Effectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of preterm labor: a systematic review and individual patient data meta-analysis

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dc.contributor.authorBreuking, S.H.
dc.contributor.authorDe Ruigh, A.A.
dc.contributor.authorMerced, C.
dc.contributor.authorEekelen, R.V.
dc.contributor.authorWely, M.V.
dc.contributor.authorDijk, C.E.V.
dc.contributor.authorPratcorona, L.
dc.contributor.authorCarreras, E.
dc.contributor.authorMol, B.W.
dc.contributor.authorSaccone, G.
dc.contributor.authorPajkrt, E.
dc.contributor.authorGoya, M.
dc.contributor.authorHermans, F.J.
dc.date.issued2025
dc.descriptionA Spanish version of the abstract is available at the end of the article.
dc.description.abstractBackground: Randomized controlled Trials (RCTs) show conflicting results on the effectiveness of a cervical pessary after an arrested episode of preterm labor (PTL) aiming to prolong pregnancy. Objective: To assess the effectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of PTL by utilizing individual participant data (IPD) meta-analysis. Data sources: Databases Central, Embase, Medline, and clinical trial databases (ClinicalTrials.gov, ISRCTN, EU-CTR) were searched from inception until January 2024. Study Eligibility Criteria Randomized controlled trials investigating individuals between 24⁺⁰ and 34⁺⁰ weeks of gestation with an arrested episode of PTL and who were subsequently randomized to cervical pessary or no intervention. Study Appraisal and Synthesis Methods: Studies were assessed for data integrity and risk of bias. Main outcomes were prolongation of pregnancy >7 days, interval between randomization and delivery, and a composite of adverse neonatal outcome. A one-step meta-analysis approach was employed, and the intention-to-treat principle was applied. Results: Four RCTs had IPD available. In singleton pregnancies (total N=546; 275 individuals in the pessary group, 271 individuals in the control group), pessary placement did not decrease delivery risk within 7 days (relative risks [RR] 0.87; 95% confidence intervals [CI] 0.40–1.9), prolong pregnancy (mean differences 4.5 days; 95% CI –0.08 to 9.0), nor reduce the risk of adverse neonatal outcomes (RR 0.95; 95% CI 0.53–1.7). The incidence of readmissions for a new episode of PTL was significantly less frequent in the cervical pessary group (RR 0.66, 95% CI 0.50–0.85). Two studies investigating multiple pregnancies (N=167, 84 individuals in the pessary group, 83 individuals in the control group) were identified, showing contradictory results that could not be explained by study differences. Therefore, merging IPD and pooling of was uninformative. Conclusion: In individuals with a singleton pregnancy with an episode of PTL between 24 and 34 weeks of gestational age, pessary placement does not prevent delivery within 7 days, preterm birth, or neonatal outcomes. A pessary might reduce the probability of readmissions for PTL. El resumen está disponible en Español al final del artículo.
dc.description.statementofresponsibilitySofie H. Breuking, Annemijn A. de Ruigh, Carme Merced, Rik van Eekelen, Madelon van Wely, Charlotte E. van Dijk, Laia Pratcorona, Elena Carreras, Ben W. Mol, Gabriele Saccone, Eva Pajkrt, Maria Goya, Frederik J. Hermans
dc.identifier.citationAmerican Journal of Obstetrics and Gynecology MFM, 2025; 7(7):101690-1-101690-13
dc.identifier.doi10.1016/j.ajogmf.2025.101690
dc.identifier.issn2589-9333
dc.identifier.issn2589-9333
dc.identifier.orcidMol, B.W. [0000-0001-6887-0262] [0000-0001-8337-550X]
dc.identifier.urihttps://hdl.handle.net/2440/147675
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1082548
dc.rights© 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
dc.source.urihttps://doi.org/10.1016/j.ajogmf.2025.101690
dc.subjectarrested; ceased; cervical pessary; individual participant data meta-analysis; pessary; preterm birth; preterm labor; threatened
dc.subject.meshHumans
dc.subject.meshPremature Birth
dc.subject.meshPregnancy, Prolonged
dc.subject.meshPregnancy Outcome
dc.subject.meshPessaries
dc.subject.meshPregnancy
dc.subject.meshFemale
dc.subject.meshObstetric Labor, Premature
dc.subject.meshRandomized Controlled Trials as Topic
dc.titleEffectiveness of a cervical pessary in prolongation of pregnancy after an arrested episode of preterm labor: a systematic review and individual patient data meta-analysis
dc.typeJournal article
pubs.publication-statusPublished

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