Cervical Pessary Versus Vaginal Progesterone to Prevent Preterm Birth in Women with a Singleton Pregnancy and a Short Cervix: A Systematic Review and Meta-Analysis.

Abstract

Vaginal progesterone (VP) is the recommended intervention for preventing preterm birth (PTB) in women with short cervix and singleton pregnancy. However, cervical pessary (CP) has been proposed as a simpler alternative. This study compares the efficacy and safety of both interventions. A systematic review and meta-analysis included randomized controlled trials (RCTs) from PubMed, CENTRAL, Scopus, Google Scholar, and Web of Science (up to November 2024). Based on heterogeneity, fixed- or random-effects models were used to analyze dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD), both with 95% confidence intervals (CI). Five RCTs with 1,427 patients were analyzed. No significant differences were found between CP and VP in PTB before 37 weeks (RR: 1.08, 95% CI: 0.87, 1.34), 34 weeks (RR: 1.08, 95% CI: 0.80, 1.44), or 28 weeks (RR: 1.42, 95% CI: 0.86, 2.33), time from randomization to delivery (MD: -0.13 h, 95% CI: -6.08, 5.82), maternal infection (RR: 0.98, 95% CI: 0.74, 1.30), neonatal/fetal mortality (RR: 1.19, 95% CI: 0.69, 2.06), neonatal sepsis (RR: 0.73, 95% CI: 0.36, 1.50), intraventicular hemorrhage (IVH; RR: 1.02, 95% CI: 0.23, 4.42), or necrotizing enterocolitis (NEC; RR: 3.36, 95% CI: 0.93, 12.22). However, CP significantly increased vaginal bleeding (RR: 2.79, 95% CI: 1.35, 5.77, p = 0.01). CP showed no clinical benefit in prolonging pregnancy, reducing PTB rates, or improving maternal or neonatal outcomes compared to VP. CP was associated with an increased risk of vaginal bleeding. However, these findings should be interpreted cautiously due to limited data.