Abstract
BackgroundSpontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary.MethodsThis is a retrospective observational study involving 58 pregnancies from 1st January 2013 to 31st December 2019. Inclusion criteria were previous mid-trimester miscarriage and/or preterm birth, previous cervical surgery or short cervical length on routine sonogram. The demographic data, characteristics of each pregnancy and details of outcomes and management were described.ResultsThe majority of women were Malay with mean age and body mass index of 32.9 ± 4.2 years and 27.1 ± 6.3 kg/m2 respectively. The most frequent indications for Arabin pessary insertion were previous mid-trimester miscarriage (46.4%) and early preterm birth (17.2%). A total of 73.4% of these women had the pessary inserted electively at a mean cervical length of 31.6 ± 9.1 mm at median gestation of 15.0 weeks. They were managed as outpatient (56.9%), inpatient (24.1%) or mixed (19.0%) with combination of progestogen (81.0%) and 53.4% received antenatal corticosteroids. Spontaneous preterm birth at or more than 34 weeks gestation occurred in 74.1% with birthweight at or more than 2000 g (82.4%). Despite cervical funneling in 12 women (20.7%), 66.7% delivered at or later than 34 weeks gestation and 2 (16.7%) resulted in miscarriage.ConclusionsInsertion of the Arabin pessary is beneficial to prevent spontaneous preterm birth in pregnant women who are at high risk. In particular, early insertion and close monitoring allows the best possible outcomes.Trial registrationThis study was retrospectively registered with ClinicalTrials.gov (NCT04638023) on 20/11/2020.
Highlights
Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide
The aim of this study was to describe the experience of managing women who were at high risk for spontaneous preterm birth using Arabin pessary
The women included in this study had singleton pregnancies who were high risk for spontaneous preterm birth based on previous spontaneous preterm birth before 34+ 0 weeks or previous cervical surgery such as large loop excision of transformation zone (LLETZ) or loop electrosurgical excision procedure (LEEP) with their gestational age confirmed via dating scans in the first trimester
Summary
Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary. Preterm birth is defined by delivery before 37 completed weeks and is a major cause of perinatal morbidity and mortality [1]. Consequences of preterm birth are among the most common cause of death in children under 5 years of age [2]. The global incidence of preterm birth in 2010 was 11.1% with the highest rate in low income countries [2]. The rate of preterm birth in Malaysia increased between 2010 (8.1%) and 2012 (11.3%) [5]. The cost of management of preterm infants is massive with the mean cost highest in infants with birthweight of less than 1000 g [5]
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