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Clinical and Experimental Obstetrics & Gynecology  2021, Vol. 48 Issue (5): 1111-1116    DOI: 10.31083/j.ceog4805179
Original Research Previous articles | Next articles
Comparative assessment of Arabin pessary and cervical cerclage in the management of cervical insufficiency
Caterina Pizzicaroli1, Veronica Arciero1, Ilaria Simonelli2, Nicola Caporale3, *(), Massimo Maria Salvatori1, Doriana Scaldaferri1, Silvio Tartaglia4, Giovanni Larciprete1
1Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Isola Tiberina Hospital, 00186 Rome, Italy
2Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, 00186 Rome, Italy
3Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
4Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Abstract  
Background: One of the most important causes of preterm birth (PTB) is cervical insufficiency, which usually it's treated by performing a surgical cervical cerclage (CC). Currently, a valid alternative to surgical treatment is represented by the application of a non-invasive intravaginal silicon device called Arabin® pessary (AP). The aim of the study is to compare these two therapeutic approaches in terms of gestational and neonatal outcomes. Methods: In this observational cohort study, we retrospectively evaluated the pregnant women between 18 and 24 gestational weeks referred to the Department of Obstetrics and Gynecology of San Giovanni Calibita Fatebenefratelli Hospital of Rome from 2015 to 2017 with the diagnosis of threatened preterm birth. The 26 women were divided into groups according to the treatment received: cervical cerclage (Group-1, in-patient) and Arabin® pessary (Group-2, out-patient), both in combination with vaginal progesterone (PG). The primary outcome was the gestational age at delivery, and various secondary maternal and neonatal outcomes were considered. Results: The results do not show a statistically significant difference between the two groups, both in terms of gestational and neonatal outcomes. Considering surgical risks (anesthesia, blood loss), recovery-time and economic costs of CC, AP showed very interesting advantages resulting in more favorable cost-benefits relation. Conclusion: We confirmed once again that out-patient combination of AP and vaginal PG is a safe, non-invasive choice as treatment of PTB. Unfortunately, the small population doesn't allow to define this a noninferiority trial. Further larger randomized controlled studies are needed to reassure clinicians about the efficacy of this combined non-invasive approach.
Key words:  Cervical insufficiency      Cervical cerclage      Arabin pessary      Late abortion      Preterm birth      Shortened cervix     
Submitted:  11 April 2021      Revised:  09 June 2021      Accepted:  18 June 2021      Published:  15 October 2021     
*Corresponding Author(s):  caporalenicola@gmail.com; nicola.caporale01@icatt.it (Nicola Caporale)   

Cite this article: 

Caterina Pizzicaroli, Veronica Arciero, Ilaria Simonelli, Nicola Caporale, Massimo Maria Salvatori, Doriana Scaldaferri, Silvio Tartaglia, Giovanni Larciprete. Comparative assessment of Arabin pessary and cervical cerclage in the management of cervical insufficiency. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(5): 1111-1116.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog4805179     OR     https://ceog.imrpress.com/EN/Y2021/V48/I5/1111

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