[Using Cervical Pessary to Prevent Premature Birth - a Clinical Analysis]. / Vermeidung der Frühgeburt durch Einlage eines Zerclage-Pessars ­ Eine klinische retrospektive Kohortenanalyse.

OBJECTIVE: In the event of a cervical shortening < 25 mm before the 34th week of gestation, a cervical pessary can be inserted in accordance with the German AMWF guidelines. However, data concerning the benefit of this intervention in order to avoid premature birth are controversial. METHODS: Between the 20th and 32nd week of gestation, we inserted a cervical pessary in 83 patients and evaluated our data with regard to the extension of gestational age due to this intervention. We also reviewed the literature on this topic. We retrospectively analysed the data in a high-risk group (cervical length<15 mm) and a low-risk group (15-25 mm). RESULTS: Our data show a preterm birth in just 20% of all cases in both subgroups. 79% of the patients gave birth after 34 weeks and 59% after 37 weeks. CONCLUSIONS: Our approach using an cervical pessary supported by local application of progesterone seems to be a well-tolerated intervention with few side effects and acceptable adherence. In addition, our data demonstrate a reduction in hospitalization, even though the evidence is divergent in this respect.

Assessment of rapid fetal fibronectin in predicting preterm delivery.

OBJECTIVE: The aim of this study was to estimate the effectiveness of cervical fetal fibronectin assayed by the rapid fetal fibronectin assay in predicting preterm delivery in patients with signs or symptoms of preterm labor. METHODS: Patients with preterm labor between 24 and 34 weeks of gestation were included. At the time of speculum examination, fetal fibronectin samples were collected from the cervix. The probe was analyzed for fetal fibronectin using the rapid fetal fibronectin assay. Managing obstetricians were blinded to fetal fibronectin results. Outcome data were collected after delivery. RESULTS: One hundred seventy patients had fetal fibronectin samples and outcome data. The mean (+/- standard deviation) gestational age at delivery was 38.63 +/- 2.5 weeks among those with negative fetal fibronectin results (n = 124) and 35.71 +/- 3 weeks for those with positive results (n = 46; P < .001). The admission-to-delivery interval was 27.3 days shorter in the group with positive fetal fibronectin results (36.1 +/- 29.9 compared with 63.4 +/- 29.2; P < .001). The rapid fetal fibronectin assays were useful in predicting risk of delivery within 7, 14, or 21 days (sensitivity 81.8%, 87.5%, and 77.3%; specificity 76.7%, 79.2%, and 80.4; positive predictive value 19.6% [9/46], 30.4% [14/46], 37% [17/46]; negative predictive value 98.4% [122/124], 98.4% [122/124], and 96% [119/124], respectively). CONCLUSION: In a population of patients with signs and symptoms of preterm labor, the presence of cervical fetal fibronectin is effective in predicting risk of delivery within 7, 14, or 21 days. The negative predictive values of fetal fibronectin using the Tli systems compared well with data from previous reports using enzyme-linked immunosorbent assay-based assays. LEVEL OF EVIDENCE: III.