The importance of experience in using cervical pessary for prevention of preterm birth

Abstract

Cervical pessary is a new treatment for preterm birth and have obtained a lot of space in clinical practice because its real efficacy, which unconsidered the bias produced by some research. There is a lack of evidence about cervical pessary in many aspects and only those who handle this device every day can note and call for attention. Experience is the central point about cervical pessary in this article, and important centers with training and expertise must be taken the front of this issue, because low experience probably is one of the causes of contradictory results in literature. In fact, we have a lot of aspects that need attention and never were treated because always the efficacy is questioned and do not open space for other important aspects. We have a lot of o issues to discuss during this article such as the indication of a cervical pessary, the needs of guidelines about pessary, including a learning curve of pessary treatment, the relevant aspects about insertion of the device, its association with other medications, needs for hospitalization, which is the best management for the vaginal discharge pessary related, how to handle the pelvic pain after insertion, the urinary symptoms, the obstipation, and the inhibition of preterm labor during pessary treatment, and finally, what are the relevant aspects about the withdrawal of cervical pessary?