Cervical pessary for preventing preterm birth in singletons and twin pregnancies: an update systematic review and meta-analysis

Abstract

Objectives

To evaluate the effectiveness of cervical pessary in preventing preterm birth (PTB) and improving perinatal outcomes among singleton and twin pregnancies.

Methods

Electronic databases were systematically searched from their inception until 14 March 2019. Randomized clinical trials comparing the effectiveness of cervical pessary placement with expectant management were included. The primary outcome was the incidence of PTB <34 weeks.

Results

Thirteen studies were included, involving eight studies about singleton and six studies about twin pregnancies. For singleton pregnancies with short cervical length, cervical pessary, comparing with expectant treatment, seemed have no effectiveness in preventing PTB <34 weeks (relative risk, 95% confidence interval, 0.73, 0.42–1.28), <37 weeks (0.69, 0.43–1.09), and <28 weeks (0.79, 0.42–1.48); while for twin pregnancies with short cervical length, cervical pessary also did not reduce the risk of PTB <34 weeks (0.81, 0.49–1.35), <37 weeks (0.93, 0.83–1.05), and <28 weeks (0.72, 0.38–1.38). However, cervical pessary seemed have the effectiveness of reducing the risk of spontaneous PTB <28 weeks (0.50, 0.25–0.99) and low birth weight (<1500 g) (0.68, 0.50–0.94) among twin pregnancies with short cervical length. In addition, cervical pessary increased the rate of vaginal discharge and did not improve perinatal outcomes among both singleton and twin pregnancies.

Conclusions

Comparing with the expectant treatment, the effectiveness of cervical pessary for reducing the risk of PTB remains uncertain. Additional trials are warranted to further evaluate the effectiveness of cervical pessary.

Keywords:

• Cervical pessary
• meta-analysis
• perinatal outcomes
• preterm birth
• transvaginal ultrasound cervix

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Author contributions

Yi-Quan Xiong: Manuscript writing and Data analysis.

Jing Tan: Manuscript writing.

Yan-Mei Liu: Data collection.

Ya-Na Qi and Qiao He: Data collection.

Ling Li: Eligible articles evaluated.

Kang Zou: Eligible articles evaluated.

Xin Sun: Project development.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Natural Science Foundation of China [No. 71704122, 81590955]; the National Key Development Plan for Precision Medicine Research [No. 2017YFC0910004]; the National Science and Technology Major Project [No. 2018ZX10302206]; and “Thousand Youth Talents Plan” of China [No. D1024002].