A new study published in The Lancet on April 3rd 2012 reveals a promising management for pregnant womyn at risk for preterm labor and delivery.
The study by Dr. Maria Goya from the Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Spain is the first multicenter randomized trial to test the use of a cervical pessary in womyn at high risk for preterm birth. The pessary was found to be an effective strategy to prevent preterm birth in pregnant womyn with a short cervix.
We already know that a short cervix early in pregnancy is one risk factor for preterm birth.
The Spanish study, called Pesario Cervical par Evitar Prematuridad (PECEP), randomly divided Pregnant womyn with cervical length of less than 2.5 cm into two groups: One group was treated with a cervical pessary and the other with watchful waiting. Spontaneous delivery before 34 weeks (8.5 months) was significantly lower (only 6%) in the cervical pessary group than in women assigned to expectant management (27%).
With the observed reduction in preterm birth, the pessary group of womyn was also found to give birth to larger infants with less complications as respiratory distress or sepsis.
Given the lack of cost-effective methods to prevent preterm delivery these findings offer new hope.
Hormonal treatment with progesterone is one method that was found to be effective in prevention of preterm birth. However, recent corporate greed might keep such effective medication away from the reach of many womyn. Even though progesterone has been available in an affordable form for more than a decade, now that the evidence of its benefits has solidified, it has been recently repackaged by a pharmaceutical company, given a name (Makena) and dropped in the market with a price that exceeds 1000 USD. Makena’s price has already caused much controversy especially that the FDA might prohibit pharmacies from compounding the cheap original formula.
Cervical cerclage is another method that has been studied significantly. So far the evidence of its benefit had been controversial. The process requires significant surgical skills and many gynecologists had not been adequately trained. It is also an invasive procedure that might be associated with significant risks such as rupture of membranes, infection, preterm delivery or miscarriage among others. Those risk, even though rare in well-trained hands remain significant given the little proven benefit of cervical cerclage.
In the above mentioned Spanish study, the use of a cervical pessary was found to be relatively safe and at low cost to patient. Side effects were limited to slight increase in vaginal discharge, and little discomfort.
The exact mechanism of action of the pessary is still not clear. But given its safety and low cost, it still stands as a promising option. I anticipate it will take some time before it becomes available in the American and Canadian market.