State birth or birth before 37 weeks of pregnancy, is a major worldwide health problems, which significantly contributes to child mortality and long -term health problems. According to the World Health Organization (WHO), India has the highest number of premature births worldwide, with around 3.6 million babies born every year. This high number of premature births contributes considerably to neonatal deaths, with more than 3.00,000 premature babies Die annually.
What is a cervical pessary and why is it used?
A cervical pessaire is a medical device, usually a silicone ring, placed around the cervix of a pregnant woman to prevent premature birth. It is used when a woman has a shortened cervix or cervical insufficiency that can lead to a miscarriage or premature delivery. The cervix acts as a barrier that holds the baby in the womb and when it is shortened too early, this can lead to premature birth. A pessaire helps by supporting the cervix and changing the corner of the cervical channel, reducing direct pressure from the uterus on the cervix.
The Pessary wants to support the cervix, which may open it too early. It is not surgery and reversible. Some international tests show variable efficacy, but different show a reduction in spontaneous premature birth before 34 or 37 weeks in women with a high risk. It is mainly used to prevent spontaneous premature birth in pregnant women who are considered in a high risk, especially those with a shortened cervix that are detected during the second trimester.
These are low -tech, cost -effective options, especially in institutions where access to surgical interventions or frequent ultrasound screening can be limited. A. Jaishree Gajaraj, Head of Obstetrics and Gynecology at MGM Healthcare, Chennai, says that cervical pessaria have been in use for decades, although their adoption is more common in recent years as a non-surgical option to manage cervical insufficiency.
In contrast to surgical procedures such as cervical cerclage-one surgical procedure in which a stab around the cervix is placed to prevent premature or late miscarriage caused by cervical insufficiency, the pessary is a non-invasive, removable device, often inserted into an outpatient. It is designed as a cheap alternative with a low risk, especially useful in institutions where surgical expertise or infrastructure can be limited. “Earlier we had to rely on cervical stitches, which require anesthesia and hospitalization. The pessaire, a soft silicone ring, offers similar support and can easily be inserted into an outpatient environment,” says Dr. Gajaraj.
According to the WHO and International Federation of Gynecology and Obstetrics (Figo), cervical pessaria can play a valuable role in preventing premature work in selected cases, such as Singleton pregnancies with a short cervix. Although its use varies from case, it is usually retained for up to 36-37 weeks, unless early removal is required. Dr. Gajaraj emphasizes that the device is intended to prevent premature birth, as supported by global tests and clinical guidelines of the British National Institute for Health and Care Excellence (Nice) and major international authorities.
Who needs a cervical pessary?
Candidates generally include women with a single -pregnancy and cervical length ≤ 25 mm in the middle trimester, especially if there is a history of spontaneous premature birth or contraintications for surgical cerclage. That said, careful assessment is essential: not every woman with a short cervix qualifies. The role of pessaria remains context sensitive, led by individual risk, symptoms and facility options, in accordance with Global WHO guidance.
Studies underline that although cervical cerclage and vaginal progesterone support pillars remain, pessaria grip in tertiary and community institutions as part of a broader evidence-inspired approach.
Is it safe for mother and baby?
With regard to safety, most studies report minimal risk. The most common side effect is increased vaginal discharge, which usually does not indicate any infection. In one Study published Through PlosA questionnaire of 166 women who used the Arabin Pessary discovered that 42 % experienced an increased discharge, 14 % had discomfort and removal was moderately painful for 35 %; Yet more than 75 % felt that the treatment exceeded expectations and reported an improved quality of life with the right clinical support.
There is no robust evidence that Pessair links use to increased infections, miscarriage or damage to the fetus that resulted in the correct follow -up and timely removal (usually approximately 37 weeks or earlier if indicated). He emphasizes that the correct placement and monitoring are crucial for maintaining safety. The decision to use a pessair must be taken in consultation with a healthcare provider, taking into account individual risk factors and the general clinical image.
In the midst of recent concerns after a legal case in which the use of a cervical pessary was cited as the reason for a premature birth, Dr. Gajaraj on a better informed concept. “In that case the pessary was placed as a preventive measure for cervical insufficiency to prevent premature birth, but it was later attributed as the cause,” she explains.
How effective is it when preventing premature birth?
Proof is mixed, yet encouraging in selected populations. By one Study published in American Journal of Obstetrics and Gynecology Randomized studies such as Goya et al. And another Italian center discovered that Pessary in pregnancies with a high risk before 34 weeks by almost half (eg 7.3 % versus 15.3 %) and the spontaneous delivery percentages before 37 weeks (22 % versus 59 %) reduced. Meta-analyzes also show advantage in twin pregnancies when used with caution, although Singleton pregnancy results are more variable. The Cochrane Review, although he remarks heterogeneity, evokes more large-scale tests and long-term follow-up
In India, no major clinical studies have yet been published that specifically evaluate pessaire effectiveness. Doctors, however, suggest that it can be useful in particular in settings with limited resources where cervical cerclage is not feasible or an ultrasound is a challenge, provided that the basic training exists for the right selection and placement.
Why is this relevant in the Indian setting?
In many parts of India, ultrasound and surgical options such as Cerclage can be limited. Cervical pessaria such as the Arabin brand are available through authorized partners with training and user guidelines that are tailored to local practice. Pessaire insertion and removal can also be done on an outpatient basis and requires no anesthesia or surgical theater, making it suitable for care at community level.
Studies recognize pessaria as a promising deputy in treated women with cervical insufficiency or short cervix, especially when Cerclage is inserted or not available.
Dr. Gajaraj emphasizes that although the cervical pessary can be a useful tool in selected cases, its use must be carefully evaluated, agreed to and controlled under good medical supervision.
Published – August 05, 2025 11:33 pm
#Cervical #Pessary