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The Cochrane Database of Systematic... Sep 2010Preterm delivery is a major health problem and contributes to more than 50% of the overall perinatal mortality. Cervical incompetence is one of the common causes of... (Review)
Review
BACKGROUND
Preterm delivery is a major health problem and contributes to more than 50% of the overall perinatal mortality. Cervical incompetence is one of the common causes of preterm birth to which different management strategies have been tried including cervical cerclage. Cervical cerclage is an invasive technique that needs anaesthesia and may be associated with complications. Moreover, there is still a matter of controversy regarding the efficacy and the group of patients which could benefit from this operation. Cervical pessary has been tried as a simple, non-invasive alternative that might replace the above invasive cervical stitch operation.
OBJECTIVES
To evaluate the efficacy of cervical pessary for prevention of preterm birth in women with cervical incompetence.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2010), Current Controlled Trials and the Australian New Zealand Clinical Trials Registry (May 2010).
SELECTION CRITERIA
We selected all published and unpublished randomised clinical trials comparing the use of cervical pessary with cervical cerclage or expectant management for prevention of preterm birth. We did not include quasi-randomised trials, cluster-randomised and crossover trials.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion.
MAIN RESULTS
The search identified two trials which we excluded. Three additional trials are ongoing. This review contains no included studies.
AUTHORS' CONCLUSIONS
The review did not identify any well-designed randomised clinical trial in order to confirm or refute the benefit of cervical pessary. However, there is evidence from non-randomised trials that showed some benefit of cervical pessary in preventing preterm birth. We are waiting for the results of three ongoing randomised controlled trials, assessing the role of cervical pessary in women with short cervix. There is a need for further well-designed randomised controlled trials.
Topics: Female; Humans; Pessaries; Pregnancy; Premature Birth
PubMed: 20824869
DOI: 10.1002/14651858.CD007873.pub2 -
European Journal of Obstetrics,... Jun 2011It is expected that with the rising female life expectancy the prevalence of pelvic organ prolapse will increase. From ancient times mechanical devices have been used to... (Review)
Review
It is expected that with the rising female life expectancy the prevalence of pelvic organ prolapse will increase. From ancient times mechanical devices have been used to reposition prolapsed organs. Given that surgical correction of prolapse is associated with high recurrence rates, pessaries offer a favorable alternative. In spite of the antiquity of pessary usage the evidence for its use, the effectiveness of symptom relief, and the nuances of clinical management with the pessary in situ have not been studied methodically. There is a need for controlled trials to assess the efficacy of pessaries as opposed to other non-surgical and surgical methods of treating pelvic organ prolapse. Additionally, the long term effects and complications of pessary usage have not been assessed in trials, and knowledge about the potential complications caused by the pessary rests mainly on anecdotal data. This review provides a historical perspective and appraises the current knowledge regarding the indications, effectiveness and the potential complications associated with pessary use. Data were obtained from an electronic search of Medline (1966-2010) and by hand searching the citations which were not available online. Keywords used were pelvic organ prolapse, pelvic floor dysfunction, vaginal pessary and urinary incontinence. Textbooks are also quoted where relevant. Most studies report moderate success rates in the short term following insertion of a pessary for the management of prolapse and concur in the remission of almost all symptoms attributable to the prolapse. Reported success is variable in the remission of urinary and bowel symptoms. We conclude that based on the available evidence (mostly retrospective and prospective cohort studies), treatment with a vaginal pessary is a feasible option that can be offered in the short term to women with prolapse. There is a need for controlled trials to assess the long term efficacy.
Topics: Female; Humans; Pelvic Organ Prolapse; Pessaries; Treatment Outcome; Urinary Incontinence
PubMed: 21255901
DOI: 10.1016/j.ejogrb.2010.12.039 -
Journal of Women's Health (2002) Jun 2022Pessary fitting and follow-up for women with pelvic organ prolapse (POP) can be performed by different health care practitioners (HCPs). We aimed to investigate...
