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Cervical pessary

Janneke van 't Hooft, Johanna H van der Lee, Brent C Opmeer, Aleid G van Wassenaer-Leemhuis, Anneloes L van Baar, Dick J Bekedam, Leonie J P Steenis, Sophie Liem, Ewoud Schuit, Cuny Cuijpers, Elise Bleeker, Margot E Vinke, Noor Simons, Irene M de Graaf, Ben Willem J Mol, Cornelieke van de Beek
OBJECTIVE: We recently found in a randomized clinical trial (ProTWIN) that cervical pessary prevented preterm birth and improved neonatal outcome in women with a multiple pregnancy and a cervical length (CL) <38mm. In this follow-up study we evaluated long-term developmental outcomes in the offspring of these women at three years corrected age. METHODS: We conducted a follow-up study of the ProTWIN trial, a trial in which between 2009 and 2012 asymptomatic women with a multiple pregnancy had been randomized to pessary or no pessary...
February 22, 2018: Ultrasound in Obstetrics & Gynecology
Berna Haliloglu Peker, Erdin Ilter, Hakan Peker, Aygen Celik, Ali Gursoy, Onur Gunaldi
STUDY OBJECTIVE: To demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks and 3 days pregnant woman. To our knowledge, this is the first case of laparoscopic sacrohysteropexy performed at 12th weeks of gestation to be reported in literature. DESIGN: A step-by-step explanation of the surgical procedure (Canadian Task Force classification III) SETTING: Uterine prolapse is very rare condition manifesting in an estimated 10000 to 15000 pregnancies (1)...
February 12, 2018: Journal of Minimally Invasive Gynecology
Michael Barsky, Robert Kelley, Faiz Y Bhora, Anne Hardart
BACKGROUND: Pessaries are a treatment option for pelvic organ prolapse, stress urinary incontinence (SUI), and cervical incompetence. An effective pessary is comfortable, corrects the presenting problem, does not cause adverse effects, and is easy to remove. Discomfort and poor fit limit the usefulness of pessaries for many women. Each patient presents with unique anatomy and thus the effectiveness of commercially available pessaries may be limited by lack of customization. METHOD: A patient presenting with SUI and failed commercial pessary fittings desired nonsurgical treatment...
March 2018: Obstetrics and Gynecology
L Story, J Hutter, T Zhang, A H Shennan, M Rutherford
Preterm birth, defined as birth occurring prior to 37 weeks gestation is a common obstetric complication affecting 8% of pregnancies and is associated with significant morbidity and mortality. Infection/inflammation has been implicated in both the aetiology of preterm birth itself and associated neonatal pulmonary and neurological morbidity. Treatment options are currently limited to prolongation of the pregnancy using cervical cerclage, pessaries or progesterone or administration of drugs including steroids to promote lung maturity and neuroprotective agents such as magnesium sulphate, the timing of which are highly critical...
March 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Gabriele Saccone, Giuseppe Maria Maruotti, Antonia Giudicepietro, Pasquale Martinelli
Importance: Spontaneous preterm birth is a major cause of perinatal morbidity and mortality. It is unclear if a cervical pessary can reduce the risk of spontaneous preterm delivery. Objective: To test whether in asymptomatic women with singleton pregnancies and no prior spontaneous preterm birth but with short cervical length on transvaginal ultrasound, use of a cervical pessary would reduce the rate of spontaneous preterm birth at less than 34 weeks of gestation...
December 19, 2017: JAMA: the Journal of the American Medical Association
Robert M Silver, D Ware Branch
No abstract text is available yet for this article.
December 19, 2017: JAMA: the Journal of the American Medical Association
Limei Zheng, Jun Dong, Yongdong Dai, Yanling Zhang, Libing Shi, Minling Wei, Xiaoying Jin, Chao Li, Songying Zhang
OBJECTIVE: The objective of this study is to evaluate the effectiveness and safety of cervical pessaries for the prevention of preterm birth. METHODS: We searched PubMed, Embase, Web of Science, and other sources from inception to July 2016. This analysis referred to pregnant women with singleton/multiple viable fetus/fetuses, with or without cervical pessary placement. RESULTS: Six randomized control trials and five cohort studies involving 3911 participants were included...
