Vaginal @entity1420 combined with cervical pessary: A chance for pregnancies at risk for XXXX ?

@entity1 @entity3152 @entity1420 @entity600 @entity3207
BACKGROUND: Precocious cervical ripening, as defined by cervical @entity3207 on transvaginal sonography, has prompted a broad evaluation of secondary strategies (such as cerclage, vaginal @entity1420 , or a cervical pessary) to prevent @entity3152 . However, there is still a lack  of direct comparisons between individual treatments or their combinations. OBJECTIVE: We sought to compare at-risk @entity1 and screening @entity1 who had been treated with cervical pessary alone with @entity1 who had been treated with pessary plus vaginal @entity1420 . STUDY DESIGN: This is a pre- and postintervention cohort study from a @entity3152 clinic where placement of a cervical pessary has been the standard treatment since 2008 for at-risk @entity1 defined by (1) a history of spontaneous @entity600 at <37 weeks of gestation, (2) conization, or (3) a cerclage because of a previous short cervical length of <3rd percentile and, additionally, with a cervical length of <10th percentile in the ongoing pregnancy. @entity1 who did not meet the criteria for the "at risk" group, but who had a cervical length of <3rd percentile comprised the screening group. From July 2011 onward, vaginal @entity1420 (200 mg, suppositories) was prescribed in addition to the pessary. Both at-risk @entity1 (n  = 55) and screening @entity1 (n  = 51) were treated at the time of diagnosis. The primary outcome was the rate of preterm deliveries at <34 weeks of gestation. Secondary outcomes included deliveries at <28, <32, and <37 weeks of gestation, the days from start of therapy until delivery, a composite index of neonatal outcome, and the number of days in the neonatal intensive care unit. Primary and secondary outcomes were compared between groups with the use of multivariable models to adjust for possible confounders. RESULTS: Delivery at <34 weeks of gestation occurred in 17 of 53 @entity1 (32.1%) who were treated with pessary plus @entity1420 , compared with 13 of 53 @entity1 (24.5%) who were treated with pessary alone (P  = .57). Similarly, there was no difference in the rate of @entity3152 at <28, <32, or <37 weeks of gestation. The composite poor neonatal outcome was 15.1% in the pessary group vs 18.9% in the combined group (P  = .96). The mean duration of stay in the neonatal intensive care unit was 46.5 days (range, 9-130 days) in the combined vs  52.0 days (range, 3-151 days) in the pessary group (P < .001). CONCLUSION: In this cohort study, treatment of precocious cervical ripening with cervical pessary plus vaginal @entity1420 did not reduce the rates of @entity3152 at <28, <32, <34, or <37 weeks of gestation compared with pessary alone. The neonatal intensive care use was shorter in @entity1 who received additional vaginal @entity1420 , although there was no difference in composite poor neonatal outcome. These preliminary results may serve as a pilot for future trials and provide a basis for treatment until larger trials are completed.
