Utility of cervical pessary in the prevention of preterm birth in triplet pregnancies: A single-center observational retrospective study of 165 triplet pregnancies

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 295; pp. 48 - 52
• Main Authors: Pena-Burgos, E.M., Sintes Álvarez-Arenas, M., Quirós-González, V., Bartha, J.L., De La Calle, M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.04.2024
• Subjects: Case-Control Studies; Cervical pessary; Cervix Uteri; Female; Humans; Infant, Newborn; Obstetric Labor, Premature; Pessaries; Pregnancy; Pregnancy, Triplet; Premature Birth - prevention & control; Prematurity; Retrospective Studies; Short uterine cervix; Tocolytic Agents; Triplet pregnancies; Short uterine cervix; Prematurity; Cervical pessary; Triplet pregnancies
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.01.036

•The cervical pessary is not useful in the prevention of preterm births (<34 weeks) in triplet pregnancies.•It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity.•Triplet pregnancies and at risk of preterm labor and those taking tocolytics±glucocorticoids may benefit from pessary insertion. Premature births are a health problem arising in triplet pregnancies, resulting in high levels of morbidity and mortality. The objective of this study is to evaluate the utility of cervical pessaries in reducing prematurity (<34 weeks) in triplet pregnancies. This is a single-center, retrospective case-control study regarding triplet pregnancies with follow-up at the La Paz University Hospital between 2000 and 2023. Maternal characteristics, obstetric and perinatal outcomes, and the use of cervical pessaries were examined. 165 triplet pregnancies were analyzed: 87 (52.7 %) in the case group (premature triplet pregnancies) and 78 in the control group (non-premature triplet pregnancies). A cervical pessary was inserted in 15 (17.2 %) triplet pregnancies in the case group and in 12 (16.7 %) triplet pregnancies in the control group (p = 0.92; OR = 1.04 (0.46–2.35)). A pessary was later inserted in the non-premature group (p = 0.01). The risk of preterm labor and the use of tocolytics ± glucocorticoids were found to be significantly more frequent in the premature group, with p = 0.01; OR = 2.30 (1.21–4.36) and p < 0.01; OR = 2.36 (1.23–4.44), respectively. Protocol-based cesarean sections were more frequent in the non-premature group (p < 0.01), while cesarean sections due to maternal complications (p < 0.01) and premature membrane rupture (p < 0.01) were more frequent in the premature group. The cervical pessary is not useful in preventing preterm births (< 34 weeks) in triplet pregnancies. It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity, despite other pregnancy conditions. Women who are pregnant with triplets and at risk of preterm labor and those taking tocolytics ± glucocorticoids may benefit from pessary insertion.