ABSTRACT
Objective: This study aimed to evaluate the effects of combined management of placenta previa with the Arabin cervical pessary and progesterone.Study design: In this randomized controlled study, we followed up 217 patients with placenta previa and high risk of preterm birth. The main group (n = 81) underwent combined management with the Arabin cervical pessary and progesterone; the control group (n = 136) received progesterone only. Placental migration was monitored using Doppler scanning from 24 weeks of pregnancy onwards.Results: Patients receiving the combination of the Arabin cervical pessary and progesterone had a three-fold reduced rate of bleeding during pregnancy compared with patients in the control group (11.3% versus 33.1%; p = .006). Placental migration occurred 1.8 times more often in the pessary group (48.1% versus 26.4%; p = .037), and preterm labor <34 weeks occurred 2.7 times less often compared with the control group (p = .031). The use of the Arabin cervical pessary caused a change in the anterior cervico-uterine angle by 7.4 degrees, and reduction in the arcuate artery RI at 32-33 weeks of pregnancy compared with the control group.Conclusions: The use of the Arabin cervical pessary combined with progesterone in patients with placenta previa significantly reduced the rate of preterm delivery <34 weeks and bleeding during pregnancy.
Subject(s)
Pessaries , Placenta Previa/therapy , Premature Birth/prevention & control , Progesterone/therapeutic use , Progestins/therapeutic use , Administration, Intravaginal , Adolescent , Adult , Combined Modality Therapy , Female , Humans , Middle Aged , Pregnancy , Pregnancy Trimester, Second , Premature Birth/etiology , Treatment Outcome , Ultrasonography, Doppler , Ultrasonography, Prenatal , Young AdultABSTRACT
OBJECTIVE: This study aimed to compare the efficacy of combined use of Arabin pessary, cervical cerclage and progesterone with progesterone-only management of pregnant women at high risk of preterm birth. MATERIALS AND METHODS: The study included 203 pregnant women at high risk of preterm birth who were randomised to receive Arabin pessary (Group 1, n = 82) and progesterone, circular cervical cerclage and progesterone (Group 2, n = 121) or progesterone treatment only (Group3, controls, n = 50). Patients in the pessary and cerclage group also received progesterone. RESULTS: The use of Arabin pessary combined with progesterone resulted in a 2.5-fold decrease in the rate of vaginal dysbiosis in pregnancy (p = 0.015) and almost three-fold reduction in in the postpartum period (p = 0.037), combined with circular cervical cerclage and progesterone. Suture eruption was observed in 4.3% of women. In patients with abnormal placental location, placental migration was observed in 62.1% of patients in Group I, 52.1% in Group II and a significantly lower proportion of patients (14.0%) in Group III (p = 0.001). Bleeding during pregnancy was observed significantly more often in both comparison groups (p = 0.005). Incidence of intrapartum bleeding was 17.4% (p = 0.011) in Group II and 24.5% in Group III (p = 0.002). Intrapartum chorioamnionitis was observed in 4.3% of patients in Group II and 2.04% of patients in Group III. CONCLUSIONS: The use of Arabin pessary compbined with progesterone reduces the rate of infectious complications and bleeding during pregnancy and the postpartum period.
