Use of pessary for cervical insufficiency: a discussion

Abstract

Annually, about 15 million of infants are born prematurely, and preterm birth is associated with an increased risk of neonatal morbidity and mortality. Further, the risk of repeated premature birth is relatively high, as 25% of pregnancies following those interrupted at 23-28 weeks of gestation also result in a preterm birth within the similar time frame. Among the major risk factors of preterm birth is cervical insufficiency, and cervical length measurement is recommended for all pregnant women at 18−21 weeks of gestation. For patients at high risk of late miscarriage and preterm birth, cervical length measurement should be performed weekly from 15 to 24 weeks of gestation. The use of pessary, which reduces amniotic sac pressure on the internal os, has been suggested as an appropriate option to correct cervical insufficiency as it does not require surgery, has low risk of complications and is easy to use. Relevant papers published hitherto report contradictory results, which require further research.