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Type: Journal article
Title: Pessaries in multiple pregnancy as a prevention of preterm birth: the ProTwin trial
Author: Hegeman, M.
Bekedam, D.
Bloemenkamp, K.
Kwee, A.
Papatsonis, D.
van der Post, J.
Lim, A.
Scheepers, L.
Willekes, C.
Duvekot, J.
Spaanderman, M.
Porath, M.
van Eyck, J.
Haak, M.
van Pampus, M.
Bruinse, H.
Mol, B.
Citation: BMC Pregnancy and Childbirth, 2009; 9(44):44-1-44-5
Publisher: BioMed Central
Issue Date: 2009
ISSN: 1471-2393
Statement of
Maud A Hegeman, Dick J Bekedam, Kitty WM Bloemenkamp, Anneke Kwee, Dimitri NM Papatsonis, Joris AM van der Post, Arianne C Lim, Hubertina CJ Scheepers, Christine Willekes, Johannes J Duvekot, Marc Spaanderman, Martina Porath, Jim van Eyck, Monique C Haak, Marielle G van Pampus, Hein W Bruinse and Ben Willem J Mol
Abstract: BACKGROUND Multiple pregnancies are at high risk for preterm birth, and therefore an important cause of infant mortality and morbidity. A pessary is a simple and potentially effective measure for the prevention of preterm birth. Small studies have indicated its effectiveness, but large studies with sufficient power on the subject are lacking. Despite this lack of evidence, the treatment is at present applied by some gynaecologists in The Netherlands. METHODS/DESIGN We aim to investigate the hypothesis that prophylactic use of a cervical pessary will be effective in the prevention of preterm delivery and the neonatal mortality and morbidity resulting from preterm delivery in multiple pregnancy. We will evaluate the costs and effects of this intervention. At study entry, cervical length will be measured. Eligible women will be randomly allocated to receive either a cervical pessary or no intervention. The cervical pessary will be placed in situ at 16 to 20 weeks, and will stay in situ up to 36 weeks gestation or until delivery, whatever comes first. The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 7.2% without to 3.9% with a cervical pessary, using a two-sided test with an alpha of 0.05 and a power of 0.80. DISCUSSION This trial will provide evidence on whether a cervical pessary will decrease the incidence of early preterm birth and its concomitant bad neonatal outcome in multiple pregnancies. TRIAL REGISTRATION Current Controlled Trials: NTR 1858
Keywords: Humans
Premature Birth
Treatment Outcome
Clinical Protocols
Pregnancy, Multiple
Pregnancy Trimester, Second
Research Design
Cost-Benefit Analysis
Cervical Length Measurement
Outcome Assessment, Health Care
Rights: © Hegeman et al. 2009 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: 10.1186/1471-2393-9-44
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Obstetrics and Gynaecology publications

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