title: Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the effectiveness of cerclage pessary in the prevention of preterm birth in asymptomatic Chinese women with a short cervix at 20 to 24 weeks.
  
  
  METHODS
  Low-risk women carrying singleton pregnancies were screened with transvaginal ultrasound, and those with a cervical length <25 mm at 20 to 24 weeks were recruited into a randomized controlled trial, comparing the prophylactic use of cerclage pessary with expectant management. The analysis was by intent-to-treat. The primary outcome measure was preterm delivery before 34 weeks.
  
  
  RESULTS
  Among 4438 screened women, 203 women (4.6%) met the inclusion criteria and 108 (58%) consented for the study. A total of 53 and 55 women were allocated to pessary and control groups, respectively. There was no difference in background demographics, including the mean cervical length (19.6 mm versus 20.5 mm) and the mean gestational age at randomization (both 21.9 weeks). Delivery before 34 weeks occurred in 9.4% and 5.5% (p = 0.46) in the pessary and the control groups, respectively. No differences in major side effects were noted between the groups.
  
  
  CONCLUSIONS
  In our population, <5% had a cervical length of less than 25 mm at 20 to 24 weeks' gestation. The prophylactic use of cerclage pessary did not reduce the rate of preterm delivery before 34 weeks.
authors.affiliation: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China. anniehui@cuhk.edu.hk
authors.forename: Shuk Yi Annie
authors.initials: SY
authors.lastname: Hui
authors.forename: Chung Ming
authors.initials: CM
authors.lastname: Chor
authors.forename: Tze Kin
authors.initials: TK
authors.lastname: Lau
authors.forename: Terence T
authors.initials: TT
authors.lastname: Lao
authors.forename: Tak Yeung
authors.initials: TY
authors.lastname: Leung
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008423:Maternal Age; D010298:Parity; D010570:Pessaries; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control*; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult