SpringerLink
Log in

Effectiveness of the cervical pessary for the prevention of preterm birth in singleton pregnancies with a short cervix: a meta-analysis of randomized trials

  • Review
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To assess the efficacy of cervical pessary application for the prevention of spontaneous preterm birth (SPB) in singleton pregnancies with a sonographically measured short cervix.

Methods

Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library, and clinical trial registries for randomized controlled trials (RCTs) published in all languages from inception through 28 July 2018. Inclusion criteria were registered RCTs of singleton pregnants with a short cervix (≤ 25 mm) measured at 22–24 weeks comparing the use of a cervical pessary versus controls over the risk of SPB. Risk of bias was evaluated with the Cochrane tool. Risk ratios (RRs) and mean differences and 95% confidence intervals (CIs) were calculated.

Results

We identified three RCTs meeting defined inclusion criteria, including a total of 1612 pregnancies (805 used a cervical pessary). SPB risk at < 37 was lower for participants using the pessary (RR  0.46; 95% CI 0.28–0.77). Pessary application was associated with a higher risk of presenting vaginal discharge (RR 2.05; 95% CI 1.82–2.31). There were no significant differences between pessary users and controls in terms of SPB at < 28 and < 34 weeks, and for any type of preterm birth < 34 weeks; mean gestational age and infant weight at delivery; and the risks of chorioamnionitis, cesarean delivery, and perinatal or neonatal outcomes. Sub-analysis by risk of bias showed that there was a lower risk of SPB < 34 weeks (RR 0.33; 95% CI 0.16–0.66) in two RCTs with low risk of bias.

Conclusion

Cervical pessary application was associated with a reduced risk of SPB at  < 37 weeks and a higher risk of vaginal discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Stout MJ, Demaree D, Merfeld E, Tuuli MG, Wambach JA, Cole FS, Cahill AG (2018) Neonatal outcomes differ after spontaneous and indicated preterm birth. Am J Perinatol 35:494–502

    Article  PubMed  Google Scholar 

  2. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, Lawn JE (2012) National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379:2162–2172

    Article  PubMed  Google Scholar 

  3. World Health Organization (2018) Preterm birth. https://www.who.int/news-room/fact-sheets/detail/preterm-birth. Accessed 25 May 2018

  4. Muglia LJ, Katz M (2010) The enigma of spontaneous preterm birth. N Engl J Med 362:529–535

    Article  CAS  PubMed  Google Scholar 

  5. MacDorman MF (2011) Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview. Semin Perinatol 35:200–208

    Article  PubMed  Google Scholar 

  6. Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Barfield WD; Centers for Disease Control and Prevention (CDC) (2014) Assisted reproductive technology surveillance--United States, 2011. MMWR Surveill Summ 63:1–28

  7. Luke B (2017) Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies. Am J Obstet Gynecol 217:270–281

    Article  PubMed  Google Scholar 

  8. Brévaut-Malaty V, Busuttil M, Einaudi MA, Monnier AS, D'Ercole C, Gire C (2010) Longitudinal follow-up of a cohort of 350 singleton infants born at less than 32 weeks of amenorrhea: neurocognitive screening, academic outcome, and perinatal factors. Eur J Obstet Gynecol Reprod Biol 150:13–18

    Article  PubMed  Google Scholar 

  9. Johnson S, Gilmore C, Gallimore I, Jaekel J, Wolke D (2015) The long-term consequences of preterm birth: what do teachers know? Dev Med Child Neurol 57:571–577

    Article  PubMed  Google Scholar 

  10. Gimenez LG, Krupitzki HB, Momany AM, Gili JA, Poletta FA, Campaña H, Cosentino VR, Saleme C, Pawluk M, Murray JC, Castilla EE, Gadow EC, Lopez-Camelo JS (2016) Maternal and neonatal epidemiological features in clinical subtypes of preterm birth. J Matern Fetal Neonatal Med 29:3153–3161

    Article  PubMed  Google Scholar 

  11. Henderson JJ, McWilliam OA, Newnham JP, Pennell CE (2012) Preterm birth aetiology 2004–2008. Maternal factors associated with three phenotypes: spontaneous preterm labour, preterm pre-labour rupture of membranes and medically indicated preterm birth. J Matern Fetal Neonatal Med 25:642–647

