Re: Pessary and preterm labor
From: Tonya Von Brooks, CPM (nbwc@ix.netcom.com)
Wed Mar 24 09:23:24 1999
Bravo! Peter, Thanks for a great post. I have down loaded it to show to my
colleague who is an MFM. I think we can use this research to look at our
approach.
Tonya Brooks
Peter Wein wrote:
> >>
> >I think there is a great difference between "having experience with..."
> >and "...having data to support the intervention..." I am unaware of any
> >data to support the use of pessaries for either preterm labor or
> >incompetent cervix.
> >
> 1. Data = information. I have information from colleagues that pessaries
> may be helpful.
> 2. "I am unaware of any data" is not the same as "there aren't any data".
> It just means you don't know of them. It's like when a bureaucrat says "We
> inquired and did not find any evidence to support the contention that....".
> It's not that there wasn't any information - they didn't try hard to find it.
> I did!
>
> Subject: Search History To: p.wein@obsgyn-mercy.unimelb.edu.au
> * #4 #2 and #3 (13 records )
> #3 explode 'Cervix Incompetence' / all subheadings (756 records )
> #2 explode 'Pessaries' / all subheadings (517 records )
> #1 pessary (333 records )
> TITLE: [Use of a pessary for bloodless cerclage for cervical insufficiency
> in pregnant women--25 years' experience]
> AUTHOR(S): Bechinie-E
> SOURCE (BIBLIOGRAPHIC CITATION): Cesk-Gynekol. 1992 Jun; 57(5): 217-9
> INTERNATIONAL STANDARD SERIAL NUMBER: 0374-6852
> LANGUAGE OF ARTICLE: CZECH; NON-ENGLISH
> MEDLINE ACCESSION NUMBER: 1993046784
> TITLE: [Conization and pregnancy--an analysis of various therapeutic
> measures for the prevention of premature labor]
> AUTHOR(S): David-M; Jorde-A
> SOURCE (BIBLIOGRAPHIC CITATION): Zentralbl-Gynakol. 1991; 113(23): 1304-12
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-4197
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: In the period under review from 1/6/1980 to 31/3/1990 119 women
> with a state after conisation of the cervix have been delivered. For
> treatment of a resultant cervical incompetence there were used in 46% a
> cervical cerclage, in 7% a support pessary, in 20% the combination of
> cerclage: pessary and in 27% conservative measures. Retrospectively the
> final gestational week, the proportion prematured rupture of membranes, of
> prematurity and dates of the fetal outcome have been examined. The results
> demonstrate that a selection of patients has to be made with state after
> conisation according to the seriousness of the cervical incompetence giving
> the adequate indication for a conservative or active (cerclage and/or
> pessary) treatment referrend to pregnancy length and the uterine cervix
> findings. A general determination of only one treatment method for
> prophylaxis of therapy with state after cervix conisation is not advisable,
> be cause the results of all examined patient grou!
> ps--after selection--were not significantly different.
> MEDLINE ACCESSION NUMBER: 1992180482
> TITLE: [The support pessary--a therapeutic possibility in premature opening
> of the uterine cervix]
> AUTHOR(S): Gmoser-G; Girardi-F; Mayer-HO; Hermann-J; Haas-J
> SOURCE (BIBLIOGRAPHIC CITATION): Gynakol-Rundsch. 1991; 31 Suppl 2: 117-9
> INTERNATIONAL STANDARD SERIAL NUMBER: 0017-6001
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> MEDLINE ACCESSION NUMBER: 1992165125
> TITLE: [The Arabin cerclage pessary--an alternative to surgical cerclage]
> AUTHOR(S): Quaas-L; Hillemanns-HG; du-Bois-A; Schillinger-H
> SOURCE (BIBLIOGRAPHIC CITATION): Geburtshilfe-Frauenheilkd. 1990 Jun;
> 50(6): 429-33
> INTERNATIONAL STANDARD SERIAL NUMBER: 0016-5751
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: During 1986-1988, the Arabin-cerclage pessary was used
> alternatively to surgical cerclage in 58 patients for prophylactic and in
> 44 cases of therapeutic indications. In 5 additional patients, the pessary
> was applied instead of emergency cerclage. The advantages of the cerclage
> pessary compared to other rigid pessary types, are based on its flexibility
> and adjustment to the anatomic conditions of vagina and cervix. The
> bowl-shaped pessary is inserted with the curvature upwards and the cervix
> is fixed in the central opening of the cerclage pessary. Thus a
> constriction, reconfiguration, and elongation of the incompetent cervix is
> obtained as evidenced by ultrasonography. The only side effect of the
> pessary treatment is an increase in cervical secretion and subsequent
> vaginal discharge. No infectious complications occurred. In 92% of the
> treated gravidae the cerclage pessary could be removed after the 36th week
> of gestation. Cerclage pessary can be recommended as a favo!
> urable alternative to surgical procedures as prophylactic or therapeutic
> approach, reducing surgical treatment significantly to less than 0.5%.
> MEDLINE ACCESSION NUMBER: 1990330123
> TITLE: [Therapy of cervix insufficiency--cerclage or support pessary?]
> AUTHOR(S): Forster-F; During-R; Schwarzlos-G
> SOURCE (BIBLIOGRAPHIC CITATION): Zentralbl-Gynakol. 1986; 108(4): 230-7
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-4197
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: To evaluate the efficiency of cerclage or pessary a prospective
> random study has been done from 1982 to 1983. Pelvic score of Bishop and
> tocolysis index of Baumgarten were used to define the situation at the
> beginning. Success has been estimated with help of neonatal parameters
> (birth weight, Apgar score and RDS-morbidity) and final gestational week.
