Retrospective Cohort Study of Cervical Pessary Use in Women with Short Cervix at Risk of Preterm Delivery

A paucity of effective interventions exists for the prevention of preterm birth (PTB). Renewed interest has focused on cervical pessaries, which have the benefits of being inexpensive, nonsurgical, and easily inserted and removed. In this study, we aim to describe our experience with this device in a Canadian tertiary care centre. Primary outcomes were rates of spontaneous or iatrogenic PTB before 37, 34, and 28 weeks gestation in pregnancies complicated by short cervix treated with cervical pessary. This was a retrospective cohort study of women with singleton, twin, and triplet pregnancies with pessary placement from August 2013 to March 2015 in the Urogynecology Clinic at the Lois Hole Hospital for Women in Edmonton, AB. Included women were deemed to be at high risk of PTB due to short cervix (≤25 mm) found on ultrasound. Among 115 women included, pessaries were placed at a mean gestation of 25.3 weeks. Forty-nine singleton women (52.7%) delivered at term. Of these deliveries, 75% were spontaneous. Rates of PTB before 34 and 28 weeks gestation for all deliveries, respectively, were 37.4% and 10.4%. Removal data were available for 87.8% of patients, and the pessary remained in situ for a mean of 48 days. In this study's high-risk obstetrical population, the rates of preterm birth remained high. The effectiveness of pessary use, particularly when compared to other preventative strategies, remains a topic in need of further investigation. To our knowledge, this is the first study to contribute pessary data from a Canadian population. Peu d'interventions efficaces existent pour prévenir l'accouchement prématuré. Les pessaires suscitent actuellement un intérêt renouvelé. Ils ont l'avantage d'être peu coûteux, de ne nécessiter aucune chirurgie et d'être faciles à insérer et à retirer. Dans cet article, nous décrivons notre expérience avec ce type de dispositif dans un centre de soins tertiaires canadien. Les indicateurs de résultat principaux étaient les taux d'accouchement spontané ou iatrogène avant 37, 34 et 28 semaines de gestation à l'issue de grossesses compliquées par un col de l'utérus court traité au moyen d'un pessaire. Cette étude de cohorte rétrospective portait sur des femmes enceintes d'un, deux ou trois bébés chez qui un pessaire a été mis en place entre août 2013 et mars 2015 à la Clinique d'urogynécologie de l'Hôpital pour femmes Lois Hole d'Edmonton (Alberta). Nous avons retenu les femmes jugées à risque élevé d'accouchement prématuré en rai