Adjunctive pessary therapy after emergency cervical cerclage in patients with protruding fetal membranes - a multicenter cohort study.

Objective: We aimed to compare the perinatal outcomes in women with cervical dilatation with fetal membranes visible before 26 weeks of gestation managed with an adjunctive pessary after emergency cervical cerclage or emergency cerclage alone.

Methods: We performed a retrospective analysis of women with singleton gestation, diagnosed with cervical dilatation accompanied by fetal membranes visible at or beyond the external os, who underwent emergency cervical cerclage. The participants were recruited at 3 tertiary perinatal centers. Adjunctive pessary treatment depended on the choice of the attending physician. The primary outcomes included preterm delivery before 34 weeks of gestation and a live infant discharged home.

Results: Emergency cerclage alone was performed in 35 women, and 39 underwent emergency cerclage and adjunctive pessary therapy. Women in the adjunctive pessary group delivered significantly later (median 36, IQR 32-38 weeks vs 34, IQR 24-37 weeks of gestation; p = 0.03). No statistically significant differences were observed in rates of deliveries <34 weeks and rates of live infants discharged home. A significant prolongation of pregnancy (median 107, interquartile range 52-134 vs median 69, interquartile range 27-99 days; p = 0.02) and reduction in the rates of preterm deliveries <28 (7.7% vs 28.6%; p = 0.03) and <30 weeks of gestation (12.8% vs 34.3%; p = 0.05) were observed in adjunctive pessary group, despite more advanced cervical insufficiency. Adjunctive pessary significantly reduced the risk of delivery <30 weeks (aOR 0.2, 95% CI 0.06-0.7) and <34 weeks of gestation (aOR 0.2, 95% CI 0.05-0.81).

Conclusion: The use of a pessary as an adjunctive therapy after emergency cervical cerclage may be effective in lowering the risk of delivery <30 weeks and may offer a new option for managing women with advanced cervical insufficiency.