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Prematurity

Poster Session 2

(397) Effectiveness of a cervical pessary to prolong pregnancy after an episode of preterm labor

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Randomized controlled trials (RCTs) on using a cervical pessary after an episode of preterm labor (PTL) show contradictive results. This study aims to perform an Individual Participant Data Meta-Analysis (IPD-MA) to assess the effectiveness of a cervical pessary to prolong pregnancy after an episode of PTL.

Study Design:

For this IPD-MA, RCTs were included that randomized pregnant women with a singleton pregnancy between 24-34 weeks with an ceased episode of PTL between cervical pessary or control (no intervention).  This IPD-MA followed the PRISMA-IPD guidelines.  Co-primary outcomes were: interval between randomization and delivery, delivery < 7 days and a composite of neonatal outcomes (mortality and severe morbidity). Secondary outcomes were maternal and neonatal outcomes according to the core outcomes set for preterm birth(PTB) studies. For all outcomes, a one-step meta-analysis approach was employed.

Results:

Five RCTs were eligible for inclusion of which three were included(n=273 pessary group, n=268 control group). Two trials were excluded since no data was provided. Mean prolongation of pregnancy was 59.3±27.7 days for pessary compared to 54.9±27.1 days for controls with a mean difference of 4.5 days (95% CI -0.08 - 9.0; P-value 0.054). Cervical pessary did not reduce risk of delivery < 7 days (RR 0.87; 95% CI 0.40 - 1.9; P-value 0.31). Moreover, there was no reduction in composite neonatal outcome (7.7% versus 8.2%, RR 0.95; 95% CI 0.53 - 1.7). Readmissions for PTL were lower in the pessary group (45 vs. 77, RR 0.50; 95% CI 0.32-0.77). No differences were found for other secondary maternal or perinatal outcomes (Table 1).    

Conclusion:

In women who went through an episode of PTL, we found no statistical significant beneficial effect for pessary placement in terms of delivery < 7 days, prolongation of pregnancy, PTB, or neonatal outcomes between both groups. Pessary reduced the probability of readmissions for PTL.