Atraumatic forceps-guided insertion of the cervical pessary: a new technique to prevent preterm birth in women with asymptomatic cervical shortening

Abstract Objectives As previous studies on the use of a cervical pessary to prevent preterm birth (PTB) have produced conflicting results, we aimed to investigate the feasibility, acceptability and safety of a new technique for inserting a cervical pessary and compare it with the traditional technique in patients at high risk of PTB. Methods Women at high risk of PTB treated with a cervical pessary between January 2018 and January 2021 were retrospectively evaluated. After applying exclusion criteria, a total of 68 eligible patients were identified and retrospectively analyzed. The primary outcome was spontaneous PTB before 34 weeks’ gestation (WG). Results Of 68 participants, 39 were treated with the traditional method (group 1) and 29 with the new insertion technique (group 2). The rate of spontaneous PTB before 34 WG was significantly lower in group 2 (p=0.020). Birthweight, APGAR scores and satisfaction with the method were significantly higher, while PTB before 37 WG was significantly lower in group 2 (p=0.043, 0.010, 0.009, 0.042 and 0.014, respectively). There were no significant differences in the rates of perinatal death (12.8 vs. 3.4 % in groups 1 and 2, respectively; p=0.229). The concomitant use of vaginal progesterone was required more frequently in group 1. According to the binary regression analysis, the new insertion technique resulted in a 5.42 and 3.97-fold protection against PTB before 34 and 37 WG. Conclusions Our preliminary results show that our new technique of pessary insertion is more effective than the traditional method in preventing PTB due to cervical shortening.