Pregnancy Outcomes Upon Using Arabin Pessary in Cases of Premature Cervical Shortening

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Spontaneous preterm birth is the leading cause of perinatal morbidity and mortality. Several methods were found to be helpful in preventing preterm deliveries in singleton gestations. Those include progesterone administration and different cervical cerclage. Arabin Pessary which is a silicone made device has been explored in recent years as a method of preterm birth prevention. In contrast to singleton gestations, neither progesterone administration nor cervical cerclage were found to be affective in a multi-gestational pregnancy. Our article describes three cases with increased chances of preterm delivery. Two singletons and one multi-gestational pregnancy. All three women received a cervical Arabin Pessary in addition to the accepted treatment of progesterone. All three women had favorable results and delivered healthy infants. We concluded from our experience and from trials conducted in centers around the world that cervical Arabin Pessary is beneficial in preventing preterm birth both in singleton and in multi-gestational pregnancies.

A 40 year old gravida 5 para 1, turned up for a medical evaluation 23+6 weeks gestation after in vitro fertilization [IVF] due to lower abdominal pressure. Primary evaluation determined 20 millimeters cervical length with a U shaped funneling. Her history included a genetic screening which demonstrated 2% 45 x0, 4% 47xxx and 94% 46 xx genetic mosaicism. During her previous pregnancy she experienced cervical shortening at 16 weeks gestation. McDonald’s cerclage was administered. At 25 weeks gestation cesarean section was performed after she experienced septic shock and the cerclage was removed. Her first trimester genetic screening determined a 1:95 chance for down’s syndrome. Second trimester genetic screening determined a 1:170 chance for down’s syndrome. She refused to go throw amniocentesis. 200 mg of Uterogestan®( Laboratoires Besins International) was given once daily and Arabin Pessary was inserted upon the cervix. During her admission period she was diagnosed with gestational diabetes mellitus which was well controlled with a low carbohydrate diet was discharged at 27 weeks gestation and returned to labor and delivery in active labor 36+4 weeks gestation. She delivered vaginally. The fetus weighed 2400 gram and received Apgar scores of 9 and 10 after 1 and 5 minutes.

A 25 year old gravida 1 para 0 bichorionic biamniotic twin pregnancy after intrauterine insemination[IUI] turned for a medical evaluation 25 weeks gestation due to uterine contractions. Her medical history is within normal limits and so does her first and second trimester genetic screenings. Her cervical length was 23 mm dilated to 3 cm [figure 1]. In addition, the amniotic sac was exposed at the external cervical os. Her Monitor exhibited recurrent contractions. After Atosiban®[Ferring] administration contractions have subsided. She received magnesium for neuroprotection and Celestone. Arabin pessary was installed upon the cervix .