A cervical length <25 mm is correlated with an increased risk of preterm delivery. Pessaries have been used in patients with a short cervix to prevent preterm birth. Compared to cerclage, it is seen as a novel approach, which is more affordable, less invasive, and can be inserted at a later gestational age. We present our experience on the use of pessaries for shortened cervix. In this case series, we inserted a pessary in pregnant patients from 10 to 30 weeks of age of gestation (mean 23 weeks) with cervical length of 0.9 cm to 2.1 cm. We were able to prolong the pregnancy in 5 of the 7 cases with a mean interval to delivery of 14 weeks. One proposed mechanism of a pessary for shortened cervix is that it directs the inclination of the cervix posteriorly, which allows majority of the weight of the pregnancy to lie on the anterior segment of the uterus instead of on the internal cervical os. Based on the cases presented, we have proposed some guidelines in offering a pessary for patients with a shortened cervix: (1) recommend a pessary in patients with a cervical length <25 mm or a diagnosis of cervical insufficiency; (2) exclude infection or active labor; and (3) remove the pessary if there is rupture of membranes, significant vaginal bleeding, or persistent uterine contractions.
Pessaries

OBJECTIVE: To evaluate the safety and efficacy of the silicone ring pessary in the management of pelvic organ prolapse. METHODS: This study was evaluated for the clinical analysis of 58 pelvic organ prolapse patients who visited our hospital and weared silicone ring pessary from January 1997, to December 1998. RESULTS: Among 58 patients, failure rate was 13.7%(8/58) and complication rate was 50%(29/58). Main causes of failure were vaginal ulcer(4 cases) and recurrent falling out of pessary(3 cases). Most common problems were recurrent falling out of pessary(10 cases) and vaginal erosion with or without ulcer(9 cases), vaginitis(6 cases). There was no significant difference of failure rates and complication rates between hysterectomized patients and the non-hysterectomized patients. CONCLUSION: In management of pelvic organ prolapse which unsuitable for operation, pessary is noninvasive, simple and effective alternative method.
Humans ; Pelvic Organ Prolapse* ; Pessaries* ; Silicones*

OBJECTIVE: The aim of this study was to compare the efficacy and safety of oral prostaglandin (PG) E1, misoprostol, and vaginal PGE2, dinoprostone pessary, in the induction of labor at term. METHODS: From March 2004 to March 2006, we retrospectively analyzed 175 women who underwent labor induction at term with an unfavorable cervix (the Bishop score=4). Women in the misoprostol group (n=72) received 100 microgram oral misoprostol and the second dose could be repeated every 6 hours if the Bishop score remained at 4 or less. Women in the dinoprostone group (n=103) received 10 mg vaginal dinoprostone pessary. Intravenous oxytocin, if necessary, was administrated 6 hours after the last dose of oral misoprostol or removal of the dinoprostone pessary. RESULTS: Mode of delivery and indications for cesarean delivery were similar in the two groups. The interval from PG administration to active phase of labor (median [range], 9.6 [3.0~37.2] hr vs. 12.0 [1.8~41.7] hr, p<0.05) and vaginal delivery (median [range], 12.7 [3.2~38.4] hr vs. 15.5 [3.3~ 37.1] hr, p<0.05) were shorter in the misoprostol group than the dinoprostone group. However, delivery within 12 hours and within 24 hours after PG administration was similar in the two groups. Uterine hyperstimulation syndrome occurred in 5 (6.9%) women in the misoprostol group and in none in the dinoprostone group (p<0.05). The neonatal outcome was not different between the two groups. CONCLUSION: Overall, oral misoprostol is as effective as vaginal dinoprostone pessary for induction of labor at term, but it is associated with shorter labor induction time and higher risk of uterine hyperstimulation syndrome.
Cervix Uteri ; Dinoprostone* ; Female ; Humans ; Misoprostol* ; Oxytocin ; Pessaries* ; Retrospective Studies

