Arabin cerclage pessary in the management of cervical insufficiency

Abstract

Objective: To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency. Methods: The pregnancy outcome of 20 women carrying singleton pregnancy referred for suspected cervical insufficiency and chose Arabin cerclage pessary for treatment from 2009–2011 were reviewed. Pregnancy outcome were analysed according to presence of risk factors, amniotic fluid sludge, cervical length and gestation at pessary insertion. Results: At presentation, mean cervical length was 1.17 cm (range 0–2.33 cm), mean gestation at pessary insertion and delivery was 20.6 (12.9–26.1) weeks and 32.1 (14.7–40.1) weeks, respectively, and mean prolongation of pregnancy was 11.5 (0.5–25.2) weeks. Overall, 5 (25%) had fetal loss between 14.7–23.1 weeks, while 3 (15%) and 12 (60%) delivered before and after 34 weeks gestation, respectively with no perinatal mortality. Compared with women with cervical length <1.5 cm, all those with cervical length ≥1.5 cm had pregnancy prolonged for ≥49 days (100 vs. 54% p = 0.032) and 86% delivered beyond 34 weeks (86 vs. 46% p = 0.085). Conclusions: Arabin cerclage pessary appears to be optimal for treating women at high risk of cervical insufficiency with a cervical length of 1.5–2.5 cm, while it is an acceptable option for high risk women with cervical length <1.5 cm.

Keywords::

• Cerclage pessary
• cervical insufficiency
• cervical incompetence
• early pregnancy loss
• preterm delivery
• preterm birth
• second trimester miscarriage

Declaration of Interest: The authors report no declarations of interest.