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For singleton pregnancies, the meta-analysis of three non-RCTs [relative risk (RR)\u2009=\u20090.41,<jats:italic>p<\/jats:italic>\u2009=\u20090.001] or total trials in non-Asian country (RR\u2009=\u20090.56,<jats:italic>p<\/jats:italic>\u2009=\u20090.03) revealed that compared with vaginal progesterone alone, cervical pessary\u2009+\u2009vaginal progesterone treatment had significant effectiveness on preventing PTB\u2009&lt;\u200934\u00a0weeks, but not for five RCTs; meta-analysis of two trials showed that cervical pessary\u2009+\u2009vaginal progesterone had no significant prevention effects of PTB compared with cervical cerclage\u2009+\u2009vaginal progesterone. For multiple pregnancies, meta-analysis of two trials showed that compared with vaginal progesterone, cervical pessary\u2009+\u2009vaginal progesterone treatment increased neonatal birth weight (standardized mean difference\u2009=\u20090.50,<jats:italic>p<\/jats:italic>\u2009=\u20090.01). Trial sequential analysis implied additional studies were required. Four studies vs other controls (pessary, three-combined, tocolysis, conservative or no treatment; one study, each) were selected for systematic review. In conclusion, cervical pessary combined with vaginal progesterone may be safe and effective to prevent PTB in singleton pregnancies and increase neonatal birth weight in the multiple pregnancies compared with vaginal progesterone alone.<\/jats:p>","DOI":"10.1007\/s43032-022-00926-x","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T18:11:12Z","timestamp":1648577472000},"page":"93-110","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis"],"prefix":"10.1007","volume":"30","author":[{"given":"Yanyan","family":"Zhuang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Na","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaowei","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5062-1807","authenticated-orcid":false,"given":"Na","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"issue":"1","key":"926_CR1","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/S2214-109X(18)30451-0","volume":"7","author":"S Chawanpaiboon","year":"2019","unstructured":"Chawanpaiboon S, Vogel JP, Moller AB, et al. 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