Navegando por Palavras-chave "Cervical pessary"

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    Pessary plus progesterone to prevent preterm birth in women with short cervixes. A randomized controlled trial
    (Wolters Kluwer Health, Inc., 2022-01-01) Pacagnella, Rodolfo de Carvalho; Silva, Thais V.; Cecatti, José Guilherme; Passini Jr., Renato; Fanton, Tatiana F.; Borovac-Pinheiro, Anderson; Pereira, Cynara Maria; Fernandes, Karayna Gil; França, Marcelo Santucci [UNIFESP]; Li, Wentao; Mol, Ben W.; P5 Working Group; http://lattes.cnpq.br/5647674022681204
    OBJECTIVE: To test the effectiveness of cervical pessary in addition to vaginal progesterone for the prevention of preterm birth in women with midpregnancy short cervixes. METHODS: We performed a multicenter, open-label, randomized controlled trial in 17 perinatal centers. Asymptomatic women with singleton or twin pregnancies and cervical lengths of 30 mm or less, measured at 18 0/7– 22 6/7 weeks of gestation, were randomized to cervical pessary plus vaginal progesterone (pessary plus progesterone group) or vaginal progesterone only (progesteroneonly group) (200 mg/day). Treatments were used from randomization to 36 weeks of gestation or delivery. The primary outcome was a composite of neonatal mortality and morbidity. Secondary outcomes were delivery before 37 weeks and before 34 weeks of gestation. Analysis was performed according to intention to treat. RESULTS: Between July 9, 2015, and March 29, 2019, 8,168 women were screened, of whom 475 were randomized to pessary and 461 to progesterone only. The composite perinatal outcome occurred in 19.2% (89/463) of the women in the pessary group compared with 20.9% (91/436) of the women in the progesterone-only group (adjusted risk ratio [aRR] 0.88, 95% CI 0.69–1.12). Delivery rates before 37 weeks of gestation were 29.1% compared with 31.4% (aRR 0.86, 95% CI 0.72–1.04); delivery rates before 34 weeks were 9.9% compared with 13.9% (aRR 0.66, 95% CI 0.47–0.93). Women in the pessary group had more vaginal discharge (51.6% [245/476] vs 25.4% [117/479] [P,.001]), pain (33.1% [157/476] vs 24.1% [111/479] [P5.002]), and vaginal bleeding (9.7% [46/476] vs 4.8% [22/479] [P5.004]). CONCLUSION: In asymptomatic women with short cervixes, the combination of pessary and progesterone did not decrease rates of neonatal morbidity or mortality when compared with progesterone only.
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    Short cervix syndrome: current knowledge from etiology to the control
    (Springer, 2013-04-01) Guimaraes Filho, Helio Antonio; Araujo Junior, Edward [UNIFESP]; Pires, Claudio Rodrigues; Machado Nardozza, Luciano Marcondes [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Imaging Training Ctr CETRIM; Universidade Federal de São Paulo (UNIFESP); São Paulo Ultrasound Training Ctr CETRUS
    Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. the strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery.To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies.Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary.We found a lot of articles about this topic, including randomized controlled trials. the etiology is multifactorial, being the diagnosis based in a cervix shortening at 20-24 weeks. the history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. the progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix.The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. the best approach should be individualized to each patient.