Premature delivery is the leading cause of death in newborns. However, according to a study published Online First in The Lancet, pregnant women who are at high risk for preterm birth (those with a short cervix) can considerably reduce the risk of delivering their baby prematurely by having a safe, low-cost cervical pessary inserted during the second trimester.

The study is the first randomized trial to examine the use of a pessary to prevent premature birth.

Elena Carreras, from the Hospital Universitari Vall d’Hebron, Barcelona, Spain, coordinator of the study, said:

“Finding a safe, economical way (38 euros per pessary) of reducing the incidence of preterm birth in the world and reducing he burden of prematurity and its sequelae is a worthwhile goal.

Our results open the door to further research into the use of this device and give us hope of finding a way to substantially reduce the incidence of prematurity and its consequences worldwide.”

Each year, approximately 13 million mothers across the world give birth prematurely (before 37 weeks of pregnancy). Spontaneous preterm birth is the leading cause of illness and mortality in newborns, and can causes lifelong health problems, including:

The Institute of Medicine reveals that each year, preterm birth costs the United States over $26 billion. However, even though efforts have been made to lower the incidence of preterm birth, not much progress has been made over the past decade.

The researchers enrolled almost 15,000 pregnant women from five hospitals in Spain who agreed to have a cervical length assessment while undergoing a routine midtrimester ultrasound, to participate in the PECEP trial.

The team randomly assigned 190 women with a cervical length of less than 22mm (a short cervix is a major risk factor for preterm birth) to cervical pessary, and 190 women to expectant management without a pessary.

In this study, the researchers defined preterm birth as birth before 34 weeks of pregnancy. They found that women who received a pessary were considerably less likely to give birth prematurely (6%) compared with women who received expectant management (27%).

Women who received the pessary reported no serious adverse effects and experienced a significantly reduced rate of low birth weight (

Furthermore, 95% of the women who received a pessary revealed that they would recommend this intervention to others.

Lead researcher of the study, Maria Goya, explained:

“Placement of a pessary is an affordable procedure, non-invasive, and easy to insert
and remove as required.”

The researchers conclude:

“The pessary is an affordable, safe, and reliable alternative for prevention of preterm birth in a population of appropriately selected at-risk pregnant women who have been screened for cervical length assessment at the midtrimester scan.”

In a comment, Steve Caritis and Hyagriv Simhan from Magee Women’s Hospital, Pittsburgh, USA, said:

“The findings…raise the novel and exciting possibility that the anatomic inter-relationship of pelvic organs and their load-bearing capacity are important in pregnancy maintenance…Additional well designed studies, however, are needed before pessary use can be validated as an effective treatment for women with precocious cervical ripening.”

Written by Grace Rattue