Cervical pessary for preterm-birth prevention among pregnant women with a short cervix: A prospective cohort study

Abstract

Objective

Congenital abnormalities or secondary factors are reasons for cervical insufficiency. The Arabin pessary has been widely adopted in several countries to manage the condition. However, its usage has yet to be prevalent in Vietnam. This study aimed to evaluate the success rate of delivery (at 34 weeks or later) after Arabin pessary in pregnant women with a short cervical length (<25 mm) at Hung Vuong Hospital and adverse events.

Materials and methods

A prospective cohort study was conducted on 176 pregnant women, involving singleton pregnancies with gestational ages ranging from 24 to 32 weeks and cervical lengths less than 25 mm. The participants who agreed to the Arabin pessary were monitored periodically, and any adverse events were recorded until spontaneous labor occurred.

Results

From January to October 2022, pregnant women with Arabin pessary placement were followed until delivery at Hung Vuong Hospital. The success rate (birth at 34 weeks or later) was 88.1 % (95 % CI: 82.3–92.5), and the full-term birth rate (at 37 weeks or later) was 64.8 %. Adverse effects included vaginal discharge (29.7 %), fungal vaginitis (8.7 %), and urinary tract infection (5.8 %); neonates admitted to the NICU accounted for 11.4 %. Regression analysis revealed a significant association between a history of preterm birth and the incidence of preterm birth before 34 weeks (OR = 3.4, 95 % CI [1.1–10.5], p = 0.02).

Conclusions

The success birth rate (delivered from 34 weeks or later) was high when placing the cervical pessary in pregnant women with a short cervical length <25 mm. The history of preterm birth was associated with the rate of delivery before 34 weeks of gestation. The results of this cohort study underscore the need for further investigation in large-scale advanced studies to establish a higher level of evidence and ensure the best outcomes for maternal and child health.