{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:02:56Z","timestamp":1783652576974,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,2,21]],"date-time":"2016-02-21T00:00:00Z","timestamp":1456012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We recently showed that a cervical pessary prevents preterm birth and reduces poor neonatal outcomes in women with a twin pregnancy and a short cervix (&lt;38 mm). The objective of this study was to evaluate the full potential treatment effect of the pessary in the whole group and in women with a short cervix.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We performed a per\u2010protocol analysis of a multicenter randomized controlled trial (ProTWIN trial, NTR1858) where we excluded women who were allocated to the pessary but never had it placed. Women who had the pessary removed before 36 gestational weeks and did not deliver within 7 days after removal, were excluded. Analyses were performed on all women and in those with a cervical length &lt;38 mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 23 (6%) women the pessary was not placed. In women with a cervical length &lt;38 mm (25th percentile) the pessary reduced poor perinatal outcome (relative risk 0.32, 95% confidence interval 0.13\u20130.78) and birth at &lt;32 weeks (relative risk 0.41, 95% confidence interval 0.20\u20130.87). After excluding 47 (12%) women, the time to delivery was longer in the pessary group than in the control group (whole group: hazard ratio 0.68, 95% confidence interval 0.55\u20130.82, cervical length &lt;38 mm: hazard ratio 0.35, 95% confidence interval 0.22\u20130.57).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The analysis confirms the principal findings of the intention\u2010to\u2010treat analysis. Time to delivery was longer in the pessary group than in the control group when censored data were used. This implies the pessary should not be removed until labor is evident.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.12849","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T03:35:12Z","timestamp":1452742512000},"page":"444-451","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cervical pessaries to prevent preterm birth in women with a multiple pregnancy: a per\u2010protocol analysis of a randomized clinical trial"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3214-2076","authenticated-orcid":false,"given":"Sophie M.S.","family":"Liem","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology Academic Medical Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9548-3214","authenticated-orcid":false,"given":"Ewoud","family":"Schuit","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Academic Medical Center Amsterdam the Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands"},{"name":"Stanford Prevention Research Center Stanford University Stanford CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3020-8908","authenticated-orcid":false,"given":"Mari\u00eblle G.","family":"van Pampus","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Onze Lieve Vrouwe Gasthuis Hospital Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4866-559X","authenticated-orcid":false,"given":"Marjo","family":"van Melick","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Academic Hospital Maastricht Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7353-7894","authenticated-orcid":false,"given":"Maurice","family":"Monfrance","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Atrium Hospital Heerlen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0107-2332","authenticated-orcid":false,"given":"Josje","family":"Langenveld","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Atrium Hospital Heerlen the Netherlands"}],"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":"Robinson Research Institute School for Pediatrics and Reproductive Medicine University of Adelaide Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3470-9344","authenticated-orcid":false,"given":"Dick","family":"Bekedam","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Onze Lieve Vrouwe Gasthuis Hospital Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,2,21]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1","article-title":"Births: final data for 2009","volume":"60","author":"Martin JA","year":"2011","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03010.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61408-7"},{"key":"e_1_2_8_5_1","unstructured":"The Cochrane Collaboration. 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