Put a Ring on It? Pessaries for Preventing Preterm Birth in Multiple Pregnancies

Allison Bryant, MD, MPH

Cervical pessary placement in women with multiple pregnancies did not reduce overall incidence of preterm birth, but seemed to help those who also had short cervix.

Preterm birth results in a high burden of morbidity and mortality worldwide; moreover, effective interventions to lower risk for early delivery (particularly in the setting of multiple gestations) are few and far between. Dutch investigators conducted a large randomized trial to determine whether second-trimester cervical pessary placement reduces risk for preterm birth in women with multiple pregnancies.

Of 813 women, 403 had a ring pessary fit to encircle the cervix at 16 to 20 weeks; 410 women in the control group received no pessary but had otherwise similar obstetric care. The groups did not differ regarding median gestational age at delivery, occurrence of poor perinatal outcomes, or maternal morbidity. In a subgroup analysis of women with cervical lengths <38 mm, poor perinatal outcomes were less likely in the pessary group (12% vs. 29%; P=0.01 for interaction), and risk for early preterm delivery (<32 weeks) was significantly lower in the pessary group.

Citation(s):

Liem S et al. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): A multicentre, open-label randomised controlled trial. Lancet 2013 Aug 5.