{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:23:14Z","timestamp":1785554594712,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T00:00:00Z","timestamp":1491868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in singleton gestations with a second trimester short cervix.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic databases were searched from their inception until February 2016. We included randomized clinical trials (RCTs) comparing the use of the cervical pessary with expectant management in singletons pregnancies with transvaginal ultrasound cervical length (TVU CL) \u226425 mm. The primary outcome was incidence of SPTB &lt;34 weeks. The summary measures were reported as relative risk (RR) with 95% confidence interval (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three RCTs (n = 1,420) were included. The mean gestational age (GA) at randomization was approximately 22 weeks. The Arabin pessary was used as intervention in all three trials, and was removed by vaginal examination at approximately 37 weeks. Cervical pessary was not associated with prevention of SPTB &lt;37 (20.2% vs 50.2%; RR 0.50, 95% CI 0.23 to 1.09), &lt;34, &lt;32, and &lt;28 weeks, compared to no pessary. No differences were found in the mean of GA at, interval from randomization to delivery, incidence of preterm premature rupture of membranes and of cesarean delivery, and in neonatal outcomes. The Arabin pessary was associated with a significantly higher risk of vaginal discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In singleton pregnancies with a TVU CL \u226425mm at 20<jats:sup>0<\/jats:sup>\u201324<jats:sup>6<\/jats:sup>weeks, the Arabin pessary does not reduce the rate of spontaneous preterm delivery or improve perinatal outcome. Individual patient data meta\u2010analysis may clarify whether cervical pessary may be beneficial in subgroups, such as only singleton gestations without prior SPTB or by different CL cutoffs.<\/jats:p><\/jats:sec>","DOI":"10.7863\/ultra.16.08054","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T14:18:14Z","timestamp":1491920294000},"page":"1535-1543","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Cervical Pessary for Preventing Preterm Birth in Singleton Pregnancies With Short Cervical Length: A Systematic Review and Meta\u2010analysis"],"prefix":"10.7863","volume":"36","author":[{"given":"Gabriele","family":"Saccone","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples Italy"},{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ciardulli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Catholic University of Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Xodo","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, School of Medicine University of Udine Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Dugoff","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine and Reproductive Genetics, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Ludmir","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Pagani","sequence":"additional","affiliation":[{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"},{"name":"Department of Maternal and Fetal Health Fondazione Poliambulanza Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Visentin","sequence":"additional","affiliation":[{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"},{"name":"Department of Woman's and Child's Health University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Gizzo","sequence":"additional","affiliation":[{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"},{"name":"Department of Woman's and Child's Health University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Volpe","sequence":"additional","affiliation":[{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"},{"name":"Feto\u2010Maternal Medicine Unit Parma University Hospital Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Maria","family":"Maruotti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples Italy"},{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"},{"name":"Department of Obstetrics and Gynecology Universit\u00e0 Roma Tor Vergata Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples Italy"},{"name":"Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Berghella","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine Sidney Kimmel Medical College of Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,11]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1","article-title":"Births: preliminary data for 2011","volume":"61","author":"Hamilton BE","year":"2012","journal-title":"Natl Vital Stat 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