Noninvasive cerclage for the management of cervical incompetence: a prospective study.
OBJECTIVE
The aim of this study was to evaluate the efficacy and safety of a noninvasive cerclage pessary in the management of cervical incompetence.


METHODS
This is a prospective cohort study of all pregnant women treated for cervical incompetence during a 4-year period. Women with known risk factors for preterm delivery had transvaginal ultrasonography every 2-3 weeks after 17-19 weeks of gestation. Those with progressive shortening of cervix diagnosed before 30 weeks were treated with a cerclage pessary when the cervical length was < or = 25 mm. The pessary was electively removed at 34-36 weeks. The course and outcome of pregnancy were recorded.


RESULTS
Thirty-two women were treated with a cerclage pessary. There were nine twin and two triplet pregnancies. Fifteen (47%) had two or more risk factors for preterm delivery. The mean gestational age at cerclage was 23 (17-29) weeks, cervical length 17 (5-25) mm. Two women required delivery before the onset of labor due to severe intrauterine growth restriction and one due to HELLP syndrome. These were excluded from further analysis. In the remaining 29 women, the interval between cerclage and delivery was 10.4 (2-19) weeks, mean gestational age at delivery 34 (22-42) weeks, and birth weight 2,255 (410-4,045) g. Thirteen (45%) women delivered before 34 weeks. There were a total of 35 live-born infants and four intrapartum fetal deaths (all between 22 and 25 weeks gestation). All women complained of increased vaginal discharge, but no other significant complications were observed that could be attributed to the use of pessary.


CONCLUSIONS
Cerclage pessary may be useful in the management of cervical incompetence. Whether it can be a noninvasive alternative to surgical cerclage merits further investigation.
Acharya
Ganesh
G
Department of Obstetrics and Gynecology, University Hospital of Northern Norway, 9038 , Tromsø, Norway. ganesh.acharya@unn.no
Eschler
Bettina
B
Grønberg
Martin
M
Hentemann
Martha
M
Ottersen
Tom
T
Maltau
Jan Martin
JM
D000328:Adult; D023802:Cerclage, Cervical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D010146:Pain; D010570:Pessaries / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery*; D014590:Uterine Contraction; D014592:Uterine Hemorrhage