Uterine cervical prolapse concurrent with pregnancy is a rare situation. Large variety of management options for pregnancy, labor, and delivery to this situation had been reported. We have experienced one case of third-degree cervical prolapse combined with pregnancy. This woman visited our hospital in the late first trimester. We had managed the patient successfully with a vaginal pessary to maintain cervical placement. hereby, We report this case with a brief review.
Female ; Humans ; Pessaries ; Pregnancy Trimester, First ; Pregnancy* ; Prolapse*

Preterm birth accounts to 35 % of deaths in a year. Twin gestation, around 7.2 per 1000 births in the Philippines, is a known risk factor that increases likelihood of preterm birth compared to singletons. Most studies that addresses preterm births are focused on singleton pregnancies. There have been no established recommendations to control preterm labor in twin pregnancies. Pessary insertion is among these recommendations. There are no reported cases of pessary insertion to control preterm birth among twins in the Philippines. This study presents a case of twin gestation in preterm labor and no functional cervix on transvaginal ultrasound. Hodge pessary was inserted at 28 weeks age of gestation. She delivered at 36 weeks to live baby girls, both 2,200 grams and were directly roomed-in. Further studies are recommended to establish stronger evidence supporting pessary use in multiple gestation to improve outcome of neonates.
Pessaries ; Premature Birth ; Obstetric Labor, Premature ; Pregnancy, Twin

OBJECTIVE: To compare the efficacy and the safety of two standardized preparations of vaginal prostaglandin E2 pessary (PGE2 pessary) and vaginal prostaglandin E2 tablet (PGE2 tablet) for the induction of labor. METHODS: Pregnant women who were hospitalized for the induction of labor from December 2002 to June 2004 at the Asan Medical Center were included for the prospective randomized study. Subjects were randomly assigned to receive PGE2 pessary or PGE2 tablet as a cervical ripening agent. A successful outcome was defined as a change in Bishop score of >or=3, Bishop score of >or=6 at 12 hours, or vaginal delivery after the insert placement. RESULTS: One hundred ninety-seven women (PGE2 pessary, 99 women; PGE2 tablet, 98 women) completed the protocol. There were no statistically significant differences between the two groups in terms of a successful outcome (85.9% vs 84.7%; p=0.952) and the following mean times: (1) time to active labor (851 vs 751 minutes; p=0.207), (2) time to vaginal delivery (1024 vs 873 minutes; p=0.091). However, in parous women the labor time interval was shorter in PGE2 tablet group. In addition, no differences were observed in the incidences of cesarean delivery, hyperstimulation syndrome, abnormal fetal heart rate patterns, and adverse neonatal outcomes. CONCLUSION: Both PGE2 preparations were equally effective in achieving cervical ripening, initiating labor, and achieving a successful vaginal delivery. However, the vaginal PGE2 pessary may offer the advantage of prompt removal when it is required.
Cervical Ripening ; Chungcheongnam-do ; Dinoprostone* ; Female ; Heart Rate, Fetal ; Humans ; Incidence ; Pessaries* ; Pregnancy ; Pregnant Women ; Prospective Studies

The incidence of uterine prolapse during pregnancy is rare. A 34-year-old G3P1 was initially presented at 16 weeks 5days of gestation with a prolapse of the uterine cervix. The cervix was edematous and protruding beyond introitus. Management included bed rest, and the patient was discharged after several days with a vaginal pessary to help maintain cervical placement. At 35 weeks of gestation, the patient did not experience any further prolapse after the removal of the pessary. Pregnancy progressed to term with no further prolapse. She was readmitted at 38weeks 5days of gestation with spontaneous labor. She delivered a 3.36kg male with an Apgar score at 1 minute and at 5 minutes of 7 and 8 respectively. The patient's cervix remained prolapsed in the early postpartum period; however it was easily reduced prior to discharge. After puerperium, the patient's cervix remained prolapsed. She was fitted with a vaginal pessary for uterine support. We reported this case with related literature.
Adult ; Apgar Score ; Bed Rest ; Cervix Uteri ; Female ; Humans ; Incidence ; Male ; Pessaries ; Postpartum Period ; Pregnancy* ; Prolapse ; Uterine Prolapse*

