Cervical pessary

Cervical pessary is a medical device used in the management of pregnancy complications, specifically to prevent preterm birth in women with a short cervix. It is a silicone ring or cup that is inserted into the vagina and placed around the cervix to provide mechanical support and potentially reduce the risk of premature cervical dilation and birth.

Indications

Cervical pessaries are primarily indicated for pregnant women who are at high risk of preterm birth due to a short cervical length identified via ultrasound. This condition is often asymptomatic and may be discovered during routine prenatal screenings. Other indications may include a history of late miscarriages or early preterm births.

Mechanism of Action

The exact mechanism by which cervical pessaries prevent preterm birth is not fully understood. However, it is believed that the device helps by supporting the cervix, thereby reducing the pressure on it and preventing its premature dilation. Additionally, it may help in keeping the amniotic sac intact and reducing the risk of ascending infections.

Types

There are various types of cervical pessaries available, differing in size, shape, and material. The most commonly used type is made of silicone, which is preferred for its flexibility, non-toxicity, and hypoallergenic properties.

Procedure

The insertion of a cervical pessary is a relatively simple procedure that can be performed in an outpatient setting. It does not require anesthesia. The pessary is usually inserted during the second trimester of pregnancy, after the cervix has been measured via transvaginal ultrasound. The device can be removed as the pregnancy approaches term, typically around 37 weeks of gestation.

Efficacy

Studies on the efficacy of cervical pessaries in preventing preterm birth have shown mixed results. Some research suggests that in women with a short cervix, the use of a cervical pessary can significantly reduce the rate of preterm birth. However, other studies have not found a significant benefit. The effectiveness of cervical pessaries may depend on individual factors such as the exact cervical length and the presence of other risk factors for preterm birth.

Risks and Complications

The use of cervical pessaries is generally considered safe, with minimal risks. Possible complications include vaginal discharge, irritation, or discomfort. In rare cases, infection or damage to the cervix may occur. It is important for the device to be correctly sized and placed by a healthcare professional to minimize these risks.

Conclusion

Cervical pessaries represent a non-invasive option for the prevention of preterm birth in women with a short cervix. While the evidence on their effectiveness is mixed, they may offer a beneficial intervention for some women at high risk of preterm delivery. Ongoing research and individualized patient assessment are essential to fully understand the role of cervical pessaries in managing pregnancy complications.