CERVICAL PESSARY TO PREVENT PRETERM BIRTH IN ASYMPTOMATIC HIGH-RISK WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Objective To evaluate the efficacy and safety of cervical pessary to prevent preterm birth and adverse perinatal outcomes in asymptomatic high-risk women. Data Sources MEDLINE, EMBASE, POPLINE, CINAHL, and LILACS (from their inception to October 31, 2019), Cochrane databases, Google Scholar, bibliographies, and conference proceedings. Study Eligibility Criteria Randomized controlled trials that compared cervical pessary with standard care (no pessary) or alternative interventions in asymptomatic women at high risk for preterm birth. Study Appraisal And Synthesis Methods The systematic review was conducted according to the Cochrane Handbook guidelines. The primary outcome was spontaneous preterm birth Results Twelve studies (4687 women and 7167 fetuses/infants) met the inclusion criteria: 8 evaluated pessary vs no pessary in women with a short cervix, 2 assessed pessary vs no pessary in unselected multiple gestations, and 2 compared pessary vs vaginal progesterone in women with a short cervix. There were no significant differences between the pessary and no pessary groups in the risk of spontaneous preterm birth Conclusion Current evidence does not support the use of cervical pessary to prevent preterm birth or improve perinatal outcomes in singleton or twin gestations with a short cervix and in unselected twin gestations.