence as to which of these two interventions is the preferred management. The objective was to compare the rate of preterm delivery in pregnant women with a short cervical length managed with Arabin cervical pessary and vaginal progesterone versus vaginal progesterone alone This was a retrospective cohort study of singletons pregnancies managed in two tertiary medical centers between September 2011 and May 2017. One center utilized the combined treatment of Arabin cervical pessary and vaginal progesterone (study group) and the second utilized vaginal progesterone approach (control group). During the study period, a total of 202 pregnant women who underwent vaginal ultrasonography between 15-29 weeks gestation. They all had short cervical length (≤25 mm). Among them 94 (46.5%) and 108 (53.5%) patients were in the study and control group respectively. A significantly higher rate of patients in the study group had either a history of cervical incompetence (9.6% vs 0.9% respectively, P=0.006) or cervical surgery (7.9% vs 0% respectively, P=0.003). Despite having shorter cervical length at recruitment (14.3±5.9 vs 16.9±5.7 respectively, P=0.002) the rate of spontaneous delivery<34 weeks gestation was lower in the study group (7.4% vs 17.6% respectively, P=0.036) and they delivered one week later compared to the control group (37.2±2.1 vs 36.2±3.7 respectively, P=0.02). We found that for pregnant women with singletons and who had a short cervical length, the combined treatment of Arabin cervical pessary and vaginal progesterone had lower rate of preterm delivery<34 weeks of gestation and prolonged gestation compared to those women who were treated with vaginal progesterone alone.