Examining the treatment of patients with a threatened preterm birth using cervical pessary

Since 2019, we have treated 26 hospitalized patients with threatened premature birth using a cervical pessary (Arabin pessary). The cervical pessary, made of silicone, is soft; hence, patients rarely complain of pain after its placement. It is minimally invasive and easy to put on and take off. It cannot be used on patients with an intrauterine infection, premature rupture of membranes, already painful regular contractions of the uterus, or vaginal bleeding. At our hospital, patients with a tocolysis index of three points or higher are admitted for treatment. We compared 45 patients who were hospitalized and treated for threatened premature birth from 2016 to 2018 with 26 patients who were hospitalized and used a cervical pessary from 2019 to 2021. Patients with a tocolysis index of five points or more at the time of consultation were judged to be inoperable and provided with maternal transport, and they were excluded from the comparative analysis. There were five maternal transport cases due to threatened premature birth from 2016 to 2018 and four from 2019 to 2021. Seven patients from 2016 to 2018 and seven from 2019 to 2021 were between 34 and 36 weeks of gestation at presentation, for whom tocolysis was impossible but who were delivered at our hospital. These patients were also excluded from the comparative analysis. No significant differences were observed between the two groups in maternal age, tocolysis index, cervical length on admission, number of gestational weeks at delivery, birth weight, Apgar score, umbilical artery blood pH, and volume of blood loss at delivery. The duration of hospital stay was 29.78±5.49 days in the non-cervical pessary group and 9.04±2.88 days in the cervical pessary group, showing a large difference. This study found that placement of a cervical pessary for patients with threatened premature birth resulted in a significant reduction in the length of their hospital stay. Almost all patients experienced an increase in the amount of vaginal fluor after discharge, but early discharge was possible. After discharge, the patients were given oral ritodrine and periodical administration of antibiotic vaginal tablets until 36 weeks of gestation, under the instruction of relative bed rest. [Adv Obstet Gynecol, 75(3) : 212-220, 2023 (R5.8)]