Safety and efficacy of the cervical pessary combined with vaginal progesterone for the prevention of spontaneous preterm birth

Introduction: The aim of this study was to evaluate the safety and efficacy of the combined treatment of cervical pessary and endovaginal progesterone for the prevention of spontaneous preterm birth (SPB) in women with a short cervical length (CL) between 20 and 24 weeks of gestation. Materials and methods: This is a prospective study of women with a singleton pregnancy and a sonographically detected mid-trimester CL <= 25 mm. The primary outcome measure was spontaneous delivery before 34 weeks (238 days) of gestation. Results: The study sample consisted of 90 women with a mean CL of 14.2 mm (SD = 6.5 mm). Of the women, 34.4% had at least one risk factor for SPB; 7.8% delivered preterm before 34 weeks of gestation, and 25.6%, before 37 weeks. Neonatal death occurred in two (2.2%) cases due to respiratory distress syndrome. Lower body mass index values, history of preterm delivery and number of second trimester miscarriages were independently associated with delivery before 34 weeks. Conclusion: The combination of vaginal progesterone and cervical pessary for the prevention of SPB in women with a short cervix is safe and well tolerated. This therapy was associated with pregnancy prolongation, reduced prematurity rate and a low rate of perinatal complications.