Association of Cervical Pessary Use with Preterm Birth in Singleton Pregnancies with a Short Cervix and Threatened Preterm Labor: A Retrospective Cohort Study

Why It Matters

The findings suggest cervical pessary could halve preterm birth risk in high‑risk women, offering a low‑cost, non‑invasive option that may ease hospital resources.

Key Takeaways

• Pessary reduced 37‑week preterm births from 51% to 21%.
• Adjusted odds ratio for ≥37 weeks: 4.65.
• Hospital stays and IV tocolysis shortened with pessary.
• No rise in severe neonatal complications observed.
• Retrospective design limits causal inference.

Pulse Analysis

Preterm birth remains the leading cause of neonatal death and long‑term disability worldwide, accounting for roughly 15 % of all deliveries. A short cervical length, typically ≤25 mm, is one of the strongest predictors of spontaneous preterm labor, prompting clinicians to explore mechanical and pharmacologic strategies to prolong gestation. Cervical pessaries—silicone devices placed around the cervix—offer a non‑surgical, low‑cost alternative to cerclage, and have been investigated in several randomized trials with mixed outcomes. Understanding their role in women who already exhibit threatened labor is critical for refining risk‑reduction protocols.

The recent single‑center retrospective cohort examined 180 women with threatened preterm labor and a short cervix, comparing outcomes after pessary placement (2021‑2024) with historical controls (2017‑2020). 65 for delivery at or beyond term. Secondary analyses showed improved rates of delivery beyond 34 and 36 weeks, shorter hospitalizations, and reduced need for intravenous tocolytics, while severe neonatal morbidity remained unchanged. Nevertheless, the use of historical controls and the retrospective design temper causal claims.

If corroborated by prospective randomized trials, cervical pessary could become a frontline intervention for high‑risk singleton pregnancies, especially in settings where surgical cerclage is impractical or costly. The device’s ease of insertion and minimal side‑effect profile align with value‑based care goals, potentially lowering intensive‑care admissions and associated expenses. Researchers should prioritize multicenter trials that stratify patients by gestational age, cervical length, and labor biomarkers to delineate the subpopulations that benefit most. Until such data emerge, clinicians must weigh the promising observational evidence against methodological limitations when counseling patients.