Abstract
Background
Cervical pessary placement as an intervention for preterm birth prevention in women
with a short cervix is a simple, painless procedure with few complications and a reasonable
cost. Its efficacy depends on the expertise of the obstetrician performing the procedure.
Therefore, it is reasonable to assume that untrained obstetricians with no expertise
in pessary placement are more likely to insert the pessary incorrectly, thereby reducing
its efficacy. Nevertheless, the impact of pessary placement expertise and training,
as well as the accuracy of cervival length measurements, has never been evaluated.
Objective
To evaluate the impact of providing training for pessary placement to obstetricians
with no expertise in this intervention. To this end, the percentage of correct pessary
placements and accuracy of cervical length measurements after pessary placement achieved
by obstetricians who received such training was compared with the results achieved
by obstetricians who did not receive any training.
Methods
This prospective, double-blind, randomized clinical trial included 91 pregnant women
requiring a cervical pessary due to a short cervix. Patients were assigned at random
to a group treated by untrained obstetricians with no expertise in pessary placement
(untrained group, n = 45) or to a group treated by trained obstetricians with no expertise in pessary
placement (trained group, n = 46). The primary outcomes were the quality of pessary placement and the accuracy
of cervical length measurements after pessary placement.
Results
Obstetricians in the trained group achieved a significantly higher percentage of correct
pessary placements than obstetricians in the untrained group (97.8 % and 65.2 %, respectively;
p < 0.001). No significant differences were observed between groups in terms of the
accuracy of cervical length measurements after pessary placement (p = 0.661), and both groups showed moderate to good agreement with the expert’s measurements
(intraclass correlation coefficient 0.840 and 0.749, respectively). No differences
in pregnancy outcomes were observed between groups.
Conclusion
This study showed that providing training in pessary placement to obstetricians with
no expertise in this procedure increases the quality of pessary placement. Furthermore,
the inconsistent results found in pessary studies may be explained, in part, by a
lack of training in pessary placement.
Keywords
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Article info
Publication history
Published online: September 30, 2022
Accepted:
September 26,
2022
Received in revised form:
August 17,
2022
Received:
October 25,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
