Using cervical pessary to prevent preterm birth for women with cervical incompetence

Giving birth before term contributes to more than half of the deaths of newborn babies. Cervical weakness is a common cause, although, its firm diagnosis is not standardised and may be based on a woman's history, including two or more second-trimester pregnancy losses. Different management techniques have been tried, and, include tightening the cervix with a stitch to prevent its premature opening. Although it is a simple operation, it requires anaesthesia and can have bleeding complications and cause infection and pregnancy loss. Closing the cervix with a silicone ring (cervical pessary) that is removed at around 37 weeks is a simple, non-invasive alternative that might replace the cervical stitch operation. To date, there is no reliable evidence from well-designed randomised controlled trials to show that a cervical pessary is beneficial. One non-randomised study showed that about half of the pessary users complained of increased vaginal discharge after the use of the cervical pessary. Three randomised controlled trials are ongoing in pregnant women with a short cervix.