Preterm birth or birth before 37 weeks of gestation, is a major global health concern, significantly contributing to infant mortality and long-term health issues. According to the World Health Organisation (WHO), India has the highest number of preterm births globally, with approximately 3.6 million babies born preterm each year. This high number of preterm births contributes significantly to neonatal deaths, with over 3,00,000 preterm babies dying annually.
What is a cervical pessary and why is it used?
A cervical pessary is a medical device, typically a silicone ring, placed around the cervix of a pregnant woman to help prevent preterm birth. It is used when a woman has a shortened cervix or cervical insufficiency that could lead to miscarriage or premature delivery. The cervix acts as a barrier keeping the baby inside the uterus and when it shortens too early, it may lead to preterm labor. A pessary helps by supporting the cervix and altering the angle of the cervical canal, reducing direct pressure from the uterus on the cervix.
The pessary aims to support the cervix, potentially preventing it from opening too early. It is non‑surgical and reversible. Some international trials show variable efficacy, but several demonstrate a reduction in spontaneous preterm delivery before 34 or 37 weeks in high‑risk women. It is primarily used to help prevent spontaneous preterm birth in pregnant women who are considered at high risk especially those with a shortened cervix detected during the second trimester.
These are low‑tech, cost‑effective options, especially in settings where access to surgical interventions or frequent ultrasound screenings may be limited. A. Jaishree Gajaraj, head of obstetrics and gynaecology at MGM Healthcare, Chennai, says cervical pessaries have been in use for decades, though their adoption has become more common in recent years as a non-surgical option to manage cervical insufficiency.
Unlike surgical procedures like cervical cerclage — a surgical procedure where a stitch is placed around the cervix to prevent preterm birth or late miscarriage caused by cervical insufficiency, the pessary is a non-invasive, removable device, often inserted in an outpatient setting. It is designed to be a low-cost, low-risk alternative, especially helpful in settings where surgical expertise or infrastructure may be limited. “Earlier, we had to rely on cervical stitches, which required anesthesia and hospitalisation. The pessary, a soft silicone ring, offers similar support and can be inserted easily in an outpatient setting,” Dr. Gajaraj says.
According to the WHO and International Federation of Gynecology and Obstetrics (FIGO), cervical pessaries can play a valuable role in preventing preterm labor in select cases, such as singleton pregnancies with a short cervix. While its use varies case by case, it’s typically retained until 36–37 weeks, unless early removal is needed. Dr. Gajaraj emphasises that the device is intended to prevent preterm birth as supported by global trials and clinical guidelines from UK based National Institute for Health and Care Excellence (NICE) and major international bodies.
Who needs a cervical pessary?
Candidates generally include women with a singleton pregnancy and cervical length ≤ 25 mm in mid‑trimester, particularly if there is a history of spontaneous preterm birth or contraindications to surgical cerclage. That said, careful assessment is essential: not every woman with a short cervix qualifies. The role of pessaries remains context-sensitive, guided by individual risk, symptoms and facility capabilities, consistent with global WHO guidance.
Studies underline that while cervical cerclage and vaginal progesterone remain mainstays, pessaries are gaining traction in tertiary and community settings as part of a broader evidence-informed approach.
Is it safe for mother and baby?
Regarding safety, most studies report minimal risk. The most common side effect is increased vaginal discharge, which typically does not indicate infection. In a study published by PLOS, a questionnaire of 166 women using the Arabin pessary found that 42 % experienced increased discharge, 14 % had discomfort and removal was moderately painful for 35 %; yet over 75 % felt the treatment exceeded expectations and reported improved quality of life with proper clinical support.
There is no robust evidence linking pessary use with increased rates of infection, miscarriage, or harm to the foetus provided proper follow‑up and timely removal (typically around 37 weeks or earlier if indicated). WHO emphasises that correct placement and monitoring are crucial for maintaining safety. The decision to use a pessary should be made in consultation with a healthcare provider, taking into account individual risk factors and the overall clinical picture.
Amid recent concerns following a legal case where the use of a cervical pessary was cited as the reason for a preterm birth, Dr. Gajaraj urges a more informed understanding. “In that case, the pessary was placed as a preventive measure for cervical insufficiency , to help avoid a preterm birth, yet it was later attributed as the cause,” she explains.
How effective is it in preventing preterm birth?
Evidence is mixed, yet encouraging in selected populations. According to a study published in American Journal of Obstetrics and Gynecology randomised trials like Goya et al. and another Italian centre found that in high‑risk singleton pregnancies, pessary reduced preterm birth before 34 weeks by nearly half (e.g. 7.3 % vs 15.3 %) and lowered spontaneous delivery rates before 37 weeks (22 % vs 59 %). Meta-analyses show benefit in twin pregnancies as well when used with caution, though singleton pregnancy outcomes are more variable . The Cochrane review, while noting heterogeneity, calls for more large‑scale trials and long‑term follow-up
In India, no large clinical trials specifically evaluating pessary effectiveness have yet been published. However, clinicians suggest it may be especially useful in resource-limited settings where cervical cerclage is not feasible or ultrasound follow-up is challenging, provided basic training exists for proper selection and placement.
Why is this relevant in the Indian setting?
In many parts of India, ultrasound and surgical options like cerclage may be limited. Cervical pessaries such as the Arabin brand are available through authorised partners with training and usage guidelines tailored to local practice. Also, pessary insertion and removal can be done on an outpatient basis and does not require anesthesia or surgical theater, making it suitable for community-level care.
Studies acknowledge pessaries as a promising adjunct in treated women with cervical insufficiency or short cervix, especially when cerclage is contraindicated or unavailable.
Dr. Gajaraj emphasises that while the cervical pessary can be a useful tool in selected cases, its use must be carefully evaluated, consented to and monitored under proper medical supervision.
Published – August 05, 2025 11:33 pm IST
