Abstract
Backgroud: The clinical efficacy and safety of cervical pessary
versus cervical cerclage in preventing spontaneous preterm birth remain
uncertain.
Objectives : To systematically review the clinical efficacy of
cervical pessary versus transvaginal cervical cerclage in preventing
spontaneous preterm birth caused by cervical shortening.
Search Strategy : The Cochrane Library, PubMed, EMbase, WanFang
Data, CNKI, VIP Data and CBM Data were electronically searched.
Selection Criteria: Randomized controlled trials (RCTs) and
non-randomized controlled trials (non-RCTs, including cohort studies)
comparing cervical pessary and transvaginal cervical cerclage in
preventing spontaneous preterm birth from the inception of the database
to August 2020.
Main Results : A total of 9 studies (2 RCTs and 7 non-RCTs) were
included, involving 1174 patients with a short cervix in the second
trimester (cervical length <25mm), 693 in the cervical pessary
group and 481 in the cervical cerclage group. The results of
meta-analysis showed that the incidence of preterm premature rupture of
the membranes (PPROM) in the cervical pessary group was significantly
lower than that in the cervical cerclage group (RR =0.48, 95% CI:
0.35 to 0.67, P <0.00001), and the premature birth rate
before 34 weeks in the cervical pessary group was also significantly
lower than that in the cervical cerclage group (RR =0.68, 95%CI:
0.51 to 0.89, P <0.006).
Conclusion: Compared with transvaginal cervical cerclage, use
of a cervical pessary may decrease the risks of PPROM and premature
birth before 34 weeks. Given its advantages of easy-to-use and minimal
damage, cervical pessary may become a useful preventive intervention
that deserves widespread clinical application.
Keywords: Pessary; Cervical cerclage; Preterm birth;
Meta-analysis; Systematic review; Randomized controlled trial;
Non-randomized controlled trial
1. Introduction
Since the late 1970s, placement of a cervical pessary as a novel
intervention has been introduced into clinical practice. In Europe,
Arabin cervical pessary has been approved for use in the prevention of
preterm birth, while in the US and Canada, cervical pessary has been
approved for use in scientific research [1]. In
addition to its benefits in reducing the incidence of preterm birth[2-4], the insertion of a cervical pessary is a
non-invasive and simple procedure associated with few adverse effects,
minimal maternal injury and short hospital
stay[5].However, its clinical efficacy and safety
versus cervical cerclage remain uncertain. Based on a systematic search
of published literatures, we performed a meta-analysis of studies on the
clinical efficacy of cervical pessary versus cervical cerclage in
preventing spontaneous preterm birth, so as to provide more evidence for
decision-making in real-world clinical practice.