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Physical Examination-Indicated Pessary

F

Federico II University

Status and phase

Withdrawn
Phase 3

Conditions

PreTerm Birth

Treatments

Device: Cervical cerclage
Device: Arabin Pessary

Study type

Interventional

Funder types

Other

Identifiers

NCT02967445
2156/15

Details and patient eligibility

About

Cervical insufficiency, previously referred to as cervical incompetence, has classically been defined as painless dilation of the cervix in the absence of contractions or bleeding in the second trimester resulting in recurrent pregnancy losses. Painless mid-trimester cervical dilation is an uncommon finding in the general population occurring in less than 1% of pregnancies. Cerclage for the prevention pregnancy loss in cases with both prior preterm births and/or second trimester losses, as well as second trimester cervical dilatation in the index pregnancy, was first reported in the 1950's. Cerclage placement in this setting has been variably referred to as "physical exam-indicated cerclage", "rescue cerclage", and "emergency cerclage". To date, the benefits of cerclage for this indication are not entirely clear.

A recent meta-analysis showed that physical exam-indicated cerclage is associated with a reduction in perinatal mortality and prolongation of pregnancy when compared to no such cerclage.

Recently, several RCTs have shown that cervical pessary could decrease the incidence of PTB in several populations.

Thus, the aim of our trial as noninferiority trial is to evaluate the efficacy of pessary compared to cervical cerclage in prevention of PTB in women in the setting of mid-trimester cervical dilation

Sex

Female

Ages

18 to 50 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Singleton pregnancies
  • Cervical dilation between 1 to 5 cm and/or visible membranes by pelvic exam or speculum exam between at 16-23 6/7 weeks gestation

Exclusion criteria

  • Pessary or cerclage already in situ
  • active vaginal bleeding
  • Placenta previa/accreta
  • Multiple gestations
  • Amniotic membranes prolapsed beyond external os into the vagina, unable to visualize cervical tissue
  • Ruptured amniotic membranes at the time of diagnosis of dilated cervix
  • Cervical dilation more than 5 cm
  • Labor (progressing cervical dilation) or painful regular uterine contractions

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

0 participants in 2 patient groups

Cervical pessary
Experimental group
Description:
Arabin Pessary
Treatment:
Device: Arabin Pessary
Cervical cerclage
Active Comparator group
Description:
McDonald Cerclage
Treatment:
Device: Cervical cerclage

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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