A case series on the use of pessaries for shortened cervix

Abstract A cervical length <25 mm is correlated with an increased risk of preterm delivery. Pessaries have been used in patients with a short cervix to prevent preterm birth. Compared to cerclage, it is seen as a novel approach, which is more affordable, less invasive, and can be inserted at a later gestational age. We present our experience on the use of pessaries for shortened cervix. In this case series, we inserted a pessary in pregnant patients from 10 to 30 weeks of age of gestation (mean 23 weeks) with cervical length of 0.9 cm to 2.1 cm. We were able to prolong the pregnancy in 5 of the 7 cases with a mean interval to delivery of 14 weeks. One proposed mechanism of a pessary for shortened cervix is that it directs the inclination of the cervix posteriorly, which allows majority of the weight of the pregnancy to lie on the anterior segment of the uterus instead of on the internal cervical os. Based on the cases presented, we have proposed some guidelines in offering a pessary for patients with a shortened cervix: (1) recommend a pessary in patients with a cervical length <25 mm or a diagnosis of cervical insufficiency; (2) exclude infection or active labor; and (3) remove the pessary if there is rupture of membranes, significant vaginal bleeding, or persistent uterine contractions.