What is the role of a pessary in the context of cervical incompetence?

The role of a pessary in the context of cervical incompetence, particularly in pregnant patients at risk for preterm birth due to cervical insufficiency, is nuanced and not universally applicable to every situation. A pessary has been shown to provide support to the cervical region and may be beneficial in select high-risk patients who are identified as having cervical incompetence and are not candidates for more invasive interventions.

This support can help reduce the risk of preterm birth in certain populations, particularly those with a history of cervical insufficiency or those presenting with a short cervix on ultrasound. The use of a pessary in these cases is part of a more tailored management strategy aimed at prolonging the pregnancy and increasing the likelihood of a successful outcome.

In contrast, while some may think of the pessary as a widely established first-line treatment—this is not the case, as there is variability in practice based on individual circumstances. It is not recommended for all pregnant patients, since many do not have cervical incompetence, and therefore, would not benefit from this intervention. Additionally, its overall success rate in preventing preterm labor is not definitive across the board; results can vary based on patient selection and other factors.