A cervical pessary is a small, flexible silicone device placed within the vagina to provide support to the cervix during pregnancy. It aims to help prevent preterm birth in pregnancies with increased risk, offering a non-surgical approach.
Purpose of a Cervical Pessary
The primary reason a cervical pessary is used involves managing a short cervix, often identified during the second trimester of pregnancy. A short cervix means the length of the cervix, measured by ultrasound, is less than 25 millimeters, which can increase the likelihood of spontaneous preterm labor. This shortened length may indicate that the cervix is less able to withstand the growing pressure of the pregnancy as it advances.
The pessary works by altering the angle of the cervical canal, directing it more towards the back of the pelvis. This repositioning helps shift the weight of the developing pregnancy away from the internal opening of the cervix. By alleviating direct pressure on the cervical os, the device aims to reduce strain that could lead to premature dilation and effacement.
In some cases, a cervical pessary may also be considered for individuals with a history of spontaneous preterm birth, even without a current short cervix diagnosis. For those carrying multiple gestations, such as twins, the increased uterine volume can place additional stress on the cervix. The pessary can offer supplementary support in these situations, although its effectiveness can vary depending on individual circumstances.
The Placement and Removal Procedure
Placing a cervical pessary is a procedure typically performed in a doctor’s office or clinic. The healthcare provider gently folds the device before inserting it into the vagina. It is then carefully positioned around the cervix.
The entire placement process is quick, taking only a few minutes. While some individuals may experience mild pressure or slight discomfort during insertion, it is a relatively painless procedure and does not require anesthesia. Patients can typically resume their regular activities immediately afterward.
Removal of the cervical pessary is also a straightforward in-office procedure. It is usually performed around 36 to 37 weeks of gestation, or earlier if labor begins spontaneously. The healthcare provider gently grasps and removes the device, which is typically quick and causes minimal discomfort.
Daily Life and Potential Side Effects
Living with a cervical pessary often involves minimal disruption to daily life, though some adjustments may be necessary. The most common experience is an increase in vaginal discharge. This discharge is typically clear or milky and is considered a normal side effect as the body adjusts to the device.
Mild discomfort or vaginal irritation can also occur, particularly in the initial days following placement. While doctors’ recommendations for activity modifications can vary, some may advise pelvic rest, which often includes avoiding sexual intercourse. It is important to follow specific instructions provided by the healthcare team regarding activity levels and any other precautions.
Individuals should be aware of certain warning signs that warrant contacting their doctor promptly. These include any signs of infection, such as fever, foul-smelling discharge, or severe itching. Significant pain, heavy vaginal bleeding, or the onset of regular contractions are also reasons to seek immediate medical attention, as these could indicate complications or the beginning of labor.
Comparing a Pessary to a Cerclage
When considering interventions to support the cervix during pregnancy, a cervical pessary is often compared to a cervical cerclage. A cervical cerclage is a surgical procedure where a stitch is placed around the cervix to reinforce and keep it closed. This involves using a strong suture material to physically tighten the cervical opening.
The distinction lies in their invasiveness and application. A pessary is a non-surgical, removable device inserted into the vagina. It does not require anesthesia for placement or removal. In contrast, a cerclage is a surgical intervention that typically requires regional anesthesia, such as a spinal or epidural, for the stitch to be placed.
A cerclage stitch remains in place until it is surgically removed, usually around 36-37 weeks of gestation, or if labor begins. The pessary can be taken out and reinserted if needed, though it typically stays in place once positioned. Both interventions serve the goal of preventing preterm birth, but they represent different approaches in terms of procedure, recovery, and potential risks, with the choice depending on individual medical history and specific circumstances.