December 17, 2017: Journal of Maternal-fetal & Neonatal Medicine
Sarah R Murray, Sarah J Stock, Jane E Norman
Globally, preterm birth rates are rising and have a significant impact on neonatal morbidity and mortality. Preterm birth remains difficult to prevent and a number of strategies for preterm birth prevention (progesterone, cervical pessaries, cervical cerclage, tocolytics, and antibiotics) have been identified. While some of these show more promise, there is a paucity of evidence regarding the long-term effects of these strategies on childhood outcomes. Strategies used to improve the health of babies if born preterm, such as antenatal magnesium sulfate for fetal neuroprotection and antenatal corticosteroids for fetal lung maturation, show evidence of short-term benefit but lack large-scale follow-up data of long-term childhood outcomes...
December 2017: Seminars in Perinatology
Hugo Madar, Aurélien Mattuizzi, Loïc Sentilhes
No abstract text is available yet for this article.
November 27, 2017: Journal of Perinatal Medicine
Zhen Jin, Liqin Chen, Dongyan Qiao, Astha Tiwari, Chhavi Devi Jaunky, Baiyun Sun, Lina Wang, Hong Yu
OBJECTIVE: To evaluate the efficacy of cervical pessary in the prevention of preterm birth and its influence on pregnancy and maternal outcomes, so as to provide a clinical basis for cervical pessary to prevent premature delivery. METHODS: The databases of PubMed, Web of Science, CNKI, WanFang Data, etc, were used to search for the eligible articles. The relevant data were abstracted by two independent reviewers and performed with Stata 12.0. RESULTS: Pregnancy Result: the PTB rates of pessary and control group before 28, 32, 34, and 37 weeks were analyzed and the combined RR (95%CI) values were 0...
November 20, 2017: Journal of Maternal-fetal & Neonatal Medicine
Georgios Daskalakis, Dimitrios Zacharakis, Marianna Theodora, Panagiotis Antsaklis, Nikolaos Papantoniou, Dimitris Loutradis, Aris Antsaklis
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...
October 21, 2017: Journal of Perinatal Medicine
Rupsa C Boelig, Vincenzo Berghella
Cervical insufficiency can be defined by a combination of obstetric history, cervical dilation on exam, and/or short cervical length in women with prior preterm birth. Options for mechanical intervention include cerclage and pessary. There is evidence to support the benefit of a cervical cerclage in women with singleton gestations who have a diagnosis of cervical insufficiency either based on second trimester painless cervical dilatation leading to recurrent early preterm births, or a history of early spontaneous preterm birth and a second trimester transvaginal ultrasound short cervical length or cervical dilation on exam...
December 2017: Seminars in Perinatology
Bouchra Koullali, Andrea R Westervelt, Kristin M Myers, Michael D House
Preterm birth is the leading cause of neonatal mortality and morbidity worldwide. Spontaneous preterm birth is a complex, multifactorial condition in which cervical dysfunction plays an important role in some women. Current treatment options for cervical dysfunction include cerclage and supplemental progesterone. In addition, cervical pessary is being studied in research protocols. However, cerclage, supplemental progesterone and cervical pessary have well known limitations and there is a strong need for alternate treatment options...
December 2017: Seminars in Perinatology
Caroline A Crowther, Pat Ashwood, Andrew J McPhee, Vicki Flenady, Thach Tran, Jodie M Dodd, Jeffrey S Robinson
BACKGROUND: Neonatal respiratory distress syndrome, as a consequence of preterm birth, is a major cause of early mortality and morbidity. The withdrawal of progesterone, either actual or functional, is thought to be an antecedent to the onset of labour. There remains limited information on clinically relevant health outcomes as to whether vaginal progesterone may be of benefit for pregnant women with a history of a previous preterm birth, who are at high risk of a recurrence. Our primary aim was to assess whether the use of vaginal progesterone pessaries in women with a history of previous spontaneous preterm birth reduced the risk and severity of respiratory distress syndrome in their infants, with secondary aims of examining the effects on other neonatal morbidities and maternal health and assessing the adverse effects of treatment...
September 2017: PLoS Medicine
Lorraine Dugoff, Vincenzo Berghella, Harish Sehdev, A Dhanya Mackeen, Laura Goetzl, Jack Ludmir
OBJECTIVE: To determine if pessary use prevents preterm birth in singleton gestations with a short transvaginal ultrasound cervical length and without a prior spontaneous preterm birth. METHODS: In this open-label multicenter randomized trial we enrolled asymptomatic women with singleton gestations with a transvaginal ultrasound cervical length ≤ 25 mm at 18(0) -23(6) weeks and no prior spontaneous preterm birth. Subjects were randomized to receive the Bioteque cup pessary or no pessary...