    Article  PubMed  Google Scholar 

  12. Oncel MY, Arayici S, Celen S, Kadioglu Simsek G, Oskovi A, Uras N, Oguz SS, Erdeve O, Danisman N, Dilmen U (2013) The association of a cervical length of %3c 25 mm in high-risk pregnancies on neonatal morbidity and mortality in preterm infants. Arch Gynecol Obstet 287:893–899

    Article  PubMed  Google Scholar 

  13. Martell B, Di Benedetti DB, Weiss H, Zhou X, Reynolds M, Berghella V, Hassan SS (2018) Screening and treatment for short cervical length in pregnancy: a physician survey in the United States. Arch Gynecol Obstet 297:601–611

    Article  PubMed  Google Scholar 

  14. Alfirevic Z, Owen J, Carreras Moratonas E, Sharp AN, Szychowski JM, Goya M (2013) Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol 41:146–151

    Article  CAS  PubMed  Google Scholar 

  15. Conde-Agudelo A, Romero R, Nicolaides K, Chaiworapongsa T, O'Brien JM, Cetingoz E, da Fonseca E, Creasy G, Soma-Pillay P, Fusey S, Cam C, Alfirevic Z, Hassan SS (2013) Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis. Am J Obstet Gynecol 208:42.e1–42.e18

    Article  CAS  Google Scholar 

  16. Robinson JN, Norwitz ER (2018) Preterm birth: Risk factors, interventions for risk reduction, and maternal prognosis. Up to date https://www.uptodate.com/contents/preterm-birth-risk-factors-interventions-for-risk-reduction-and-maternal-prognosis. Accessed 25 May 2018

  17. Goya M, Pratcorona L, Merced C, Rodó C, Valle L, Romero A, Juan M, Rodríguez A, Muñoz B, Santacruz B, Bello-Muñoz JC, Llurba E, Higueras T, Cabero L, Carreras E; Pesario Cervical para Evitar Prematuridad (PECEP) Trial Group (2012) Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 379:1800–1806 (erratum in: Lancet 379:1790, 2012)

  18. Hui SY, Chor CM, Lau TK, Lao TT, Leung TY (2013) Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol 30:283–288

    PubMed  Google Scholar 

  19. Nicolaides KH, Syngelaki A, Poon LC, Picciarelli G, Tul N, Zamprakou A, Skyfta E, Parra-Cordero M, Palma-Dias R, Rodriguez Calvo J (2016) A randomized trial of a cervical pessary to prevent preterm singleton birth. N Engl J Med 374:1044–1052

    Article  CAS  PubMed  Google Scholar 

  20. Karis Allen L, Schulz J, Flood C, Ross S, Naud K (2017) Retrospective cohort study of cervical pessary use in women with short cervix at risk of preterm delivery. J Obstet Gynaecol Can 39:1137–1142

    Article  Google Scholar 

  21. Daskalakis G, Zacharakis D, Theodora M, Antsaklis P, Papantoniou N, Loutradis D, Antsaklis A (2018) Safety and efficacy of the cervical pessary combined with vaginal progesterone for the prevention of spontaneous preterm birth. J Perinat Med. 46:531–537

    Article  CAS  PubMed  Google Scholar 

  22. ** XH, Li D, Huang LL (2017) Cervical pessary for prevention of preterm birth: a meta-analysis. Sci Rep 7:42560

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Saccone G, Ciardulli A, Xodo S, Dugoff L, Ludmir J, Pagani G, Visentin S, Gizzo S, Volpe N, Maruotti GM, Rizzo G, Martinelli P, Berghella V (2017) Cervical pessary for preventing preterm birth in singleton pregnancies with short cervical length: a systematic review and meta-analysis. J Ultrasound Med 36:1535–1543

    Article  PubMed  Google Scholar 

  24. Prior M, Hibberd R, Asemota N, Thornton JG (2017) Inadvertent P-hacking among trials and systematic reviews of the effect of progestogens in pregnancy? A systematic review and meta-analysis. BJOG 124:1008–1015

