title: Comparative assessment of arabin pessary, cervical cerclage and medical management for preterm birth prevention in high-risk pregnancies.
abstract: 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.
  
  
  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.
authors.affiliation: a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia.
authors.forename: Sergey V
authors.initials: SV
authors.lastname: Barinov
authors.affiliation: a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia.
authors.forename: Irina V
authors.initials: IV
authors.lastname: Shamina
authors.affiliation: a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia.
authors.forename: Oksana V
authors.initials: OV
authors.lastname: Lazareva
authors.affiliation: a Russian Ministry of Healthcare, State Budget Educational Institution of Higher Professional Education "Omsk State Medical Academy" , Omsk , Russia.
authors.forename: Yuliya I
authors.initials: YI
authors.lastname: Tirskaya
authors.affiliation: b Perinatal Centre, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital" , Omsk , Russia.
authors.forename: Vyacheslav V
authors.initials: VV
authors.lastname: Ralko
authors.affiliation: b Perinatal Centre, Budget Healthcare Omsk Region Institution "Regional Clinical Hospital" , Omsk , Russia.
authors.forename: Lyudmila L
authors.initials: LL
authors.lastname: Shkabarnya
authors.affiliation: c Federal State Autonomous Educational Institution "Peoples' Friendship University of Russia" , Moscow , Russia.
authors.forename: Galina B
authors.initials: GB
authors.lastname: Dikke
authors.affiliation: d ZAO "Pentkroft Pharma" , Moscow , Russia , and.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kochev
authors.affiliation: e OOO "Alpha-EmBio" , Omsk , Russia.
authors.forename: Lyudmila L
authors.initials: LL
authors.lastname: Klementyeva
mesh_terms: D023802:Cerclage, Cervical / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010570:Pessaries / Q000009:adverse effects; D010920:Placenta / Q000002:abnormalities; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000008:administration & dosage; D011446:Prospective Studies; D011897:Random Allocation; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000453:epidemiology
chemical_list: D011374:Progesterone
keywords: Pessary; abnormal placental location; cervical incompetence; circular cervical cerclage; preterm labour