{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:02:38Z","timestamp":1780466558332,"version":"3.54.1"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T00:00:00Z","timestamp":1493856000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether cervical pessary placement prevents preterm birth (<jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content>) in twin gestations with a short mid\u2010trimester cervical length (<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>) on transvaginal sonography (<jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a multicenter randomized controlled trial of asymptomatic women with a twin gestation and a <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content> of \u2264\u200930\u2009mm at 18\u2009+\u20090 to 27\u2009+\u20096\u2009weeks' gestation. <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content> was measured at the time of the fetal anatomy scan at 18\u2009+\u20090 to 23\u2009+\u20096\u2009weeks and at subsequent scheduled ultrasound scans prior to 28 weeks. Women with a <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content> of \u2264\u200930\u2009mm at 18\u2009+\u20090 to 27\u2009+\u20096\u2009weeks were randomized to receive either the Bioteque\u2122 cup cervical pessary or no pessary. Randomization was stratified by gestational age, study site and chorionicity. Women with a monoamniotic twin gestation, twin\u2013twin transfusion syndrome, early selective intrauterine growth restriction or placenta previa were excluded. Cervical pessaries were inserted by maternal\u2010fetal medicine staff centrally trained in proper placement. No other treatment for women with a short cervix was recommended. Primary outcome was <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> &lt;\u200934\u2009weeks. The trial was stopped early before complete enrollment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 421 women with a twin gestation were screened for <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content>, and 85 (20%) had a <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content> of \u2264\u200930\u2009mm. Of these, 80 (94%) met the eligibility criteria and 46 (58%) of the eligible women agreed to randomization. Twenty\u2010three (50%) women were randomized to pessary placement and 23 (50%) to no pessary. Demographic characteristics, including median gestational age (21.0 <jats:italic>vs<\/jats:italic> 21.2\u2009weeks; <jats:italic>P<\/jats:italic>\u2009=\u20090.69) and <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content> (16.7 <jats:italic>vs<\/jats:italic> 22.9\u2009mm; <jats:italic>P<\/jats:italic>\u2009=\u20090.45) at randomization, were similar between the pessary and no\u2010pessary groups, except for level of education (more than high school education: 48% <jats:italic>vs<\/jats:italic> 78%, respectively; <jats:italic>P<\/jats:italic>\u2009=\u20090.03) and proportion of spontaneous conceptions (83% <jats:italic>vs<\/jats:italic> 43%, respectively; <jats:italic>P<\/jats:italic>\u2009=\u20090.01). There were no significant differences between the pessary and no\u2010pessary groups in rate of primary outcome, <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> &lt;\u200934\u2009weeks (39% <jats:italic>vs<\/jats:italic> 35%; relative risk, 1.13 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 0.53\u20132.40)), as well as other  outcomes, including <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> &lt;\u200937\u2009weeks and &lt;\u200928\u2009weeks, gestational age at delivery, birth weight and composite adverse neonatal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Treatment with cervical pessary was not associated with the prevention of <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> in women with a twin gestation and a mid\u2010trimester <jats:styled-content style=\"fixed-case\">TVS\u2010CL<\/jats:styled-content> of \u2264\u200930\u2009mm in this small underpowered randomized controlled trial. Copyright \u00a9 2017 ISUOG. 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