    Article  CAS  PubMed  Google Scholar 

  25. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341

    Article  Google Scholar 

  26. NIH quality assessment of controlled intervention studies for randomized controlled trials (2018). https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed 12 May 2018

  27. Higgins JPT, Green S (2018) Cochrane handbook for systematc reviews of interventions. https://handbook-5-1.cochrane.org/. Accessed 12 May 2018

  28. US Clinical Trials (2018) https://clinicaltrials.gov. Accessed 30 March 2018

  29. UK Clinical Trials Gateway (2018) https://www.ukctg.nihr.ac.uk/. Accessed 30 Mar 2018

  30. Deeks JJ, Higgins JPT, On behalf of the Statistical Methods Group of The Cochrane Collaboration Statistical Algorithms in Review Manager 5 (2010) https://training.cochrane.org/handbook/statistical-methods-revman5

  31. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed  PubMed Central  Google Scholar 

  32. Higgins J, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  33. Higgins JP, Altman DG, Gotzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  Google Scholar 

  34. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748

    CAS  PubMed  Google Scholar 

  35. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  36. Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Review Manager (RevMan) (computer program) (2014) version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen

  38. Saccone G, Maruotti GM, Giudicepietro A, Martinelli P; Italian Preterm Birth Prevention (IPP) Working Group (2017) Effect of cervical pessary on spontaneous preterm birth in women with singleton pregnancies and short cervical length: a randomized clinical trial. JAMA 318:2317–2324

    Article  Google Scholar 

  39. Kyvernitakis I, Arabin B (2017) Re: Prevention of preterm birth with pessary in twins (PoPPT): a randomized controlled trial. Ultrasound Obstet Gynecol 50:408–409

    Article  CAS  PubMed  Google Scholar 

  40. Zhang G, Feenstra B, Bacelis J, Liu X, Muglia LM, Juodakis J, Miller DE, Litterman N, Jiang PP, Russell L, Hinds DA, Hu Y, Weirauch MT, Chen X, Chavan AR, Wagner GP, Pavličev M, Nnamani MC, Maziarz J, Karjalainen MK, Rämet M, Sengpiel V, Geller F, Boyd HA, Palotie A, Momany A, Bedell B, Ryckman KK, Huusko JM, Forney CR, Kottyan LC, Hallman M, Teramo K, Nohr EA, Davey Smith G, Melbye M, Jacobsson B, Muglia LJ (2017) Genetic associations with gestational duration and spontaneous preterm birth. N Engl J Med 377:1156–1167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G (2017) Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 49:322–329

    Article  CAS  PubMed  Google Scholar 

  42. Sundtoft I, Langhoff-Roos J, Sandager P, Sommer S, Uldbjerg N (2017) Cervical collagen is reduced in non-pregnant women with a history of cervical insufficiency and a short cervix. Acta Obstet Gynecol Scand 96:984–990

    Article  CAS  PubMed  Google Scholar 

  43. Hao J, Yao W, Harris WR, Vink JY, Myers K, Donnelly E (2018) Characterization of collagen microstructural organization of human cervical tissue. Reproduction 156:71–79

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Pachtman SL, Ghorayeb SR, Blitz MJ, Harris K, Vohra N, Sison CP, Rochelson BL (2018) Ultrasonic assessment of cervical heterogeneity for prediction of spontaneous preterm birth: a feasibility study. Am J Perinatol 35:292–297

    Article  PubMed  Google Scholar 

  45. Stout MJ, Zhou Y, Wylie KM, Tarr PI, Macones GA, Tuuli MG (2017) Early pregnancyvaginal microbiome trends and preterm birth. Am J Obstet Gynecol 217(3):356.e1–356.e18

    Article  Google Scholar 

  46. Freitas AC, Bocking A, Hill JE, Money DM; VOGUE Research Group (2018) Increased richness and diversity of the vaginal microbiota and spontaneous preterm birth. Microbiome 6:117

    Article  Google Scholar 

  47. Son KA, Kim M, Kim YM, Kim SH, Choi SJ, Oh SY et al (2018) Prevalence of vaginal microorganisms among pregnant women according to trimester and association with preterm birth. Obstet Gynecol Sci 61:38–47