> Both methods are equal in their effects.
> MEDLINE ACCESSION NUMBER: 1986210699
> TITLE: [Changes in the vaginal flora caused by supporting pessary treatment
> in pregnancy]
> AUTHOR(S): Jorde-A; Kastli-K; Hamann-B; Pockrandt-H
> SOURCE (BIBLIOGRAPHIC CITATION): Zentralbl-Gynakol. 1983; 105(13): 855-62
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-4197
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: 200 pregnant women with supporting pessary treatment because of
> cervical insufficiency were compared with one of normal pregnancies
> concerning microbiological findings and puerperal morbidity. -- 5,5% of the
> women in the supporting pessary group had pathogenic organisms in their
> cervix before first amnioscopy, compared to 2% in the control group. The
> different results of cultural microbiologic examinations in both groups
> depend on type and duration of birth as well as time of amnion rupture.
> Women with premature rupture of the membranes (31,0%) had more pathogenic
> organisms than women with rupture (2,5%) in time. There was no higher
> infection morbidity compared to the control group.
> MEDLINE ACCESSION NUMBER: 1983304542
> TITLE: The incompetent cervix: a 1982 update.
> AUTHOR(S): Thomason-JL; Sampson-MB; Beckmann-CR; Spellacy-WN
> SOURCE (BIBLIOGRAPHIC CITATION): J-Reprod-Med. 1982 Apr; 27(4): 187-92
> INTERNATIONAL STANDARD SERIAL NUMBER: 0024-7758
> LANGUAGE OF ARTICLE: ENGLISH
> MEDLINE ACCESSION NUMBER: 1982241878
> TITLE: Cervical incompetence, 1980: a time for reappraisal.
> AUTHOR(S): Cousins-L
> SOURCE (BIBLIOGRAPHIC CITATION): Clin-Obstet-Gynecol. 1980 Jun; 23(2): 467-79
> INTERNATIONAL STANDARD SERIAL NUMBER: 0009-9201
> LANGUAGE OF ARTICLE: ENGLISH
> MEDLINE ACCESSION NUMBER: 1980244860
> TITLE: [Prevention of premature labor by means of supporting pessaries (1st
> experiences)]
> AUTHOR(S): Dahl-J; Barz-MS
> SOURCE (BIBLIOGRAPHIC CITATION): Z-Arztl-Fortbild-Jena. 1979 Nov 1; 73(21):
> 1010-1
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-2178
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> MEDLINE ACCESSION NUMBER: 1981017194
> TITLE: [Non-invasive cerclage using supportive pessaries for prevention and
> therapy of premature birth]
> AUTHOR(S): Seyffarth-K
> SOURCE (BIBLIOGRAPHIC CITATION): Zentralbl-Gynakol. 1978; 100(23): 1566-70
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-4197
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: It was told about a pessary, with the help of which could be done
> an excellent therapy and prophylaxis of the threatening of a partus
> pramaturus imminens in cervixinsufficiency. To make use of it is very
> simple. With the help of this method one could lower the rate of
> miscarriages to 3,6% in comparison to a period without cerclage or pessary,
> when the rate of premature children was 6,6%.
> MEDLINE ACCESSION NUMBER: 1979120666
> TITLE: [A cubical support pessary within the scope of complex therapy of
> threatening prematurity]
> AUTHOR(S): Jorde-A; Hamann-B; Deicke-P; Belling-KH
> SOURCE (BIBLIOGRAPHIC CITATION): Zentralbl-Gynakol. 1978; 100(4): 235-41
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-4197
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: Report about experience with a cubic supperting pessary for the
> prophylaxis and therapy in cervixinsufficiency or inpending premature
> delivery. The indication, selection, evaluation of riscfactors and the
> application of a complex therapy are discussed.--Information on therapeutic
> results and a first conclusion concerning the longtime incorporation of
> pessaries during pregnancy and the questions related to this. For the
> period under review, in which intensive prophylactic measures were carried
> out, a considerable decrease in premature deliveries could be achieved in
> the territory of pregnancy care center attached to our hospital.
> MEDLINE ACCESSION NUMBER: 1978183306
> TITLE: [Various new aspects for prevention and therapy of impending
> premature birth]
> AUTHOR(S): Bayer-H
> SOURCE (BIBLIOGRAPHIC CITATION): Zentralbl-Gynakol. 1977; 99(9): 547-51
> INTERNATIONAL STANDARD SERIAL NUMBER: 0044-4197
> LANGUAGE OF ARTICLE: GERMAN; NON-ENGLISH
> ABSTRACT: After a short representation of the present possibilities in
> prophylaxis and therapy of premature infants an information is given about
> disturbances of metabolism of the liver follow up the treatment with
> beta-adrenergic substances. Further a first report is given about laying in
> of pessars in addition to cerclage in cases of insufficiency of the cervix
> uteri.
> MEDLINE ACCESSION NUMBER: 1977238666
> TITLE: [Treatment of cervix incompetence in pregnant women by means of
> Mayer's pessary. Discussion contribution on the paper of K. Jiratek et al.
> "Directed therapy of threatened premature abortion--comparison of treatment
> results using cerclage and pessary"]
> AUTHOR(S): Bechinie-E
> SOURCE (BIBLIOGRAPHIC CITATION): Cesk-Gynekol. 1977 Apr; 42(3): 205-6
> INTERNATIONAL STANDARD SERIAL NUMBER: 0069-231X
> LANGUAGE OF ARTICLE: CZECH; NON-ENGLISH
> MEDLINE ACCESSION NUMBER: 1977160166
>
> Peter Wein
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