{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:09:55Z","timestamp":1784790595255,"version":"3.55.0"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Both twin pregnancy and short cervix are risk indicators for preterm birth. Cervical pessary and progesterone have been suggested to prevent preterm birth. A randomised trial was conducted in individuals carrying twins with cervix below the 25th centile (less than 38\u2009mm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a single centre open\u2010label randomised clinical trial at Monash Medical Centre in Victoria, Australia (Trial registration number: ACTRN12616000875404). Individuals with a twin pregnancy and mid\u2010trimester (16\n                      <jats:sup>+0<\/jats:sup>\n                      to 23\n                      <jats:sup>+6<\/jats:sup>\n                      weeks) cervical length &lt;\u200925th percentile were invited to participate. After informed consent, participants were randomly assigned to placement of cervical pessary or self\u2010administered daily vaginal progesterone (200\u2009mg), until 36\u2009weeks of gestation or until onset of labour, whichever occurred first. Primary outcome was a composite adverse neonatal outcome, with preterm birth before 28\u2009weeks as an important secondary outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between 2 December 2019 and 27 July 2023, 159 individuals were screened, of whom 66 had a cervical length \u2264\u200938\u2009mm, and 34 were randomised to Arabin pessary (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200916) or progesterone (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200918). One woman in the progesterone group withdrew consent after randomisation. The study was halted as studies elsewhere had indicated no benefit from pessary. Composite adverse neonatal outcome occurred in 41% (13\/32) of the neonates in the Arabin pessary group compared with 29% (10\/34) of the neonates in the progesterone group (risk ratio [RR] 1.38, 95% CI 0.71\u20132.69). Delivery before 28\u2009weeks occurred in 19% (3\/16) and 5.9% (1\/17) (RR: 3.19, 95% CI 0.37\u201327.58).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In individuals with a twin pregnancy and a short cervix, we could not report benefit from cervical pessary over progesterone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajo.70100","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T13:09:30Z","timestamp":1774444170000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Effectiveness of a Cervical Pessary to Improve Neonatal Outcome by Preventing Preterm Birth in Individuals With Twin Pregnancy and Short Cervix:\n                    <scp>QUAD<\/scp>\n                    \u2010P Twins"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6555-1044","authenticated-orcid":false,"given":"Claire","family":"McGannon","sequence":"first","affiliation":[{"name":"Monash Medical Centre Monash Health  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling Shan","family":"Au","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Neil","sequence":"additional","affiliation":[{"name":"Monash Medical Centre Monash Health  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calum","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-550X","authenticated-orcid":false,"given":"Ben W. J.","family":"Mol","sequence":"additional","affiliation":[{"name":"Monash Medical Centre Monash Health  Clayton Victoria Australia"},{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"},{"name":"Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences &amp; Nutrition University of Aberdeen  Aberdeen UK"},{"name":"Department of Obstetrics and Gynaecology Amsterdam University Medical Centre  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Australian Institute of Health and Welfare \u201cAustralia's Mothers and Babies 2017\u2014In Brief \u201d(2019) Perinatal Statistics Series No. 35. Cat. No. PER 100 Canberra: AIHW."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000705"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000267498.95402.bd"},{"key":"e_1_2_6_5_1","volume-title":"Report of the Australian and New Zealand Neonatal Network 2021","author":"Chow S. S. W.","year":"2023"},{"key":"e_1_2_6_6_1","unstructured":"Australian Bureau of Statistics \u201cBirths Australia \u201dABS (2022) https:\/\/www.abs.gov.au\/statistics\/people\/population\/births\u2010australia\/latest\u2010release."},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.10.132"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340904"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000864"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.08.006"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)00217\u20108"},{"key":"e_1_2_6_12_1","article-title":"Prenatal Administration of Progestogens for Preventing Spontaneous Preterm Birth in Women With a Multiple Pregnancy","volume":"11","author":"Dodd J. M.","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.11.012"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61408-7"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.10812"},{"issue":"12","key":"e_1_2_6_16_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-077033","article-title":"Cervical Pessary Versus Vaginal Progesterone in Women With a Singleton Pregnancy, a Short Cervix, and No History of Spontaneous Preterm Birth at Less Than 34\u2009Weeks' Gestation: Open Label, Multicentre, Randomised, Controlled Trial","volume":"384","author":"Dijk C. E.","year":"2024","journal-title":"BMJ"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003136"}],"container-title":["Australian and New Zealand Journal of Obstetrics and Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.70100","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ajo.70100","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.70100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:35:15Z","timestamp":1784788515000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/ajo.70100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/ajo.70100"],"URL":"https:\/\/doi.org\/10.1111\/ajo.70100","archive":["Portico"],"relation":{},"ISSN":["0004-8666","1479-828X"],"issn-type":[{"value":"0004-8666","type":"print"},{"value":"1479-828X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]},"assertion":[{"value":"2024-06-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70100"}}