Speakers - 2026

Title: Clinical and Diagnostic Features of Obstetric Pessary Reducing Tension in Pregnant Women with Cervical Insufficiency

Abstract

Background: Right from ancient times up to the present,  the prevention of preterm birth has remained a principal objective of the gynecologists, as it continues to constitute the major cause of trauma for the newborn and mother. It is an important cause of neonatal mortality and health complications. According to global estimates, approximately 10–11% of all births worldwide are preterm, and complications related to prematurity remain the leading cause of death among children under five years of age. Among the various etiological factors, cervical insufficiency is considered one of the major causes of spontaneous preterm birth and second-trimester pregnancy loss.

Objective: Although cervical cerclage and other surgical techniques are commonly used in the management of cervical insufficiency, all these techniques have certain limitations, potential complications, and associated risks. Therefore, the investigation and evaluation of effective, safer, and less invasive alternatives are of significant importance. The aim of this study is to examine the clinical and diagnostic features and to assess the effectiveness of the tension-reducing pessary in pregnant women with a short cervix, focusing on pregnancy prolongation, reduction in preterm birth rates, and perinatal outcomes.

Materials and Methods: This retrospective study included 30 women with singleton pregnancies and ultrasound-confirmed cervical insufficiency. A tension-reducing obstetric pessary was inserted at different gestational ages. The participants were aged between 20 and 40 years. Of the study population, 60% were primigravida, while 40% were multigravida with a history of 1–3 miscarriages. Cervical insufficiency was congenital in 60% of cases and acquired in 40%.

Before pessary insertion, cervical length and cervical status, degree of internal and external os dilation, gestational age, uterine tone, placental location, and characteristics of the amniotic fluid were assessed. Vaginal swabs were collected, and serum testosterone and dehydroepiandrosterone (DHEA) levels were measured using immunoassay methods. All patients were followed up until spontaneous vaginal delivery.

Results: Among women who received a pessary, the study results indicated that there was prolongation of pregnancy, reduction in uterine tone, and an increase in amniotic fluid index and cervical length. Mean gestation weeks at the time of pessary removal were 37.42 ± 0.19 weeks, with a mean gestation age of 37.7 weeks at delivery.

The term spontaneous vaginal delivery occurred in 60% of the cases, preterm spontaneous vaginal delivery in 20%, and planned cesarean section in 20% of the pregnancies. No serious maternal or fetal adverse effects were observed, and neonatal outcomes were found to be satisfactory.

Conclusion: In pregnant women with cervical insufficiency, the tension-reducing obstetric pessary, biologically inert, sterile and designed for single-use, may be considered as a simple, non-invasive, cost-effective, and highly efficient method for the prevention of preterm birth, and it can be safely applied as an outpatient procedure. Moreover, in women whose previous pregnancy was managed successfully with an obstetric pessary and whose cervical condition remains stable, repeat pessary use might be advised in subsequent pregnancies.