TITLE:
First Experience Using Brazilian Ingamed® Cervical Pessary in Twin Pregnancy: A Case Series
AUTHORS:
Janete Vettorazzi, Cristiano Caetano Salazar, Edimárlei Gonsales Valério, Ana Lúcia Isotton, Anthomy Petermann, Marcos Wengrover Rosa, Gabriela Francoes Rostirolla
KEYWORDS:
Cervical Pessary, Ingamed Pessary, Progesterone, Twin Pregnancy, Preterm Birth
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.13,
November
1,
2018
ABSTRACT: Background: The rate of prematurity in twin pregnancies is higher than 50%. Due to
its multifactorial nature, different strategies are necessary to reduce the
incidence of premature birth or to increase the gestational age at birth of
pregnancies at risk. In this context, cervical pessary may be indicated in twin
pregnancies with short cervix. Methods: In this case series, we describe six twin pregnancies that were considered as
high-risk for preterm labor due to short cervix (CL at
second trimester and multiple risk factors for prematurity. Several strategies
were associated for the goal of delaying gestational age at birth. The main
strategies were: removal of labor activities, treatment of infections, vaginal
micronized progesterone 400 mg/day and vaginal pessary insertion (Ingamed®Brazil). Results: The gestational age of
insertion of the pessary ranged from 16 to 24 weeks. The gestational age of
birth ranged from 26 to 34 weeks. Three of the pregnancies were delivered due
to spontaneous onset of labor, and three were delivered due to medical reasons.
The mean length of pregnancy since pessary insertion to birth was 9 weeks
(range 2 to 17 weeks). All infants without severe fetal malformation were
discharged from the hospital without major sequelae. Conclusion: The use of cervical pessaries associated to micronized progesterone at a dose
of 400 mg/day may be an option in the management of twins at risk for preterm
birth. More controlled studies are needed to evaluate the simultaneous use of
cervical pessary and progesterone on twin pregnancies.