Pregnancy outcomes following pessary insertion in short cervices: A retrospective cohort study at a tertiary hospital in the Philippines
Divine Saberon Macanip, Almira Jose Amin-Ong, Ira Dominique T. Alatraca-MalonzoAbstract:
BACKGROUND:
Preterm birth remains a major cause of neonatal morbidity and mortality and short cervical length is a well-established predictor of spontaneous preterm delivery. Cervical pessaries are used to mechanically support the cervix and prolong gestation, but international evidence is conflicting. Philippine studies describing pregnancy outcomes after pessary insertion remain limited.
OBJECTIVE:
The objective of this study is to describe pregnancy outcomes following pessary insertion in women with a short cervix and to determine the associations between maternal characteristics, gestational factors, and cervical factors and immediate and long-term outcomes after pessary insertion.
METHODS:
This single-center, retrospective, cohort study included all eligible pregnant women with singleton gestations and short cervix who underwent pessary insertion at the Philippine General Hospital from January 2007 to December 2024. Maternal characteristics (age, body mass index, parity, comorbidities, and history of preterm birth), gestational factors (gestational age at diagnosis and delivery, C-reactive protein, white blood cell count, vaginal infection, and symptoms), and cervical factors (cervical length, dilation, effacement, funneling, and type of pessary) were gathered from the charts and analyzed. Immediate outcome was defined as inability to maintain pregnancy for at least 48 h postpessary insertion and long-term success as maintenance of pregnancy until at least 32 weeks’ gestation; crude and multivariable logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS:
Of 69 women who underwent pessary insertion, 59 met inclusion criteria; almost all received a Hodge pessary (98.3%), and only one received an Arabin device. Two patients (3.4%, 95% CI: 0.4–11.7) were unable to maintain pregnancy for at least 48 h, while 50 patients (84.7%, 95% CI: 73.0–92.8) maintained pregnancy to at least 32 weeks. In crude analysis, higher body mass index (BMI) (OR = 1.22, 95% CI: 1.01–1.48), lower cervical effacement (OR = 0.94, 95% CI: 0.89–1.00), and higher gestational age at diagnosis (OR = 1.24, 95% CI: 1.01–1.51) were associated with the maintenance of pregnancy to ≥32 weeks, but these associations were no longer statistically significant after adjustment (BMI adjusted OR = 1.16, 95% CI: 0.96–1.40; effacement adjusted OR = 0.97, 95% CI: 0.91-1.03; gestational age adjusted OR = 1.19, 95% CI: 0.95–1.48). No single maternal, gestational, or cervical factor independently predicted long-term success.
CONCLUSION:
In this Filipino cohort of women with short cervix, predominantly managed with Hodge pessaries, most maintained pregnancy to at least 32 weeks. However, no evaluated maternal characteristics, gestational, and cervical factors showed a statistically significant independent association with maintenance of pregnancy until 32 weeks in the exploratory adjusted analysis. To establish pessary effectiveness, larger prospective comparative studies are needed.