Assessment of the risk of spontaneous preterm birth in pregnant women with the Dr. Arabin cervical pessary

Abstract

BACKGROUND: Preterm birth has a multifactorial etiology, including both maternal and fetal complications, amid the effect of functionally impaired variants of multiple genes. Preterm birth is therefore considered as the major obstetric syndrome. One of the anatomical components of this syndrome is a short cervix, and a cervical pessary is used as a prevention of preterm birth in these patients. AIM: The aim of this study was to identify risk factors for spontaneous preterm birth in pregnant women who received a cervical pessary. MATERIALS AND METHODS: This prospective, open, randomized cohort study included 189 women with a singleton pregnancy and a short cervix (25 according to the Salomon scale) and a threatened miscarriage / preterm birth in the second and third trimesters trimester, who received the Dr. Arabin cervical pessary. We analyzed 183 parameters and identified the main risk factors leading to spontaneous preterm birth based on pregnancy outcomes. RESULTS: Based on the pregnancy outcomes, all patients were categorized into two main groups: group I included 167 women with term birth and group II consisted of 19 pregnant women with spontaneous preterm birth. The main risk factors for spontaneous preterm birth in singleton pregnancies in descending order were: the Bishop score 7 points (p = 0.00032, OR 12.38, 95 % CI [3.5043.87]), the modified Steinberg score 8 points (p = 0.00056, OR 10.55, 95% CI [3.0936.03]), cervical length 15 mm by transvaginal cervicometry (p 0.001, OR 7.94, 95% CI [2.8322.26]), history of preterm birth (p = 0.00128, OR 6.91, 95% CI [2.3220.56]), chronic placental insufficiency (p = 0.00307, OR 5.06, 95 % CI [1.8214.01]), genital anomalies (p = 0.07452, OR 5.03, 95% CI [1.1522.06]), and history of surgical manipulations on the cervix (p = 0.07003, OR 2.90, 95% CI [1.058.00]). In multivariate analysis, the risk of spontaneous preterm birth was five times higher in pregnant women with the concomitant presence of three risk factors: cervical length 15 mm, the modified Steinberg score 8 points, and the Bishop score 7 points (83.33% of spontaneous preterm birth compared to 16.67% of term birth; p 0.05, OR 59.29, 95% CI [6.47543.29]). CONCLUSIONS: Among patients with a short cervix and the Dr. Arabin cervical pessary, we have identified groups at higher risk for spontaneous preterm birth.