Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and meta-analysis

Background: Preterm births occur frequently in multiple pregnancies with a short cervix. The cervical pessary is a potential intervention for prevention of preterm births.

Objective: To assess the effectiveness of cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix (<25 mm).

Search strategy: Major databases from 2006 to 20th November 2016 were searched for relevant terms.

Selection criteria: We included randomized controlled trials that assessed the effectiveness of cervical pessary on pregnancy outcomes in multiple pregnancies with a short cervix.

Data collection and analysis: Risk ratio was used as the summary measure with random effects model. We assessed heterogeneity between studies using the I2 index. Quality assessment was done based on Cochrane Handbook Method.

Main results: Pooled data showed no benefit of using cervical pessary in the prevention of preterm births, birth weights less than 1500 g, less than 2500 g, adverse neonatal events and fetal/neonatal deaths in twin pregnancies with a short cervix.

Conclusion: We are unable to show benefit of using cervical pessary in preventing preterm births in twin pregnancies with a short cervix. However, as cervical pessary is a reasonable intervention, there is a need for more randomized controlled trials in this area.