Comparative assessment of arabin pessary, cervical cerclage and medical management for preterm birth prevention in high-risk pregnancies

• Published in: The journal of maternal-fetal & neonatal medicine 2017-08, Vol.30 (15), p.1841-1846
• Main Authors: Barinov, Sergey V., Shamina, Irina V., Lazareva, Oksana V., Tirskaya, Yuliya I., Ralko, Vyacheslav V., Shkabarnya, Lyudmila L., Dikke, Galina B., Kochev, Dmitry M., Klementyeva, Lyudmila L.
• Format: Article
• Language: English
• Subjects: abnormal placental location; Cerclage, Cervical - adverse effects; cervical incompetence; circular cervical cerclage; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature - physiology; Obstetric Labor Complications - epidemiology; Pessaries - adverse effects; Pessary; Placenta - abnormalities; Pregnancy; Pregnancy, High-Risk; Premature Birth - prevention & control; preterm labour; Progesterone - administration & dosage; Prospective Studies; Random Allocation; Treatment Outcome; Uterine Hemorrhage - epidemiology
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2016.1228054

Objective: This study aimed to compare the efficacy of combined use of Arabin pessary, cervical cerclage and progesterone with progesterone-only management of pregnant women at high risk of preterm birth. Materials and methods: The study included 203 pregnant women at high risk of preterm birth who were randomised to receive Arabin pessary (Group 1, n = 82) and progesterone, circular cervical cerclage and progesterone (Group 2, n = 121) or progesterone treatment only (Group3, controls, n = 50). Patients in the pessary and cerclage group also received progesterone. Results: The use of Arabin pessary combined with progesterone resulted in a 2.5-fold decrease in the rate of vaginal dysbiosis in pregnancy (p = 0.015) and almost three-fold reduction in in the postpartum period (p = 0.037), combined with circular cervical cerclage and progesterone. Suture eruption was observed in 4.3% of women. In patients with abnormal placental location, placental migration was observed in 62.1% of patients in Group I, 52.1% in Group II and a significantly lower proportion of patients (14.0%) in Group III (p = 0.001). Bleeding during pregnancy was observed significantly more often in both comparison groups (p = 0.005). Incidence of intrapartum bleeding was 17.4% (p = 0.011) in Group II and 24.5% in Group III (p = 0.002). Intrapartum chorioamnionitis was observed in 4.3% of patients in Group II and 2.04% of patients in Group III. Conclusions: The use of Arabin pessary compbined with progesterone reduces the rate of infectious complications and bleeding during pregnancy and the postpartum period.