    Article  PubMed  Google Scholar 

  48. Brabant G (2016) Bacterial vaginosis and spontaneous preterm birth. J Gynecol Obstet Biol Reprod (Paris) 45:1247–1260

    Article  CAS  Google Scholar 

  49. Haahr T, Ersbøll AS, Karlsen MA, Svare J, Sneider K, Hee L, Weile LK, Ziobrowska-Bech A, Østergaard C, Jensen JS, Helmig RB, Uldbjerg N (2016) Treatment of bacterial vaginosis in pregnancy in order to reduce the risk of spontaneous preterm delivery—a clinical recommendation. Acta Obstet Gynecol Scand 95:850–860

  50. Subtil D, Brabant G, Tilloy E, Devos P, Canis F, Fruchart A, BissingerC Dugimont JC, Nolf C, Hacot C, Gautier S, Chantrel J, Jousse M, DesseauveD Plennevaux JL, Delaeter C, Deghilage S, Personne A, Joyez E, Guinard E, KipnisE Faure K, Grandbastien B, Ancel PY, Goffinet F, Dessein R (2018) Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet 392:2171–2179

    Article  CAS  PubMed  Google Scholar 

  51. Herrera-Muñoz A, Fernández-Alonso AM, Fischer-Suárez N, Chedraui P, Pérez-López FR (2017) Maternal serum cytokine levels in pregnancies complicated with threatened preterm labour. Gynecol Endocrinol 33:408–412

    Article  CAS  PubMed  Google Scholar 

  52. RCOG Preterm labour, antibiotics, and cerebral palsy. Scientific impact paper no. 33 (2013) https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip33/ . Accessed 2 Dec 2018

  53. Flenady V, Hawley G, Stock OM, Kenyon S, Badawi N (2013) Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev 5:CD000246

  54. Stricker N, Timmesfeld N, Kyvernitakis I, Goerges J, Arabin B (2016) Vaginal progesterone combined with cervical pessary: a chance for pregnancies at risk for preterm birth? Am J ObstetGynecol 214:739.e1–739.e10

    Article  CAS  Google Scholar 

  55. Goya M, Cabero L, Carreras (2016) Cervical pessary and preterm singleton birth. N Engl J Med 375:e10

  56. Martinelli P, Saccone G (2018) Cervical pessary and spontaneous preterm birth—reply. JAMA 319:1821–1822

  57. Kindinger LM, Bennett PR, Lee YS, Marchesi JR, Smith A, Cacciatore S, Holmes E, Nicholson JK, Teoh TG, MacIntyre DA (2017) The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome 19(5):6

    Article  Google Scholar 

  58. Willan AR (2016) Accounting for treatment by center interaction in sample size determinations and the use of surrogate outcomes in the pessary for the prevention of preterm birth trial: a simulation study. Trials 17:310

    Article  PubMed  PubMed Central  Google Scholar 

  59. Dziadosz M, Bennett TA, Dolin C, West Honart A, Pham A, Lee SS, Pivo S, Roman AS (2016) Uterocervical angle: a novel ultrasound screening tool to predict spontaneous preterm birth. Am J ObstetGynecol 215:376.e1–7

    Article  Google Scholar 

  60. Baños N, Murillo-Bravo C, Julià C, Migliorelli F, Perez-Moreno A, Ríos J, Gratacós E, Valentin L, Palacio M (2018) Mid-trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low-risk population. Ultrasound Obstet Gynecol 51:629–636

    Article  PubMed  Google Scholar 

  61. Baños N, Perez-Moreno A, Julià C, Murillo-Bravo C, Coronado D, Gratacós E, Deprest J, Palacio M (2018) Quantitative analysis of cervical texture by ultrasound in mid-pregnancy and association with spontaneous preterm birth. Ultrasound Obstet Gynecol 51:637–643

    Article  PubMed  Google Scholar 

  62. de Tejada BM, Faltin DL, Kinkel K, Guittier MJ, Boulvain M, Irion O (2011) Magnetic resonance imaging of the cervix in women at high risk for preterm delivery. J Matern Fetal Neonatal Med 24:1392–1397

