Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and meta-analysis

Background: Preterm births occur frequently in multiple pregnancies with a short cervix. The cervical pessary is a potential intervention for prevention of preterm births.

Objective: To assess the effectiveness of cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix (<25?mm).

Search strategy: Major databases from 2006 to 20th November 2016 were searched for relevant terms.

Selection criteria: We included randomized controlled trials that assessed the effectiveness of cervical pessary on pregnancy outcomes in multiple pregnancies with a short cervix.

Data collection and analysis: Risk ratio was used as the summary measure with random effects model. We assessed heterogeneity between studies using the I² index. Quality assessment was done based on Cochrane Handbook Method.

Main results: Pooled data showed no benefit of using cervical pessary in the prevention of preterm births, birth weights less than 1500?g, less than 2500?g, adverse neonatal events and fetal/neonatal deaths in twin pregnancies with a short cervix.

Conclusion: We are unable to show benefit of using cervical pessary in preventing preterm births in twin pregnancies with a short cervix. However, as cervical pessary is a reasonable intervention, there is a need for more randomized controlled trials in this area.