Alternative Treatment for a Short Cervix: The Cervical Pessary
Section snippets
Pessary for Cervical Insufficiency
The first report on the use of a ring pessary, the Bakelite ring, for the treatment of incompetent cervix, was published in 1959 in the Lancet by Cross.7 A series of 13 patients is described, wherein the Bakelite ring is pushed up and around the cervix, to the level of the internal os. The indications for placement are noted as incompetent cervix (4 patients), history of cervical lacerations (8 patients), and a didelphys uterus (1 patient). The article describes a history of pregnancy loss
Guidelines for Pessary Placement
The following describes basic guidelines to be considered when offering placement of a pessary for prevention of spontaneous preterm birth.
- 1
Identify the population with a history of spontaneous preterm birth or cervical length shortening at <25 mm on transvaginal ultrasound.
- 2
Ensure that the patient does not have an infection or has signs or symptoms of active preterm labor.
- 3
Counsel and inform the patient that there is yet not strong evidence that a cervical pessary can prevent spontaneous preterm
Conclusions
Conventional cervical cerclage can be associated with complications and is not without risk.19 The cervical pessary may offer a safe and easy alternative to cerclage for the treatment of cervical insufficiency and prevention of preterm birth. Several types of pessaries have been used and shown to be effective in various observational trials. Cerclage pessary is a relatively noninvasive, operator-independent, cost-effective outpatient procedure. Although this modality has been described for 50
References (20)
Treatment of habitual abortion due to cervical incompetence
Lancet
(1959)Simple treatment of the incompetent cervical os
Am J Obstet Gynecol
(1961)- et al.
Births: final data for 2005
Natl Vital Stat Rep
(2007) - et al.
From concept to practice: the recent history of preterm delivery prevention. Part I: cervical competence
Am J Perinatol
(2006) - et al.
The length of the cervix and the risk of spontaneous premature delivery
N Engl J Med
(1996) A new method of operative treatment for habitual abortion in the second trimester of pregnancy
Antiseptic
(1955)Suture of the cervix for inevitable miscarriage
J Obstet Gynaecol Br Emp
(1957)Pessaries for the treatment of incompetent cervix and premature delivery
Obstet Gynecol Surv
(2000)The incompetent cervical os and the pessary
Am J Obstet Gynecol
(1963)Pessary treatment of the incompetent cervical os
Obstet Gynecol
(1968)