Pelvic organ prolapse is defined anatomically as the descent of a pelvic organ into or beyond the vagina, perineum or anal canal. As a society is industrialized and the average span of life is increased, there are a growing numbers and concerns with pelvic organ prolapse. It can endanger our quality of life not only by a specific mechanical symptom, such as bulge outside the vagina, but by functional symptoms like bladder, bowel and sexual problems. Growth in demand for services to care for pelvic organ prolapse generates a demand for objective diagnostic tool and successful treatment strategies. So, first, we would like to discuss the POP Q system which is by far the most often used by clinicians and researchers since it's adoption in 1996, and second, we would like to compare the types, characteristics, success rates, and recurrence rates of two broad categories of prolapse management, nonsurgical treatment, which includes pelvic floor muscle training and pessary use, and surgery for anterior, apical and posterior vaginal wall defects.
Anal Canal ; Diagnosis* ; Pelvic Floor ; Pelvic Organ Prolapse* ; Perineum ; Pessaries ; Prolapse ; Quality of Life ; Recurrence ; Urinary Bladder ; Vagina

Vulvo-vaginal candidiasis (VVC) is a common infection among women. 5% of women with acute infection experience recurrent vulvo-vaginal candidiasis (RVVC). There is currently no optimal or recommended regime for RVVC. Although antifungal agents, such as imidazoles, have been successfully used as a first-line treatment for acute VVC, its effectiveness is limited in RVVC. This could be due to patient factors, drug application (such as leakage) or dosing factors. A sustained-release (SR) bioadhesive vaginal cream (2% butoconazole nitrate) has incorporated VagiSite technology, a topical drug delivery system that allows SR of the drug. We describe its efficacy and the successful use of a butoconazole-SR formulation in the treatment of two cases of RVVC.
Adult ; Antifungal Agents ; administration & dosage ; Candidiasis, Vulvovaginal ; drug therapy ; Female ; Humans ; Imidazoles ; administration & dosage ; Middle Aged ; Pessaries ; Recurrence

OBJECTIVE: The aim of this study was to evaluate whether the Bishop score, length, volume and gray-scale histogram of the cervix has a predictive value of assessing the rate of success in trial of induction. METHODS: Forty-one nulliparous patients with its Bishop score six or less were enrolled for this prospective study. All were on prostaglandin E2 (PGE2, Propess(R); Controlled Therapeutics Ltd) pessary. Three-dimensional transvaginal ultrasound scans of the cervix were performed on the ACCUVIX XQ (Medison) to measure length, volume, and gray-scale histogram. Bishop score was determined by digital examination. The successful induction was defined as the ability to achieve the active phase of labor corresponding to a cervical dilatation of > or =4 cm within 12 hours of removing the PGE2 pessary. The receiver operating characteristics (ROC) curves were also used to estimate an optimal cutoff point for the Bishop score, length, volume, and gray-scale histogram of the cervix. Logistic regression analysis was used for statistical analyses. RESULTS: The overall successful rate of labor induction was 73.2% (30/41). Multiple logistic regression analyses demonstrated that the value of anterior lip histogram was significantly associated with the successful labor induction. ROC curve for anterior lip histogram value in predicting success of induction indicated a significant relationship with successful induction. The best cutoff value was 69.4. CONCLUSION: The value of anterior lip histogram associates significantly with the prediction of successful induction in nulliparous women. But, Bishop score and other sonographic measurement of cervical length, volume, and posterior lip histogram have no predictive values for successful induction.
Cervix Uteri ; Dinoprostone ; Female ; Humans ; Labor Stage, First ; Lip ; Lipids ; Logistic Models ; Pessaries ; Pregnancy ; Prospective Studies ; Quaternary Ammonium Compounds ; ROC Curve