Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment

Aim. To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. Material and Methods. A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. Results. The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, p=0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, p=0.045). The mean neonatal birthweight and neonatal “discharge alive” ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, p=0.14, and 93.3% versus 70.5%, p=0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, p=0.9). Conclusions. Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings

Clinical Study Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment

Aim. To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. Material and Methods. A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. Results. The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, = 0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, = 0.045). The mean neonatal birthweight and neonatal "discharge alive" ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, = 0.14, and 93.3% versus 70.5%, = 0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, = 0.9). Conclusions. Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings

A 59-year-old female with surgically removed meningioma.

<p>A lesion of mixed signal intensity (arrows) is seen in the posterior fossa on a T2-FLAIR image of the head (A) and a coronal whole-body T2-STIR image (B). A supplementary, preoperative contrast-enhanced MR study (C) demonstrated enhancing lesion with a tail sign (arrow).</p

The incidence of the most frequent type II lesions in two age groups.

<p>* χ² test was applied to compare the differences in the incidence of abnormalities.</p><p>The incidence of the most frequent type II lesions in two age groups.</p

Graph illustrating the incidence of lesions, which reached statistically significant differences (p<0.05), in two different age groups.

<p>Graph illustrating the incidence of lesions, which reached statistically significant differences (p<0.05), in two different age groups.</p

A 55-year-old female with a 5 mm nodule in the right lung (arrows).

<p>The lesion noted on both 3D T1-GRE axial (A) and coronal (B) images.</p

The incidence of the most frequent type I lesions in two age groups.

<p>* χ² test was applied to compare the differences in the incidence of abnormalities.</p><p>The incidence of the most frequent type I lesions in two age groups.</p

A 43-year-old male with confirmed Leydig cell tumor of the left testis seen as a hypointense lesion (arrows) on a coronal whole-body T2-STIR image (A) and a saggital whole-spine T2-STIR image (B).

<p>A 43-year-old male with confirmed Leydig cell tumor of the left testis seen as a hypointense lesion (arrows) on a coronal whole-body T2-STIR image (A) and a saggital whole-spine T2-STIR image (B).</p

Selected parameters of applied MR sequences.

<p>Selected parameters of applied MR sequences.</p