{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:43:12Z","timestamp":1790800992184,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,4,2]],"date-time":"2019-04-02T00:00:00Z","timestamp":1554163200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate whether the classification of a previous spontaneous preterm birth (sPTB) as preterm labor (PTL) with intact membranes (IM) or as preterm prelabor rupture of membranes (PPROM) impacts the efficacy of cervical pessary or vaginal progesterone for prevention of sPTB in pregnant women with short cervix on transvaginal ultrasound.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of asymptomatic high\u2010risk singleton pregnancies with a short cervix and history of sPTB, treated using Arabin pessary or vaginal progesterone for primary PTB prevention, conducted at four European hospitals. A log\u2010rank test on Kaplan\u2013Meier curves was used to assess the difference in performance of pessary and progesterone, according to history of PTL\u2010IM or PPROM. Linear regression analysis was used to evaluate significant predictors of gestational age at delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2008 and 2015, 170 women were treated with a pessary and 88 with vaginal progesterone. In women treated with a pessary, rate of sPTB &lt;\u200934\u2009weeks was 16% in those with a history of PTL\u2010IM and 55% in those with a history of PPROM. In women treated with progesterone, rate of sPTB &lt;\u200934\u2009weeks was 13% in those with a history of PTL\u2010IM and 21% in those with a history of PPROM. Treatment with a pessary resulted in earlier delivery in women with previous PPROM than in any other subgroup (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.0001). Linear regression analysis showed a clear effect of PPROM history (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.0001), combination of PPROM history and treatment (<jats:italic>P<\/jats:italic>\u00a0=\u20090.0003) and cervical length (<jats:italic>P<\/jats:italic>\u00a0=\u20090.0004) on gestational age at birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cervical pessary may be a less efficacious treatment option for women with previous PPROM; however, these results require prospective validation before change in practice is recommended. Phenotype of previous preterm birth may be an important risk predictor and treatment effect modifier; this information should be reported in future clinical trials. \u00a9 2018 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.19118","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T17:15:24Z","timestamp":1529428524000},"page":"529-534","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Should phenotype of previous preterm birth influence management of women with short cervix in subsequent pregnancy? Comparison of vaginal progesterone and Arabin pessary"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2131-0406","authenticated-orcid":false,"given":"A.","family":"Care","sequence":"first","affiliation":[{"name":"Harris Wellbeing Preterm Birth Centre, Department of Women and Children's Health Research Liverpool Women's Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Muller\u2010Myhsok","sequence":"additional","affiliation":[{"name":"Waterhouse Building University of Liverpool  Liverpool UK"},{"name":"Max Plank Institute of Psychiatry  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Olearo","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit 2, Department of Surgical Sciences University of Turin  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Todros","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit 2, Department of Surgical Sciences University of Turin  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Caradeux","sequence":"additional","affiliation":[{"name":"Barcelona Center for Maternal\u2010Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u) University of Barcelona  Barcelona Spain"},{"name":"Fetal Medicine Unit, Cl\u00ednica D\u00e1vila  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Goya","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron Universitat Autonoma de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Palacio","sequence":"additional","affiliation":[{"name":"Barcelona Center for Maternal\u2010Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de D\u00e9u) University of Barcelona  Barcelona Spain"},{"name":"Center for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3471-7248","authenticated-orcid":false,"given":"E.","family":"Carreras","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron Universitat Autonoma de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Alfirevic","sequence":"additional","affiliation":[{"name":"Harris Wellbeing Preterm Birth Centre, Department of Women and Children's Health Research Liverpool Women's Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,2]]},"reference":[{"key":"e_1_2_6_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_6_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.10.866"},{"key":"e_1_2_6_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.10.877"},{"key":"e_1_2_6_2_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/576723"},{"key":"e_1_2_6_2_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0108578"},{"key":"e_1_2_6_2_7_1","doi-asserted-by":"crossref","first-page":"3153","DOI":"10.3109\/14767058.2015.1118035","article-title":"Maternal and neonatal epidemiological features in clinical subtypes of preterm birth","volume":"29","author":"Giminez LG","year":"2016","journal-title":"J Maternal and Fetal Med"},{"key":"e_1_2_6_2_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12507"},{"key":"e_1_2_6_2_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050600949829"},{"key":"e_1_2_6_2_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6332"},{"key":"e_1_2_6_2_11_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aag1026"},{"key":"e_1_2_6_2_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-015-2811-9"},{"key":"e_1_2_6_2_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-016-0223-9"},{"key":"e_1_2_6_2_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60030-0"},{"key":"e_1_2_6_2_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511014"},{"key":"e_1_2_6_2_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.18956"},{"key":"e_1_2_6_2_17_1","first-page":"283","article-title":"Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: A randomized controlled trial","volume":"30","author":"Hui SY","year":"2013","journal-title":"Am J Perinatol"},{"key":"e_1_2_6_2_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12512"}],"container-title":["Ultrasound in Obstetrics &amp; 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