title: Cervical Pessary for Preventing Preterm Birth in Singleton 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 singleton gestations with a second trimester short cervix.
  
  
  METHODS
  Electronic databases were searched from their inception until February 2016. We included randomized clinical trials (RCTs) comparing the use of the cervical pessary with expectant management in singletons pregnancies with transvaginal ultrasound cervical length (TVU CL) ≤25 mm. The primary outcome was incidence of SPTB <34 weeks. The summary measures were reported as relative risk (RR) with 95% confidence interval (CI).
  
  
  RESULTS
  Three RCTs (n = 1,420) were included. The mean gestational age (GA) at randomization was approximately 22 weeks. The Arabin pessary was used as intervention in all three trials, and was removed by vaginal examination at approximately 37 weeks. Cervical pessary was not associated with prevention of SPTB <37 (20.2% vs 50.2%; RR 0.50, 95% CI 0.23 to 1.09), <34, <32, and <28 weeks, compared to no pessary. No differences were found in the mean of GA at, interval from randomization to delivery, incidence of preterm premature rupture of membranes and of cesarean delivery, and in neonatal outcomes. The Arabin pessary was associated with a significantly higher risk of vaginal discharge.
  
  
  CONCLUSIONS
  In singleton pregnancies with a TVU CL ≤25mm at 200-246weeks, the Arabin pessary does not reduce the rate of spontaneous preterm delivery or improve perinatal outcome. Individual patient data meta-analysis may clarify whether cervical pessary may be beneficial in subgroups, such as only singleton gestations without prior SPTB or by different CL cutoffs.
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.|Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciardulli
authors.affiliation: Department of Gynaecology and Obstetrics, School of Medicine, University of Udine, Udine, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Xodo
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Reproductive Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dugoff
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Ludmir
authors.affiliation: Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.|Department of Maternal and Fetal Health, Fondazione Poliambulanza, Brescia, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pagani
authors.affiliation: Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.|Department of Woman's and Child's Health, University of Padua, Padua, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Visentin
authors.affiliation: Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.|Department of Woman's and Child's Health, University of Padua, Padua, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.|Feto-Maternal Medicine Unit, Parma University Hospital, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Volpe
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.|Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Maruotti
authors.affiliation: Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.|Department of Obstetrics and Gynecology, Università Roma Tor Vergata, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.|Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martinelli
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000503:physiopathology*; D005260:Female; D006801:Humans; D010570:Pessaries; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*
keywords: cerclage; cervix; meta-analysis; obstetrics; preterm birth; review; transvaginal ultrasound cervix