Pessaries for the treatment of incompetent cervix and premature delivery

The purpose of this study was to review published articles about using pess aries in women with an incompetent cervix or who are at risk for preterm de livery. A MEDLINE search was performed from 1966 to 2000, with articles pub lished before 1966 being extracted from the reference lists of articles obt ained. Foreign articles were translated into English. Key words included pe ssary, incompetent cervix, and preterm labor. All studies that included pat ient data were included. A variety of studies suggest that pessaries can in crease the percentage of full-term deliveries when used in women with an in competent cervix or at risk for preterm delivery. When looking at women tho ught to have an incompetent cervix, the studies are mostly old case series. One prospective, randomized trial demonstrated no difference between women treated with a pessary and a cerclage. However, 27 weeks was the average g estational age at which therapy was started. In women at risk for preterm d elivery, retrospective studies show an increase in full-term pregnancy rate s with pessary use. One prospective, nonrandomized study also shows an incr ease in full-term pregnancy rate. However, in this study, lower risk patien ts received the pessary. Because of the poor nature of most of the studies, pessaries should not replace cerclage use at this time in women with an in competent cervix. However, pessary use should be considered as adjuncts to cerclage or in women who are not candidates for cerclage. Also, pessary use may be considered in some women at risk for preterm delivery. Randomized p erspective controlled trials are in progress to address the use of pessarie s in these situations. Vaginal pessaries have been reported to be useful in women at risk for pret erm delivery since 1959. Bedrest and cervical cerclage has become standard therapy in the United States for women with an incompetent cervix. However, cerclage is not without risk. Furthermore, advances in ultrasound have all owed us to identify women potentially at risk for preterm delivery by detec ting cervical shortening before dilatation. This ability has raised questio ns concerning how to manage patients with subtle ultrasound changes. This a rticle reviews the published literature concerning the use of pessaries in women with an incompetent cervix or at risk for early delivery. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be a ble to describe the various types of pessaries used during pregnancy, to ex plain their mechanism of action, and to appraise the data surrounding the u se of pessaries to prevent complications of pregnancy.