    Article  PubMed  Google Scholar 

  63. Cannie MM, Dobrescu O, Gucciardo L, Strizek B, Ziane S, Sakkas E, Schoonjans F, Divano L, Jani JC (2013) Arabin cervical pessary in women at high risk of preterm birth: a magnetic resonance imaging observational follow-up study. Ultrasound Obstet Gynecol 42:426–433

    CAS  PubMed  Google Scholar 

  64. Callahan BJ, DiGiulio DB, Goltsman DSA, Sun CL, Costello EK, Jeganathan P, Biggio JR, Wong RJ, Druzin ML, Shaw GM, Stevenson DK, Holmes SP, Relman DA (2017) Replication and refinement of a vaginal microbial signature of preterm birth in two racially distinct cohorts of US women. Proc Natl Acad Sci USA 114:9966–9971

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Stout MJ, Zhou Y, Wylie KM, Tarr PI, Macones GA, Tuuli MG (2017) Early pregnancy vaginal microbiome trends and preterm birth. Am J Obstet Gynecol 217:356.e1–356.e18

    Article  Google Scholar 

  66. Ashford K, Chavan NR, Wiggins AT, Sayre MM, McCubbin A, CritchfieldAS O'Brien J (2018) Comparison of serum and cervical cytokine levels throughout pregnancy between preterm and term births. AJP Rep 8:e113–e120

    Article  PubMed  PubMed Central  Google Scholar 

  67. García-Blanco A, Diago V, Serrano De La Cruz V, Hervás D, Cháfer-Pericás C, Vento M (2017) Can stress biomarkers predict preterm birth in women with threatened preterm labor? Psychoneuroendocrinology 83:19–24

    Article  CAS  PubMed  Google Scholar 

  68. Jelliffe-Pawlowski LL, Rand L, Bedell B, Baer RJ, Oltman SP, Norton ME, Shaw GM, Stevenson DK, Murray JC, Ryckman KK (2018) Prediction of preterm birth with and without preeclampsia using mid-pregnancy immune and growth-related molecular factors and maternal characteristics. J Perinatol 38:963–972

    Article  PubMed  PubMed Central  Google Scholar 

  69. Guolo A, Varin C (2017) Random-effects meta-analysis: the number of studies matters. Stat Methods Med Res 26:1500–1518

    Article  PubMed  Google Scholar 

  70. Borenstein M (2011) Chapter 11: Software for publication bias. In: Borenstein M, Rothstein H (eds) Comprehensive metaanalysis: a computer program for research synthesis, pp193–220. https://www.meta-analysis.com. Accessibility verified 2 Dec 2018

Download references

Funding

This research received no specific grant from any funding agency of the public, commercial, or non-profit sector. The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Red de Investigación en Ginecología, Obstetricia y Reproducción, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain

    Faustino R. Pérez-López, Gonzalo R. Pérez-Roncero & Samuel J. Martínez-Domínguez

  2. Departament of Obstetrics and Gynecology, Hospital Clínico Lozano-Blesa, Faculty of Medicine, University of Zaragoza, Domingo Miral s/n, 50009, Zaragoza, Spain

    Faustino R. Pérez-López

  3. Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador

    Peter Chedraui

  4. Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay

    Peter Chedraui

Authors
  1. Faustino R. Pérez-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Chedraui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gonzalo R. Pérez-Roncero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samuel J. Martínez-Domínguez
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Health Outcomes and Systematic Analyses (HOUSSAY) Project

Contributions

FRPL conceived, designed, supervised, and drafted the article. PC searched clinical trial registries and interpreted the results. GRPR conceived and designed the study, carried out the search strategy, and interpreted the results. SJMD extracted data, assessed the risk of bias, performed the meta-analyses, and interpreted the results. All authors approved the final manuscript.

Corresponding author

Correspondence to Faustino R. Pérez-López.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement for meta-analyses. Formal institutional review board approval was not required due to the fact that this analysis consisted of the pooling of published studies.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pérez-López, F.R., Chedraui, P., Pérez-Roncero, G.R. et al. Effectiveness of the cervical pessary for the prevention of preterm birth in singleton pregnancies with a short cervix: a meta-analysis of randomized trials. Arch Gynecol Obstet 299, 1215–1231 (2019). https://doi.org/10.1007/s00404-019-05096-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-019-05096-x

Keywords

Search

Navigation