CL measurement in straight line technique.

Transvaginal ultrasonography in sagittal section. The endocervical mucosa (arrow) is used as a guide to identify the internal (IO) and external (EO) os. The straight-line technique is presented (dashed line).</p

Curve of percentile values for the curve CL measurement.

Curve of percentile values for the curve distance between the internal and external os according to gestational age (weeks) at transvaginal scan.</p

Curve of percentile values for the volume of the uterine cervix according to gestational age (weeks) at transvaginal scan.

Curve of percentile values for the volume of the uterine cervix according to gestational age (weeks) at transvaginal scan.</p

CL measurement curve line technique.

Transvaginal ultrasonography in sagittal section. The endocervical mucosa (arrow) is used as a guide to identify the internal (IO) and external (EO) os. The curve technique is presented (continue line): two lines are drawn respecting the curvature of the endocervical canal.</p

Main sociodemographic characteristics of the sample population, mean, median of the ultrasonographic measurements in straight line of the uterine cervix in millimeters and percentage of cervical length ≤ 25 mm.

Main sociodemographic characteristics of the sample population, mean, median of the ultrasonographic measurements in straight line of the uterine cervix in millimeters and percentage of cervical length ≤ 25 mm.</p

Values of percentile 5, 10, 25, 50, 75, 90 e 95 for the cervical length measurement in linear distance between internal and external os and in curve by ultrasonography according to gestational age.

Values of percentile 5, 10, 25, 50, 75, 90 e 95 for the cervical length measurement in linear distance between internal and external os and in curve by ultrasonography according to gestational age.</p

Inclusion and exclusion flowchart.

Eligible pregnant women, excluded and included in the analysis.</p

Multiple analysis for cervical length ≤ 25 mm in women with previous pregnancies.

Multiple analysis for cervical length ≤ 25 mm in women with previous pregnancies.</p

The P5 working group.

(DOCX)</p

Pessary plus progesterone to prevent preterm birth in women with short cervixes. A randomized controlled trial

OBJECTIVE: To test the effectiveness of cervical pessary in addition to vaginal progesterone for the prevention of preterm birth in women with midpregnancy short cervixes. METHODS: We performed a multicenter, open-label, randomized controlled trial in 17 perinatal centers. Asymptomatic women with singleton or twin pregnancies and cervical lengths of 30 mm or less, measured at 18 0/7– 22 6/7 weeks of gestation, were randomized to cervical pessary plus vaginal progesterone (pessary plus progesterone group) or vaginal progesterone only (progesteroneonly group) (200 mg/day). Treatments were used from randomization to 36 weeks of gestation or delivery. The primary outcome was a composite of neonatal mortality and morbidity. Secondary outcomes were delivery before 37 weeks and before 34 weeks of gestation. Analysis was performed according to intention to treat. RESULTS: Between July 9, 2015, and March 29, 2019, 8,168 women were screened, of whom 475 were randomized to pessary and 461 to progesterone only. The composite perinatal outcome occurred in 19.2% (89/463) of the women in the pessary group compared with 20.9% (91/436) of the women in the progesterone-only group (adjusted risk ratio [aRR] 0.88, 95% CI 0.69–1.12). Delivery rates before 37 weeks of gestation were 29.1% compared with 31.4% (aRR 0.86, 95% CI 0.72–1.04); delivery rates before 34 weeks were 9.9% compared with 13.9% (aRR 0.66, 95% CI 0.47–0.93). Women in the pessary group had more vaginal discharge (51.6% [245/476] vs 25.4% [117/479] [P,.001]), pain (33.1% [157/476] vs 24.1% [111/479] [P5.002]), and vaginal bleeding (9.7% [46/476] vs 4.8% [22/479] [P5.004]). CONCLUSION: In asymptomatic women with short cervixes, the combination of pessary and progesterone did not decrease rates of neonatal morbidity or mortality when compared with progesterone only.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Bill & Melinda Gates Foundation [OPP1107597], the Brazilian Ministry of Health, and the Brazilian National Council for Scientific and Technological Development (CNPq) [401615/20138]