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Prevention of preterm birth in obstetrics: Pessary in midwifery

This study discusses the prevention of preterm birth in obstetrics using pessary. It analyzes the results of the PECEP trial and highlights the benefits and side effects of pessary usage. The ProTwin trial for preventing preterm birth in twin pregnancies is also mentioned. The study suggests using TV cervix length measurement and vaginal progesterone for singleton pregnancies, and TV cervix length measurement and pessary for twin pregnancies.

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Prevention of preterm birth in obstetrics: Pessary in midwifery

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  1. Pessaria in de verloskunde: preventie van preterme partus VVOG Lentevergadering 2013 Liesbeth Lewi, UZ Leuven

  2. Preventie preterme partus bij eenling zwangerschap: PECEP trial 18.235 eligible women 6360 declined to participate 11.875 consented 11149 did not meet inclusion criteria: 10568 cervix > 25 mm 351 fetal abnormalities 126 contractions 104 bleeding 726 cervix ≤ 25 mm 341 declined to participate 385 randomly assigned 192 assigned to Arabinpessary 193 assigned to expectant management 2 lost to follow up 3 lost to follow up 190 included in intention-to-treat analysis 190 included in intention-to-treat analysis Primary endpoint: spontanepretermepartusvoor 34 weken Goya et al .Lancet. 2012 12;379(9828):1800-6

  3. PECEP trial: Results Goya et al .Lancet. 2012 12;379(9828):1800-6

  4. Kaplan-Meier plot of the probability of continued pregnancy without delivery in the cervical pessary and expectant management groups PECEP trial: Results Goya et al .Lancet. 2012 12;379(9828):1800-6

  5. PECEP trial: Results Goya et al .Lancet. 2012 12;379(9828):1800-6

  6. PECEP trial: nevenwerkingen Goya et al .Lancet. 2012 12;379(9828):1800-6

  7. PECEP trial: nevenwerkingen Goya et al .Lancet. 2012 12;379(9828):1800-6

  8. PECEP trial: Insertie en verwijdering van pessarium Goya et al .Lancet. 2012 12;379(9828):1800-6 Goya et al .Lancet. 2012 May 12;379(9828):1800-6

  9. Problemen met PCEP trial Te hoge incidentie van PTB < 34 w in de controle groep Bij cervixlengte van < 25 mm verwacht men een 5-10% PTB < 34 w ipv 27% FMF pessary trial (n=800): no difference 10% vs 10% PTB <34 w Goya et al .Lancet. 2012 12;:1800-6; Hui et al Am J Perinatol. 2012 [Epub ahead of print]; FMF pessary trial [oral communication]

  10. Preventie preterme partus bij tweelingzwangerschap: ProTwin trial Liem et al Oral Communication 2013 SMFM San Francisco

  11. ProTwin trial Liem et al Oral Communication 2013 SMFM San Francisco

  12. ProTwin trial: Results Liem et al Oral Communication 2013 SMFM San Francisco

  13. ProTwin trial: Results Liem et al Oral Communication 2013 SMFM San Francisco

  14. ProTwin trial: Results Liem et al Oral Communication 2013 SMFM San Francisco

  15. ProTwin trial: Results Liem et al Oral Communication 2013 SMFM San Francisco

  16. Take Home Message….. Voor eenling zwangerschappen TV cervixlengtemeting->vaginaal progesteronezo <20 mm Voor tweeling zwangerschappen ? TV cervixlengtemeting->vaginaal progesterone zo <25 mm ? TV cervixlengtemeting->pessarium zo <38 mm Romero R, BJOG 2012

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