September 20, 2017: Ultrasound in Obstetrics & Gynecology
Gabriele Saccone, Fabrizio Zullo, Amanda Roman, Andrew Ward, Giuseppe Maruotti, Pasquale Martinelli, Vincenzo Berghella
OBJECTIVE: To compare the mean transvaginal ultrasound (TVU) cervical length (CL) at midtrimester in screening for preterm birth in in vitro (IVF)-conceived twin pregnancies versus spontaneously-conceived twin pregnancies. METHODS: This was a retrospective cohort study. Potential study subjects were identified at the time of a routine second trimester fetal ultrasound exam at 18 0/7 to 23 6/7-week gestation. All women with twin diamniotic pregnancies screened with a single TVU CL for this trial were included...
September 21, 2017: Journal of Maternal-fetal & Neonatal Medicine
Maud D van Zijl, Bouchra Koullali, Christiana A Naaktgeboren, Ewoud Schuit, Dick J Bekedam, Etelka Moll, Martijn A Oudijk, Wilhelmina M van Baal, Marjon A de Boer, Henricus Visser, Joris van Drongelen, Flip W van de Made, Karlijn C Vollebregt, Moira A Muller, Mireille N Bekker, Jozien T J Brons, Marieke Sueters, Josje Langenveld, Maureen T Franssen, Nico W Schuitemaker, Erik van Beek, Hubertina C J Scheepers, Karin de Boer, Eveline M Tepe, Anjoke J M Huisjes, Angelo B Hooker, Evelyn C J Verheijen, Dimitri N Papatsonis, Ben Willem J Mol, Brenda M Kazemier, Eva Pajkrt
BACKGROUND: Preterm birth is in quantity and in severity the most important topic in obstetric care in the developed world. Progestogens and cervical pessaries have been studied as potential preventive treatments with conflicting results. So far, no study has compared both treatments. METHODS/DESIGN: The Quadruple P study aims to compare the efficacy of vaginal progesterone and cervical pessary in the prevention of adverse perinatal outcome associated with preterm birth in asymptomatic women with a short cervix, in singleton and multiple pregnancies separately...
September 4, 2017: BMC Pregnancy and Childbirth
Laura KarisAllen, Jane Schulz, Catherine Flood, Sue Ross, Kentia Naud
OBJECTIVE: A paucity of effective interventions exists for the prevention of preterm birth (PTB). Renewed interest has focused on cervical pessaries, which have the benefits of being inexpensive, nonsurgical, and easily inserted and removed. In this study, we aim to describe our experience with this device in a Canadian tertiary care centre. Primary outcomes were rates of spontaneous or iatrogenic PTB before 37, 34, and 28 weeks gestation in pregnancies complicated by short cervix treated with cervical pessary...
December 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Carlota Rodó, Sílvia Arévalo, Liesbeth Lewi, Isabel Couck, Bettina Hollwitz, Kurt Hecher, Elena Carreras
BACKGROUND: Fetoscopic LASER coagulation of the placental anastomoses has changed the prognosis of twin-twin transfusion syndrome. However, the prematurity rate in this cohort remains very high. To date, strategies proposed to decrease the prematurity rate have shown inconclusive, if not unfavourable results. METHODS: This is a randomised controlled trial to investigate whether a prophylactic cervical pessary will lower the incidence of preterm delivery in cases of twin-twin transfusion syndrome requiring fetoscopic LASER coagulation...
August 1, 2017: BMC Pregnancy and Childbirth
Bouchra Koullali, Liselotte E M van Kempen, Maud D van Zijl, Christiana A Naaktgeboren, Ewoud Schuit, Dick J Bekedam, Maureen T M Franssen, Sebastiaan W A Nij Bijvank, Marieke Sueters, Marchien van Baal, Marjon A de Boer, Angelo B Hooker, Brenda B J Hermsen, Toon A A M Toolenaar, Joost J Zwart, David P van der Ham, Flip W van der Made, Federico Prefumo, Begoña Martinez de Tejada, Dimitri N M Papatsonis, Anjoke J M Huisjes, Liesbeth H C J Scheepers, Marion E van Hoorn, Tom H M Hasaart, Nico W E Schuitemaker, Karlijn C Vollebregt, Moira A Müller, Inge M Evers, Marinka S Post, Karin de Boer, Henricus Visser, Nico A Mensing van Charante, Josje Langenveld, Nicole Y C Steemers, Ben W J Mol, Martijn A Oudijk, Eva Pajkrt
No abstract text is available yet for this article.
July 6, 2017: BMC Pregnancy and Childbirth
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