Efficacy of Vaginal Progesterone versus Cervical Pessary in Preventing Preterm Delivery in Asymptomatic Twin Pregnancies with a Short Cervix

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 133–144

DOI: 10.46882/2026/IJOG/000488

Original Research Article

Title: Efficacy of Vaginal Progesterone versus Cervical Pessary in Preventing Preterm Delivery in Asymptomatic Twin Pregnancies with a Short Cervix

Names of Authors: Anita P. Nwosu¹, Samuel T. Kudoyin²

Authors’ Affiliations:
¹Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynecology, Lagos State University Teaching Hospital, Ikeja, Nigeria
²Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria

Abstract:
Twin pregnancies present an inherently heightened risk of spontaneous preterm birth, which is further exacerbated by the presence of a shortened cervix. This randomized clinical trial compared the efficacy of daily vaginal progesterone against a cervical Arabin pessary for preventing preterm birth before 34 weeks of gestation in asymptomatic twin pregnancies with a transvaginal ultrasound cervical length ≤ 25 mm. One hundred and forty women with twin gestations identified with a short cervix during mid-trimester screening (18 to 22 weeks) were randomized to receive either vaginal progesterone (200 mg capsules daily, n = 70) or a cervical pessary (n = 70) up to 36 completed weeks. The primary outcome evaluated was delivery before 34 completed weeks. The incidence of preterm delivery before 34 weeks did not differ significantly between the vaginal progesterone and cervical pessary groups (21.4% vs. 24.3%; Relative Risk [RR] = 0.88; 95% CI, 0.48 to 1.61; p = 0.69). Mean gestational age at delivery was comparable between both arms (34.6 ± 1.8 weeks vs. 34.2 ± 2.1 weeks, p = 0.24). Neonatal outcomes, including mean birth weight, respiratory distress syndrome, and admission rates to neonatal intensive care units, were statistically similar (p > 0.05). Vaginal discharge was reported significantly more often in the progesterone cohort, while increased vaginal discomfort was noted in the pessary group. Vaginal progesterone capsules and cervical pessary placement offer equivalent clinical efficacy and safety profiles for managing twin pregnancies complicated by a shortened cervix.

Keywords: Twin Pregnancy; Short Cervix; Preterm Birth; Vaginal Progesterone; Cervical Pessary; Neonatal Outcomes.

Manuscript Timeline: Received: April 22, 2026; Revised: June 15, 2026; Accepted: July 12, 2026; Published: August 25, 2026.

Citation: Nwosu AP, Kudoyin ST. Efficacy of Vaginal Progesterone versus Cervical Pessary in Preventing Preterm Delivery in Asymptomatic Twin Pregnancies with a Short Cervix. International Journal of Obstetrics and Gynecology. 2026; 14(8): 133–144.

Subscribe to read the full article: https://mail.internationalscholarsjournals.org/subscribe-to-read