Pessaries for the prevention of preterm birth in multiple pregnancies

In the Western world, preterm birth is the contributing factor to perinatal morbidity and mortality. Women with a multiple pregnancy are at increased risk for preterm birth. Interventions to reduce preterm birth in these women have been unsuccessful. Consequently, reduction of preterm birth remains a major challenge in modern obstetric healthcare.
We randomly allocated 813 women to the pessary (403 women) or the no-pessary group (410 women). The results demonstrated a that in unselected women with a multiple pregnancy prophylactic use of a cervical pessary does not reduce poor perinatal outcome. However, in women with a cervical length below 38 mm at 16-22 weeks, a pessary significantly reduces both poor perinatal outcome and very preterm birth rates.
In a per-protocol analysis we demonstrated that women with a twin pregnancy and a cervix below the 25th percentile, the treatment potential of the pessary if applied consequently was stronger than we found in the intention-to-treat analysis. Furthermore, a cost-effectiveness analysis shows that in unselected women with a multiple pregnancy treatment with a cervical pessary generates comparable costs as in women without treatment. However, a screen-treat program using a pessary in women with a CL <38 mm results in better outcomes and lower costs.