The use of Arabin cervical pessaries in cases of cervical insufficiency at the 2nd trimester of pregnancy for the prevention of spontaneous preterm birth.

Doctoral Dissertation uoadl:2778987 893 Read counter

Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
Deposit date:
Zacharakis Dimitrios
Dissertation committee:
Λουτράδης Δημήτριος, Καθηγητής, Ιατρική, ΕΚΠΑ
Παπαντωνίου Νικόλαος, Καθηγητής, Ιατρική, ΕΚΠΑ
Ροδολάκης Αλέξανδρος, Καθηγητής, Ιατρική, ΕΚΠΑ
Δασκαλάκης Γεώργιος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Γρηγοριάδης Θεμιστοκλής, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Ελευθεριάδης Μακάριος, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Θωμάκος Νικόλαος, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Η χρήση τραχηλικών πεσσών σιλικόνης τύπου "Arabin" στην ανεπάρκεια τραχήλου στο Β΄τρίμηνο της κύησης και η επίπτωσή τους στη συχνότητα του πρόωρου τοκετού.
Translated title:
The use of Arabin cervical pessaries in cases of cervical insufficiency at the 2nd trimester of pregnancy for the prevention of spontaneous preterm birth.
Introduction: 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 between 20 to 24 weeks of gestation.

Materials and Methods: Prospective study of women with a singleton pregnancy and a sonographically detected mid-trimester cervical length ≤25mm. The primary outcome measure was spontaneous delivery before 34 weeks (238 days) of gestation. . Secondary outcome measures were SPB before 37 completed weeks (259 days) of gestation, pregnancy prolongation, birth weight, apgar score, major adverse neonatal outcomes (intraventricular hemorrhage, infant respiratory distress syndrome, septicaemia, or necrotizing entercolitis), admission to the neonatal intensive care unit, use of continuous positive airway pressure, mechanical ventilation and fetal or neonatal death. Once the patients were identified were combined to form two groups. The first group (high-risk group) consisted of women that were found to have in their previous obstetrical and/or gynecological history at least one risk factor for SPB. The second group (low-risk group) consisted of women who were not found to have risk factors for SPB.

Results: The study sample consisted of 90 women with a mean cervical length of 14.2 mm (SD=6.5 mm). 34.4% of the women had at least one risk factor for SPB. 7.8% of the women delivered preterm before 34 weeks of gestation, and 25.6% before 37 weeks. Neonatal death occurred in 2.2% of the cases. Women with lower body mass index (BMI) values, history of preterm delivery and the number of 2nd trimester miscarriages were independently associated with delivery before 34 weeks. Concerning association of primary and secondary study outcomes with the two study groups (table 5) it was found that rates of preterm delivery <34 weeks were similar between low and high-risk pregnancies after the combined treatment with both cervical pessary and vaginal progesterone. However, it was found a significantly greater rate of preterm delivery (<37 weeks) in women with high-risk pregnancies (p=0.005).

Conclusion: 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 a pregnancy prolongation, reduced prematurity rate and a low rate of perinatal complications. Moreover combined treatment may result in prolongation of the pregnancy regardless of the obstetrical and gynecological maternal history. Therefore combined treatment is a feasible and safe option in both low and high-risk women that may result in delaying birth and reducing prematurity.
Main subject category:
Health Sciences
Preterm delivery, Cervical pessary, Cervical insufficiency, Progesterone, Pregnancy
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