Pessary fitting and follow-up for women with pelvic organ prolapse (POP) can be performed by different health care practitioners (HCPs). We aimed to investigate knowledge and current practices among the main HCPs involved in pessary use in France. We sent an electronic questionnaire about pessary use to the members of eight French learned societies between April and October 2020. During the study period, 1017 HCPs responded to the questionnaire: 712 (70.0%) were doctors, 208 (20.4%) physiotherapists, 95 (9.3%) midwives, and 7 (0.6%) nurses. Of the respondents, 69.1% claimed to be comfortable with pessary fitting and follow-up, and 54.1% think that a pessary can be offered as a first-line treatment in the management of POP. However, 60.1% reported that the main indications for pessaries were "older women," 71.3% for women with contraindications to surgery, and 60.5% for women waiting for surgery. 23.9% do not prescribe local estrogen therapy with a pessary for postmenopausal women. The main pessaries used are the ring and cube types (63.7 and 57.5%, respectively). Wide introitus (53.3%), difficulties of use (56.3%), a short vagina (41.4%), and major unmasked urinary incontinence (47.2%) are considered to be the main risk factors for pessary failure. The most common complications related to pessaries reported by the patients are vaginal discharge (48.6%) and pain or discomfort (40.6%). Up to 43.4% of respondents considered that a follow-up visit every 3-6 months was optimal. The need for training ranged from 42.8% for nurses to 65.2% for general practitioners. This national multidisciplinary survey revealed that HCPs in France are on the whole comfortable with pessaries and mainly prescribe the ring and cube form. Even if opinion about pessaries appears to be changing, HCPs would welcome additional training to improve knowledge and practices.
Topics: Aged; Female; Humans; Pelvic Organ Prolapse; Pessaries; Surveys and Questionnaires; Urinary Incontinence; Vagina
PubMed: 34569823
DOI: 10.1089/jwh.2021.0229 -
International Urogynecology Journal Jun 2011Pessaries have been used to treat women with pelvic organ prolapse (POP) since the beginning of recorded history. This review aims to assess the effect of pessary... (Review)
Review
Pessaries have been used to treat women with pelvic organ prolapse (POP) since the beginning of recorded history. This review aims to assess the effect of pessary treatment on the disease-specific, health-related quality of life in women with pelvic organ prolapse. After a Medline search using the Mesh term 'pessary' and critical appraisal, 41 articles were selected and used in this review. Pessaries are widely used to treat pelvic organ prolapse. It is minimally invasive and appears to be safe. Although there is evidence that the use of pessaries in the treatment of pelvic organ prolapse is effective in alleviating symptoms and that patient satisfaction is high, the follow-up in many published papers is short, and the use of validated urogynaecological questionnaires is limited. Comparison with surgical treatment of pelvic organ prolapse is rare and not assessed in a randomised controlled trial.
Topics: Female; Humans; Patient Satisfaction; Pelvic Organ Prolapse; Pessaries; Quality of Life; Sexual Behavior
PubMed: 21472447
DOI: 10.1007/s00192-011-1390-7 -
Gynecologie, Obstetrique, Fertilite &... Jun 2018The use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical... (Review)
Review
OBJECTIVES
The use of pessary to put back up prolapsed organs to their normal position dates back prior to several millennia. This work aims to discuss its place in our clinical practice through an updated bibliographic review and emphasizes a hands-on approach to pessary fitting and management in terms of indication, pessary type selection, device' size, insertion, removal, follow-up visits and care.
METHODS
A review of the literature, in the light of the latest publications and recommendations of French and international learned societies, as well as our own experience, were analyzed.
RESULTS
This device appears to be as effective as surgical management to relieve symptoms related to urogenital prolapse and restore body image. It can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. However, despite its moderate cost and its harmlessness, this device remains somewhat little known as regards the practical modalities of its use, which, moreover, appear not consensual.
CONCLUSION
A guide intended for the attention of the patients as well as a film relating to the practical modalities of the device' use were elaborated to improve the knowledge of both professionals and users in order to optimize and secure the care pathway.
Topics: Female; Humans; Pelvic Organ Prolapse; Pessaries; Treatment Outcome; Urinary Incontinence
PubMed: 29786534
DOI: 10.1016/j.gofs.2018.05.003 -
Journal of Lower Genital Tract Disease Oct 2021In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse... (Review)
Review
OBJECTIVE
In this study, we present a series of 2 cases of rectovaginal fistula (RVF) due to the use of a ring-type pessary in the conservative treatment of pelvic organ prolapse and a literature review on the management of RVF related to the use of pessaries.
METHODS
Two patients were selected from the medical records of the urogynecology service, and their demographic and clinical data were retrieved. An updated literature review was included presenting cases of RVF induced by or after use of a pessary.
RESULTS
Both patients evolved with removal of the pessary and correction of the fistula. The surgical procedures of choice were Le Fort Colpocleisis and posterior colporraphy without major complications. In the literature review, we selected 17 studies with a total of 23 cases reporting RVFs induced or followed by the use of pessaries.
