Health of Pessary Versus Progesterone Supplement for Preventing Preterm Birth Children
Health of Pessary Versus Progesterone Supplement for Preventing Preterm Birth Children
To give strong recommendations on the efficacy and safety of vaginal progesterone versus
 cervical cerclage, we conduct this study to investigate the physical and mental development
 of children from vaginal progesterone versus cervical cerclage. Based on our research (Dang
 et al., 2019), the twin pregnancies with cervical lengths less than 38mm were randomly
 assigned to receive vaginal progesterone or cervical cerclage, which leads to the similarity
 in characteristics of these two groups. Hence, the result of analyzing these offsprings would
 be preciously valuable.
Preterm birth (PB) is the leading cause of neonatal morbidity and mortality. Twin pregnancies
 and short cervical length are two high-risk factors of PB. Generally, in singleton
 pregnancies with short cervical length below 25 mm, or with a history of preterm birth,
 preventive measures of PB are vaginal progesterone and cervical cerclage. The cervical
 pessary is also being investigated for effectiveness in PB prevention in different
 populations. However, the effective preventive methods for PB has not been identified up to
 now in twin pregnancies with short cervical length.

 In our research, the results showed that the preterm birth rate before 34 weeks in the
 cervical pessary group was lower than the progesterone group (16% vs 22%, RR 0.73; 95% CI
 0.46 - 1.18). The perinatal outcomes were also better in the cervical pessary group than in
 the progesterone group (19% vs 27%, RR 0.70; 95% CI 0.43 - 0.93). The cost of the cervical
 pessary method was also significantly lower than the vaginal progesterone method cost.
 Pessary insertion was also more convenient since it was only inserted once during pregnancy,
 compared to daily vaginal progesterone. Therefore, the cervical pessary may be an appropriate
 option for preventing preterm birth in twin pregnancies with a short cervix.

 However, besides these short-term outcomes, we need to pay more attention to the longer-term
 issues of both mothers and infants. Some evidence up to now has demonstrated that both these
 two methods are safe with no impact on physical, mental, and motor development of children up
 to 3 years old and even in older children. However, such evidence is still rare. Also, there
 hasn't been any study evaluating the impact, if any, of these two PB preventive methods.
Inclusion Criteria:

 -  Live babies born from The pessary versus vaginal progesterone in women with a twin
 pregnancy and a cervix <38 mm study (NCT02623881)

 -  Parents agree to participate in the study.

 Exclusion Criteria:

 -  Babies died after the perinatal period.