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• W2781708789 abstract "To compare the effectiveness of cervical pessary and vaginal progesterone for the prevention of preterm birth (PTB) in twin pregnant women with a cervical length (CL) <38 mm. This randomized controlled trial was conducted at My Duc Hospital, HCM City, Vietnam, where approximately 1000 twin pregnant women are seen each year. Asymptomatic twin pregnant women underwent CL measurement at 16 - 22 weeks of gestation. After informed consent, women with a CL <38 mm were randomized to cervical pessary (Arabin) or vaginal progesterone (400 mg once a day). Treatment was continued until 36 weeks of gestation or delivery. Due to the nature of interventions, the study was not blinded but neonatologists assessing the children were not aware of the allocated treatment. Primary outcome was PTB <34 weeks. Secondary outcomes were maternal and neonatal complications. Analysis was by intention to treat. For neonatal outcomes, we used cluster analysis taking into account the dependency between the twins. We planned a subgroup analysis according to CL divided into four quartiles. The study was approved by the hospital ethics committee (09/15/ĐĐ-BVMĐ) and was registered in ClinicalTrials.gov (NCT02623881). Between March 2016 and June 2017, we randomized 300 women to pessary (n=150) or progesterone (n=150). The PTB rate <34 weeks was 16.0% versus 22.0% (RR 0.73, 95% CI 0.45 - 1.17). Among the secondary endpoints, there were statistically significant lower rates of PTB <37 weeks, birthweight <2500g, admission to NICU, respiratory distress syndrome (RDS) and neonatal sepsis in the pessary group. In women with a CL <25th percentile (< 28mm), PTB rate <34 weeks was 20.4% in pessary group and 44.4% in progesterone group (RR 0.46, 95% CI 0.24 - 0.89). In this subgroup, the use of pessary resulted in a statistically significant lower rates of delivery <37 weeks, birthweight <2500g, admission to NICU, RDS, neonatal sepsis and a higher mean birthweight (Table). In women with a twin pregnancy and a CL <38 mm, cervical pessary did not reduce PTB <34 weeks as compared to vaginal progesterone. However, in a prespecified subgroup of women with a CL <25th percentile, we found a significant reduction in PTB <34 weeks and better neonatal outcomes after the use of cervical pessary." @default.
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• W2781708789 date "2018-01-01" @default.
• W2781708789 modified "2023-09-27" @default.
• W2781708789 title "LB03: Cervical pessary versus vaginal progesterone for the prevention of preterm birth in women with a twin pregnancy and a cervix <38 mm: a randomized controlled trial" @default.
• W2781708789 doi "https://doi.org/10.1016/j.ajog.2017.11.598" @default.
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