Arabin-pessary or McDonald Cerclage in Cervical Shortening?

We conducted a retrospective analysis of data from patients who underwent either Arabin pessary or McDonald cerclage between January 1, 2019, and January 1, 2023. A total of 174 patients were included in the study, with 31 undergoing Arabin pessary and 143 receiving cervical cerclage using the McDonald technique in singleton pregnant women with cervical insufficiency, which applied between 14 and 22 gestational weeks. We included singleton pregnant women with normal morphology, and with normal combined test. The primary outcome was the impact of each method on preterm delivery (< 34 gestational weeks).

Results

The weeks of cervical cerclage or pessary application were compatible with each other (p < 0.680). The pessary group had a statistically significant longer time to delivery compared with the Cerclage group (cerclage group mean 30.8 c 7.1 standard deviation [SD] versus pessary group mean 35.1 ± 4.4 SD; p < 0.002). A statistically significant difference was found between the pessary and cerclage groups in terms of delivery at < 34 weeks (p = 0.002). In patients with cervical length between 25 and 15mm and < 15mm, no significant difference was found between the pessary and cerclage groups in terms of delivery week (p < 0.212; p < 0.149). Regardless of the technique applied, no statistically significant difference was observed between cervical length and birth < 34 weeks.

Conclusion

Our study found that pessary use for cervical insufficiency is statistically more effective than cervical cerclage surgery in preventing preterm births < 34 weeks in singleton pregnancy.

Keywords
cerclage; pessary; cervical insufficiency; McDonald cerclage

	Cerclage	Pessary
	mean	mean	p-value
Number of patients (n)	143	31	—
Age, years old (mean ± SD)	30.5 ± 4.4	29.9 ± 3.9	0.526
BMI (mean ± SD)	23.8 ± 3.5	23.5 ± 2.2	0.680
Parity (mean ± SD)	0.45 ± 0.8	0.38 ± 0.5	0.651
Number of abortions (mean ± SD)	0.53 ± 1.0	0.64 ± 1.1	0.611

	Cerclage	Pessary	p-value
	Mean	Mean
Cervical effacement (cm)	12.9 ± 3.7	18.6 ± 5.2	0.000
Cervical dilatation (cm)	26.4 ± 6.4	26.7 ± 5	0.823
Processing week	18 ± 3.1	17.8 ± 2.4	0.680
Birth week	30.8 ± 7.1	35.1 ± 4.4	0.002
Progesterone user	0.8 ± 0.4	1 ± 0	0.000
Prenatal death	0.24 ± 0.4	0.06 ± 0.2	0.030
Birth weight, gr (mean)	1855.85 ± 98.668	2566.48 ± 156.581	0.002

	Cerclage (n)	Pessary (n)	p-value
< 1,500 gr	61	5	0.005^c c Chi-squared Test.
1,501 to 2,500gr	22	3	0.411^c c Chi-squared Test.
> 2,501gr	60	23	0.001^c c Chi-squared Test.

	Cerclage	Pessary
	Mean	Mean	p-value
Progesterone user (Birth week)	30.8 SD ± 7.1	35.1 ± 4.5	0.0021
Progesterone nonuser (Birth week)	30.9 ± 7.3	0	—

	CERCLAGE			PESSARY
Cervical length (mm)	n	Birth week (mean)	Rate birth < 34 w (%)	n	Birth week (mean)	Rate birth < 34 w (%)	p-value
I 25-15 mm	32	30.5225	(n = 12) 37.5%	23	34.3750	(n = 5) 21.7%	0.212^c c Chi-squared Test.
II < 15mm	111	32.0000	(n = 57) 51.4%	8	35.3913	(n = 2) 25%	0.149^c c Chi-squared Test.
Total	143			31

	CERCLAGE		PESSARY
Birth week	n	Rate (%)	n	Rate (%)	p-value
< 24	34	23.8	2	6.5	0.031^c c Chi-squared Test.
24 to 27 + 6	16	11.2	1	3.2	0.175
28 to 33 + 6	19	13.3	4	12.9	0.954
34 to 36 + 6	24	16.7	3	9.7	0.321
> 37	50	35	21	67.7	0.007
Total	143	100	31	100

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[1] Address for correspondence Aytaj Jafarzade, MD, Koru Hospital Ankara, Obstetrics and Gynaecology Department, Kızılırmak, 1450. Sk. No:13, 06510 Çankaya/Ankara, Turkey (e-mail: jafarzade_aytac@yahoo.com).