Santos Ana Clara Felix de Farias, Pimenta Nicole Dos Santos, Pereira Ana Gabriela Alves, Molino Gabriela Oliveira Gonçalves, Dias Maírla Marina Ferreira, da Silva Pedro Henrique Costa Matos
Universidade Cidade de São Paulo São PauloSP Brazil Universidade Cidade de São Paulo, São Paulo, SP, Brazil.
Universidade Federal do Estado do Rio de Janeiro Rio de JaneiroRJ Brazil Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Rev Bras Ginecol Obstet. 2025 Mar 17;47. doi: 10.61622/rbgo/2025rbgo10. eCollection 2025.
Preterm birth remains a significant contributor to neonatal morbidity and mortality. The use of cervical pessaries as an intervention for preventing preterm delivery in women with a short cervix has been a subject of interest. We evaluated the effectiveness of cervical pessary compared to standard care in preventing preterm delivery in women with a short cervix.
Databases were systematically searched in PubMed, Cochrane, and Embase databases in December 2023.
Randomized clinical trials with the outcomes of interest were included.
We computed risk ratios for binary endpoints, with 95% confidence intervals. Heterogeneity was assessed using I2 statistics. Data were analyzed using R software (version 4.3.0). The primary outcomes of interest were preterm delivery before 37 weeks, and preterm delivery before 34 weeks.
Seventeen studies with 5,704 patients were included. The use of cervical pessary was associated with a decreased risk of preterm delivery before 37 (RR 0.88; 95% CI 0.81-0.96) and 34 weeks (RR 0.79; 95% CI 0.63-0.99) of gestation in twin pregnancies as compared to standard care without progesterone. There were no significant differences in preterm delivery in singleton pregnancy, neonatal outcomes, preterm premature rupture of the membranes or chorioamnionitis.
The use of cervical pessary was associated with a significant reduction in preterm delivery at 34 and 37 weeks of gestation in twin pregnancies among patients with a short cervix compared to no treatment. No significant difference was found in singleton pregnancies or maternal outcomes.
早产仍然是新生儿发病和死亡的一个重要原因。使用宫颈托作为预防宫颈短的女性早产的一种干预措施一直是人们关注的话题。我们评估了与标准护理相比，宫颈托在预防宫颈短的女性早产方面的有效性。
2023年12月系统检索了PubMed、Cochrane和Embase数据库。
纳入具有感兴趣结局的随机临床试验。
我们计算了二元终点的风险比及95%置信区间。使用I²统计量评估异质性。使用R软件（版本4.3.0）进行数据分析。主要关注的结局是37周前早产和34周前早产。
纳入了17项研究，共5704例患者。与不使用孕激素的标准护理相比，在双胎妊娠中使用宫颈托与妊娠37周（风险比0.88；95%置信区间0.81 - 0.96）和34周（风险比0.79；95%置信区间0.63 - 0.99）前早产风险降低相关。单胎妊娠的早产、新生儿结局、胎膜早破或绒毛膜羊膜炎方面无显著差异。
与不治疗相比，宫颈短的患者在双胎妊娠中使用宫颈托与妊娠34周和37周时早产显著减少相关。在单胎妊娠或母体结局方面未发现显著差异。
