ALL YOU NEED TO KNOW ABOUT: CERVICAL PESSARY
What is a Cervical Pessary?
A cervical pessary is a soft, flexible device usually made of silicone or synthetic material, shaped like a ring, that is inserted into the vagina to provide support to the cervix. It is primarily used during pregnancy to help prevent preterm birth in women diagnosed with a short cervix. Additionally, pessaries are used to manage pelvic organ prolapse (POP) and sometimes address stress urinary incontinence by supporting weakened pelvic structures.
How Does a Cervical Pessary Work?
The pessary works by physically supporting and repositioning the cervix, reducing pressure from the uterus and helping maintain cervical closure during pregnancy. By altering the cervical-uterine angle and reinforcing the cervix, the pessary lowers the risk of premature cervical opening, a key factor leading to spontaneous preterm birth.
Who Can Benefit from Cervical Pessary?
Pregnant individuals with a short cervix (typically less than 25 mm) detected via ultrasound, at high risk of preterm labor.
Women with a history of cervical insufficiency or prior preterm births.
Patients experiencing pelvic organ prolapse symptoms who prefer a non-surgical, conservative treatment.
Women with stress urinary incontinence related to pelvic floor weakness.
Effectiveness and Research Insights
Clinical studies have shown mixed results:
Some randomized controlled trials indicate that cervical pessaries significantly reduce preterm birth rates before 37 and 34 weeks compared to expectant management, especially when combined with progesterone therapy. (Risk reduction in preterm birth and increased gestational age at delivery were reported.)
Other trials found no significant benefit of pessary placement alone, particularly when progesterone is routinely used, and in pregnancies with very short cervical lengths (<20 mm).
Pessary use is generally well-tolerated with low risk, though patients often report increased vaginal discharge or mild irritation.
The device is considered a relatively non-invasive, outpatient procedure that does not require anesthesia and can be easily removed.
Types of Cervical Pessaries
Ring Pessary: The most common, donut-shaped and flexible; used for mild cervical support or prolapse.
Gellhorn Pessary: More rigid with a central stem, designed for more severe pelvic organ prolapse.
Other shapes and sizes exist tailored to individual anatomical needs.
Placement and Maintenance
A trained healthcare provider inserts the pessary during a pelvic exam, often in the second trimester for pregnancy use or when prolapse symptoms arise.
The pessary remains in place until delivery in pregnancy or until symptoms improve in prolapse cases.
Regular follow-ups and hygienic care are essential to avoid infections or discomfort. The device is cleaned periodically, and any unusual symptoms must be reported promptly.
Possible Side Effects
Increased vaginal discharge due to foreign body irritation.
Rare cases of vaginal infection if hygiene is poor.
Occasional discomfort or pressure that may require adjustment or removal.
Not a substitute for surgical or other medical interventions when needed but a supportive tool in a comprehensive care plan.
FREQUENTLY ASKED QUESTIONS (FAQ)
Q1: What conditions are treated with a cervical pessary?
Mainly used to prevent preterm birth in pregnant women with a short cervix and to manage pelvic organ prolapse and urinary incontinence.
Q2: How effective is the cervical pessary in preventing preterm labor?
Evidence shows that cervical pessaries can reduce preterm birth rates in some women with short cervices, especially when combined with progesterone. However, some studies report no significant benefit when used alone.
Q3: Is pessary placement painful?
Insertion is typically painless or causes minimal discomfort and is performed by a healthcare professional during a routine exam.
Q4: Can cervical pessaries cause infections?
While generally safe, increased vaginal discharge and mild irritation are common. Proper hygiene reduces infection risk.
Q5: How long is the pessary worn?
Usually worn throughout pregnancy until delivery for prevention of preterm birth or as long as needed for prolapse symptoms, with regular medical checks.
Published on: August 6, 2025
Published by: PAVAN
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