Pessaries in multiple pregnancy as a prevention of preterm birth: The ProTwin trial

Maud A. Hegeman, Dick J. Bekedam, Kitty W.M. Bloemenkamp, Anneke Kwee, Dimitri N.M. Papatsonis, Joris A.M. van der Post, Arianne C. Lim, Hubertina C.J. Scheepers, Christine Willekes, Johannes J. Duvekot, Marc Spaanderman, Martina Porath, Jim van Eyck, Monique C. Haak, Marielle G. van Pampus, Hein W. Bruinse, Ben Willem J. Mol

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Background: Multiple pregnancies are at high risk for preterm birth, and therefore an important cause of infant mortality and morbidity. A pessary is a simple and potentially effective measure for the prevention of preterm birth. Small studies have indicated its effectiveness, but large studies with sufficient power on the subject are lacking. Despite this lack of evidence, the treatment is at present applied by some gynaecologists in The Netherlands. Methods/Design: We aim to investigate the hypothesis that prophylactic use of a cervical pessary will be effective in the prevention of preterm delivery and the neonatal mortality and morbidity resulting from preterm delivery in multiple pregnancy. We will evaluate the costs and effects of this intervention. At study entry, cervical length will be measured. Eligible women will be randomly allocated to receive either a cervical pessary or no intervention. The cervical pessary will be placed in situ at 16 to 20 weeks, and will stay in situ up to 36 weeks gestation or until delivery, whatever comes first. Discussion: The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 7.2% without to 3.9% with a cervical pessary, using a two-sided test with an alpha of 0.05 and a power of 0.80. Trial registration: This trial will provide evidence on whether a cervical pessary will decrease the incidence of early preterm birth and its concomitant bad neonatal outcome in multiple pregnancies. Current Controlled Trials: NTR 1858.

Original languageEnglish
Article number1471
Pages (from-to)44
Number of pages1
JournalBMC Pregnancy and Childbirth
Publication statusPublished or Issued - 17 Sept 2009
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this