title: Pessary versus cerclage versus expectant management for cervical dilation with visible membranes in the second trimester.
abstract: OBJECTIVE
  We evaluated pessary for dilated cervix and exposed membranes for prolonging pregnancy compared to cerclage or expectant management.
  
  
  METHODS
  Multicenter retrospective cohort study of women, 15-24 weeks, singleton pregnancies, dilated cervix ≥2 cm and exposed membranes. Women received pessary, cerclage or expectant management. Primary outcome was gestational age (GA) at delivery. Secondary outcomes were time until delivery, preterm premature rupture of membranes (PPROM) and neonatal survival.
  
  
  RESULTS
  About 112 women met study criteria; 9 - pessary, 85 - cerclage and 18 - expectant management. Mean GA at delivery was 22.9 ± 4.5 weeks with pessary, 29.2 ± 7.5 weeks with cerclage and 25.6 ± 6.7 weeks with expectant management (p = 0.015). Time until delivery was 16.1 ± 18.9 days in the pessary group, 61.7 ± 48.2 days in the cerclage group and 26.8 ± 33.4 days in the expectant group (p < 0.001). PPROM occurred less frequently and neonatal survival increased in women with cerclage. There was a significant difference in all the perinatal outcomes with cerclage compared with either pessary or expectant management.
  
  
  CONCLUSIONS
  Perinatal outcomes with pessary were not superior to expectant management in women with dilated cervix with exposed membranes in the second trimester in this small retrospective cohort.
authors.affiliation: a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine, Thomas Jefferson University , Philadelphia , PA , USA and.
authors.forename: Alexis C
authors.initials: AC
authors.lastname: Gimovsky
authors.affiliation: a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine, Thomas Jefferson University , Philadelphia , PA , USA and.
authors.forename: Anju
authors.initials: A
authors.lastname: Suhag
authors.affiliation: a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine, Thomas Jefferson University , Philadelphia , PA , USA and.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roman
authors.affiliation: b Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Hofstra North Shore-LIJ School of Medicine , Manhasset , NY , USA.
authors.forename: Burton L
authors.initials: BL
authors.lastname: Rochelson
authors.affiliation: a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel College of Medicine, Thomas Jefferson University , Philadelphia , PA , USA and.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery*; D057832:Watchful Waiting / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Advanced cervical dilation; cerclage; exposed membranes; pessary