Cervical Pessaries: A Promising Solution for Preterm Birth Prevention

Preterm birth presents a significant challenge to global health, contributing to high rates of infant mortality and long-term health complications. Each year, approximately 3.6 million babies are born preterm in India, as noted by the World Health Organization (WHO). This troubling statistic results in over 300,000 neonatal deaths annually, highlighting the urgent need for effective preventive measures. One such measure is the cervical pessary, a non-invasive medical device designed to support women at risk of preterm birth.

Understanding the Cervical Pessary

A cervical pessary is typically a silicone ring placed around the cervix to help prevent early labor. It is particularly beneficial for women diagnosed with a shortened cervix or cervical insufficiency, conditions that increase the likelihood of miscarriage or premature delivery. The cervix serves as a barrier, and when it shortens prematurely, it can lead to preterm labor. By supporting the cervix and altering the cervical canal’s angle, the pessary helps reduce pressure from the uterus and aims to prevent early cervical dilation.

The use of cervical pessaries has been documented for decades, but their adoption has increased recently as a viable alternative to surgical interventions. A. Jaishree Gajaraj, head of obstetrics and gynecology at MGM Healthcare in Chennai, emphasizes that the pessary is a low-risk, non-surgical option. Unlike cervical cerclage, which involves stitching the cervix and requires anesthesia and hospitalization, the pessary can be inserted in an outpatient setting.

Dr. Gajaraj explains, “Earlier, we had to rely on cervical stitches, which required anesthesia and hospitalization. The pessary, a soft silicone ring, offers similar support and can be inserted easily in an outpatient setting.”

Research indicates that cervical pessaries can effectively prevent preterm birth in selected high-risk cases. According to WHO and the International Federation of Gynecology and Obstetrics (FIGO), the device is primarily recommended for women with singleton pregnancies and a cervical length of 25 mm or less during the mid-trimester, particularly if there is a history of spontaneous preterm birth.

Safety and Efficacy of Cervical Pessaries

In terms of safety, studies indicate that the risk associated with cervical pessaries is minimal. Common side effects include increased vaginal discharge, which does not typically signify infection. A study published in the *American Journal of Obstetrics and Gynecology* found that while 42% of participants using the Arabin pessary experienced increased discharge, over 75% reported that the treatment exceeded their expectations and improved their quality of life.

Concerns regarding potential links between pessary use and adverse outcomes, such as infection or harm to the fetus, are largely unfounded when proper clinical follow-up is maintained. The WHO stresses the importance of correct placement and ongoing monitoring, advocating for the decision to use a pessary to be made jointly with healthcare providers.

Despite some controversies, particularly regarding a legal case where the pessary was implicated in a preterm birth, Dr. Gajaraj highlights the necessity for informed understanding among patients and healthcare professionals. “In that case, the pessary was placed as a preventive measure for cervical insufficiency, yet it was later attributed as the cause,” she states.

Research on the effectiveness of cervical pessaries shows promising results, particularly in high-risk singleton pregnancies. A study revealed that the use of a pessary reduced the likelihood of preterm birth before 34 weeks by nearly half, from 15.3% to 7.3%, and decreased spontaneous delivery rates before 37 weeks from 59% to 22%.

In India, the availability of cervical pessaries such as the Arabin brand is increasing, particularly in areas where access to surgical options is limited. The insertion and removal procedures can be performed in outpatient settings, making them suitable for community-level care.

Dr. Gajaraj emphasizes that while cervical pessaries can be effective, their use must be carefully considered based on individual circumstances and monitored by healthcare professionals. The combination of clinical expertise and patient consent is crucial for ensuring the safety and success of this intervention.

In conclusion, cervical pessaries represent a valuable tool in the prevention of preterm birth, particularly in resource-limited settings where more invasive procedures may not be viable. As research continues to evolve, the integration of this device into broader treatment strategies could enhance outcomes for high-risk pregnant women worldwide.