Obstetric pessary: pros and cons, versions and controversies (A retrospective study)
DOI:
https://doi.org/10.37800/RM.4.2025.484Keywords:
preterm labor, isthmic-cervical insufficiency, progestogens, Caesarean section, fetal distressAbstract
Relevance: Preterm labor is the leading cause of perinatal mortality and disability. Various scholars propose different methods of management, ranging from surgical correction of cervical insufficiency during pregnancy, pessary insertion, and progestogen support to surgical correction of cervical insufficiency during preconception care. Despite its long history, the effectiveness of pessary insertion is still being debated.
The study aimed to analyze the pregnancy outcomes and the condition of newborns in women with isthmic-cervical insufficiency, with and without a pessary.
Materials and Methods: This retrospective statistical analysis included 297 pregnant women with an established diagnosis of cervical insufficiency, 158 without a pessary, and 139 with a pessary installed. Participants were randomly assigned to ensure uniform distribution of characteristics across groups.
Results: The groups with and without pessaries did not differ statistically regarding age, medical history, parity, or extragenital diseases. Women without pessaries had 2.5 times more spontaneous miscarriages, as well as more preterm labor after 32 weeks. Women with pessaries more often underwent Cesarean section, with the main indications being advanced maternal age in primiparas and multiple pregnancies. In the group without pessaries, the predominant indications were uterine scar and ineffective labor induction or stimulation. In the group without pessaries, neonatal respiratory distress syndrome occurred more frequently, which may be associated with a higher incidence of preterm labor.
Conclusion: Differences were observed in the timing and outcomes of pregnancy, indications for operative delivery, and the condition of newborns. Using a pessary slightly reduces the incidence of preterm birth, thereby improving neonatal outcomes. A statistical difference was found in the indicator “older primiparous women” during operative delivery in the group with pessaries. Although the debate around pessary use is unlikely to be resolved soon, its application in clinical practice appears well justified. The use of pessaries in clinical practice remains entirely justified, given the desire of doctors to ensure the most complete pregnancy possible.
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Copyright (c) 2025 Шолпан Сармулдаева, Т.М. Джусубалиева , А.П Джаимбетова , Л.Г. Баймурзаева, В.Г. Хорун, МУ Абдуллаева, Т.В. Рослякова, А Миреева, ДО Карибаева, ФА Кусаинова, АШ Джусангалиева
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