title: Cervical pessary for preventing preterm birth in twin pregnancies with short cervical length: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in twin pregnancies with an asymptomatic transvaginal ultrasound cervical length (TVU CL) in the second trimester.
  
  
  METHODS
  We performed a meta-analysis including all randomized clinical trials (RCTs) comparing the use of cervical pessary (i.e. intervention group) with expectant management (i.e. control group). The primary outcome was incidence of SPTB <34 weeks.
  
  
  RESULTS
  Three trials, including 481 twin pregnancies with short cervix, were analyzed. Two RCTs defined short cervix as TVU CL ≤25 mm and one as TVU CL ≤38 mm. Pessary was not associated with prevention of SPTB, and the mean gestational age at delivery and the mean latency were similar in the pessary group compared to the control group. Moreover, no benefits were noticed in neonatal outcomes.
  
  
  CONCLUSIONS
  Use of the Arabin pessary in twin pregnancies with short TVU CL at 16-24 weeks does not prevent SPTB or improve perinatal outcome.
authors.affiliation: a Department of Neuroscience, Reproductive Sciences and Dentistry , School of Medicine, University of Naples Federico II , Naples , Italy.|b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).
authors.forename: Gabriele
authors.identifier: http://orcid.org/0000-0003-0078-2113
authors.initials: G
authors.lastname: Saccone
authors.affiliation: c Department of Obstetrics and Gynecology , Catholic University of Sacred Heart , Rome , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciardulli
authors.affiliation: d Department of Gynaecology and Obstetrics , School of Medicine, University of Udine , Udine , Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Xodo
authors.affiliation: e Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Reproductive Genetics , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA USA.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dugoff
authors.affiliation: f Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Ludmir
authors.affiliation: b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).|g Fetal Medicine and Cardiology Unit, Department of Obstetrics and Gynecology , University Hospital of Northern Norway. Perinatology Research group , Department of Clinical Medicine , University of Tromso , Norway.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Antonio
authors.affiliation: b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).|h Department of Obstetrics and Gynecology , L. Mangiagalli Fondazione IRCCS Ca'Granada, Ospedale Maggiore Policlinico , Milan , Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Boito
authors.affiliation: b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).|i Department of Surgical Sciences , University of Turin , Turin , Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Olearo
authors.affiliation: b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).|j Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynaecology , Magna Graecia University of Catanzaro , Catanzaro , Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Votino
authors.affiliation: a Department of Neuroscience, Reproductive Sciences and Dentistry , School of Medicine, University of Naples Federico II , Naples , Italy.|b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Maruotti
authors.affiliation: b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).|k Department of Obstetrics and Gynecology , Università Roma Tor Vergata , Rome , Italy.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0002-5525-4353
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: a Department of Neuroscience, Reproductive Sciences and Dentistry , School of Medicine, University of Naples Federico II , Naples , Italy.|b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG).
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martinelli
authors.affiliation: l Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009929:Organ Size; D010570:Pessaries; D011247:Pregnancy; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
keywords: Meta-analysis; cerclage; cervix; review; transvaginal ultrasound