Objective:To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency. Methods: The pregnancy outcome of 20 women carrying ...
The Journal of Maternal-Fetal and Neonatal Medicine, 2012; Early Online: 1–3 © 2012 Informa UK, Ltd. ISSN 1476-7058 print/ISSN 1476-4954 online DOI: 10.3109/14767058.2012.712559
ORIGINAL ARTICLE
Arabin cerclage pessary in the management of cervical insufficiency Yuen Ha Ting1, Terence T. Lao1, Lai Wa Law1, Shuk Yi Annie Hui1, Chung Ming Chor1, Tze Kin Lau2 & Tak Yeung Leung1
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Chinese University of Hong Kong on 09/23/12 For personal use only.
1
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong, and 2Fetal Medicine Centre, Paramount Clinic, Hong Kong used as an objective parameter to guide treatment in patients with history suggestive of cervical insufficiency [5]. Surgical cervical cerclage has been the conventional treatment for cervical insufficiency, but unfortunately, randomized controlled trials failed to prove its efficacy, particularly when the diagnosis is uncertain [1,6]. Moreover, this is an invasive procedure which can be associated with significant maternal and fetal risks. At the same time, different kinds of vaginal pessaries have been proffered as a non-invasive alternative to treat cervical insufficiency since 1959, but it is only in recent years that the awareness and popularity of cerclage pessaries have risen enough to be offered as an alternative to surgical cerclage [7,8]. Amongst the available pessaries, the Arabin cerclage pessary is the most widely reported to be effective [9–11]. Therefore, Arabin cerclage pessary was introduced as an alternative treatment for cervical insufficiency in our department since 2009. In order to evaluate its efficacy, we have analysed the patients managed with this treatment for the period 2009–2011, and to elucidate the clinical characteristics of the women who had benefited most from this non-invasive treatment.
Objective: To evaluate the use of Arabin cerclage pessary in the management of cervical insufficiency. Methods: The pregnancy outcome of 20 women carrying singleton pregnancy referred for suspected cervical insufficiency and chose Arabin cerclage pessary for treatment from 2009–2011 were reviewed. Pregnancy outcome were analysed according to presence of risk factors, amniotic fluid sludge, cervical length and gestation at pessary insertion. Results: At presentation, mean cervical length was 1.17 cm (range 0–2.33 cm), mean gestation at pessary insertion and delivery was 20.6 (12.9–26.1) weeks and 32.1 (14.7–40.1) weeks, respectively, and mean prolongation of pregnancy was 11.5 (0.5–25.2) weeks. Overall, 5 (25%) had fetal loss between 14.7–23.1 weeks, while 3 (15%) and 12 (60%) delivered before and after 34 weeks gestation, respectively with no perinatal mortality. Compared with women with cervical length