CONCLUSIONS
Although the pessary is commonly indicated for the conservative treatment of pelvic organ prolapse, this device is not exempt from generating complications.
Topics: Female; Humans; Pelvic Organ Prolapse; Pessaries; Rectovaginal Fistula
PubMed: 34542087
DOI: 10.1097/LGT.0000000000000629 -
Clinical Obstetrics and Gynecology Jun 2016Prevention of spontaneous preterm birth is an important public health priority. Pessary may be a potential therapy in cases of cervical insufficiency, in singleton and... (Review)
Review
Prevention of spontaneous preterm birth is an important public health priority. Pessary may be a potential therapy in cases of cervical insufficiency, in singleton and multiple gestations. Availability of transvaginal sonography for accurate assessment of cervical length is allowing for the tailoring of therapy to a more specific subset of patients who may benefit from this treatment. Pessary therapy is attractive given the favorable side effect profile, low cost, and ease of placement and removal. Large randomized trials are ongoing to validate initial favorable findings.
Topics: Asymptomatic Diseases; Cervical Length Measurement; Female; Humans; Pessaries; Pregnancy; Pregnancy, Multiple; Premature Birth; Uterine Cervical Incompetence
PubMed: 26992180
DOI: 10.1097/GRF.0000000000000196 -
Journal of Minimally Invasive Gynecology Jun 2021
Topics: Anesthesia, Local; Female; Humans; Pelvic Organ Prolapse; Pessaries; Vagina
PubMed: 33238209
DOI: 10.1016/j.jmig.2020.11.011 -
International Urogynecology Journal Jul 2022The objective was to assess if specific reasons for unsuccessful pessary fitting have different predictive parameters. (Observational Study)
Observational Study
INTRODUCTION AND HYPOTHESIS
The objective was to assess if specific reasons for unsuccessful pessary fitting have different predictive parameters.
METHODS
This is a prospective observational case-control study of women with symptomatic pelvic organ prolapse (POP) choosing pessary treatment. All women underwent an interview, clinical examination, and 3D/4D transperineal ultrasound (TPUS). Groups were defined based on fitting outcome: successful, pessary dislodgment, failure to relieve POP symptoms, pain/discomfort, increased/de novo urinary incontinence, or other reasons. Clinical, demographic, and TPUS parameters were assessed in the prediction of different reasons for unsuccessful fitting and receiver operating characteristic (ROC) curves were constructed.
RESULTS
A total of 162 women were assessed and 130 were included. Levator hiatal area (HA) on maximum Valsalva divided by ring pessary size ("Valsalva HARP ratio") was a predictor of unsuccessful fitting (OR 3.00, 95% CI 1.15-7.81, p = 0.025) with an area under the ROC curve (AUC) of 0.62 (95% CI 0.50-0.74, p = 0.04). Predictors of pessary dislodgment were: complete avulsion (OR 24.20, 95% CI 2.46-237.84, p value 0.01) and Valsalva HARP ratio (OR 2.94, 95% CI 1.32-6.55, p value 0.01) with an area under the ROC curve (AUC) of 0.92 (95% CI 0.84-0.99, p = 0.00). No significant parameter was identified in the prediction of pain/discomfort. Solitary predominant posterior compartment POP was a predictor of failure to relieve POP symptoms (OR 20.00, 95% CI 3.48-115.02, p value 0.00; AUC 0.75, 95% CI 0.53-0.98, p = 0.03).
CONCLUSION
Complete avulsion and a small ring pessary with respect to the levator HA in Valsalva are predictors of pessary dislodgment, whereas solitary predominant posterior compartment POP is a predictor of failure to relieve POP symptoms.
Topics: Case-Control Studies; Female; Humans; Pain; Pelvic Organ Prolapse; Pessaries; Urinary Incontinence
PubMed: 35066658
DOI: 10.1007/s00192-021-05053-w -
Archives of Gynecology and Obstetrics Jun 2024There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary.
METHODS
We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis.
RESULTS
Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66-85%) with a I-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1-23%) with a I-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96-1.27; p = 0.15), with a related I-test of 37% (p = 0.21).
CONCLUSION
Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.
Topics: Humans; Pelvic Organ Prolapse; Pessaries; Female; Self Care; Patient Compliance; Treatment Outcome
PubMed: 38634900
DOI: 10.1007/s00404-024-07506-1