PREMATURITY: The pessary could delay delivery - The Lancet

Silicone pessary could effectively delay preterm birth in women at risk 94%. Spanish study, whose findings are published in the April 3 issue of The Lancet shows that the rate of preterm pregnant women at increased risk can be reduced by 27% to 6% with this medical device ring-shaped , very inexpensive. And 95% of women who have worn it, could recommend it.

The pessary is a medical device is inserted into the vagina in women with uterine prolapse (or prolapse) to maintain its position in the uterus. This is a flexible ring of plastic or silicone. The authors recall that prematurity is a major cause of morbidity and mortality for babies. Find a safe and effective way to reduce the number of premature infants is an objective in itself.

Current clinical practice is focused on identifying women at risk of preterm delivery, the management of their risk factors, such as, diabetes and hypertension during pregnancy, close monitoring of women with pregnancies multiple or a history of preterm birth, encouraging smoking cessation, or a balanced diet. Interventions "direct" to prevent premature labor and birth are limited. Certainly, there is cervical cerclage but the technique is rather limited to women with a history of premature births or miscarriages. Of anti-contractions may also be considered in very specific situations.


A need for other proven methods to prevent preterm labor: This test Spanish, controlled trial, conducted by researchers from research institutes and universities funded by the Spanish Health Institute Carlos III has evaluated the effectiveness of here a ring pessary silicone non-drug-inserted into the cervix of women with a short cervix (25mm or less) thus increased risk of preterm delivery. This is the first attempt to use pessaries of the cervix in the prevention of preterm birth. It was conducted in five Spanish hospitals on 385 women aged 18 to 42 years of a child pregnant single. The participating women were randomized to receive a pessary or not. The pessary was removed after 37 weeks gestation or earlier. The researchers analyzed the number of women who had a spontaneous delivery before 34 weeks of pregnancy in each group.

The study suggests that pessaries can reduce the number of premature births before 34 weeks of pregnancy only 6% of women at risk:

· Spontaneous delivery preterm (before 34 weeks) is indeed significantly less frequent in the pessary group, occurring in 6% of group vs. 27% in the control group (OR: 0.18 CI 95% 0.08 to 0.37). This is a 21% reduction in absolute risk.

· The average gestational age at delivery was significantly higher in the pessary group, with births averaged 37.7 weeks vs. 34.9 weeks of pregnancy in the control group.

· As a result, drug treatments are more frequent in the control group.

· Low birth weight, respiratory distress syndrome, sepsis and all complications are less frequent in the pessary.

· The only negative point, the insertion and removal of the pessary frequently reported as painful.

· But 95% of women in the group recommend the pessary device.

The pessary can be an affordable alternative, safe and reliable for preventing preterm birth in pregnant women at high risk of premature birth.