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At least 19 recordsLinked to original sources
PubMed1998

[Safety and acceptance of self application of cubic pessaries and urethral ring pessaries].

OBJECTIVE: Flexible cubic and ring pessaries with a suburethral thickening are devices for the treatment of genital prolapse and urinary stress incontinence. Threads attached to the pessary enable overnight self-removal and self-application. Little is known about the safety and women's acceptance of these devices. METHODS: Eighteen women (age 36-85 years), 9 of them with failed surgery, tried this therapy (cubic pessary n = 6; ring pessary n = 12). The size of the pessary was chosen clinically. All patients were seen after a week and then monthly. RESULTS: All women showed up after 1 week. Twelve of 18 women felt comfortable with these devices at that time. During follow-up, 5/18 women wanted surgical therapy within the first 2 months, 3/18 refused the device later, 1/18 was lost to follow-up and 9/18 patients continued pessary therapy for a mean duration of 11 months. During 107 treatment months, only 2 mild complications were observed without the need to intervention (mild vaginal erosion, spotting). CONCLUSIONS: Pessary therapy is safe but has a dropout rate of approximately 50%. It can be an efficient alternative method in motivated women.

Female↗
PubMed2000

A survey of pessary use by members of the American urogynecologic society.

OBJECTIVE: To describe trends in pessary use for pelvic organ prolapse. METHODS: An anonymous survey administered to the membership of the American Urogynecologic Society covered indications, management, and choice of pessary for specific support defects. RESULTS: The response rate was 48% (359 of 748). Two hundred fifty surveys were received at the scientific meeting and 109 were returned by mail. Seventy-seven percent used pessaries as first-line therapy for prolapse, while 12% reserved pessaries for women who were not surgical candidates. With respect to specific support defects, 89% used a pessary for anterior defects, 60% for posterior defects, 74% for apical defects, and 76% for complete procidentia. Twenty-two percent used the same pessary, usually a ring pessary, for all support defects. In the 78% who tailored the pessary to the defect, support pessaries were more common for anterior (ring) and apical defects (ring), while space-filling pessaries were more common for posterior defects (donut) and complete procidentia (Gellhorn). Less than half considered a prior hysterectomy or sexual activity contraindications for a pessary, while 64% considered hypoestrogenism a contraindication. Forty-four percent used a different pessary for women with a prior hysterectomy and 59% for women with a weak pelvic diaphragm. Ninety-two percent of physicians believed that pessaries relieve symptoms associated with pelvic organ prolapse, while 48% felt that pessaries also had therapeutic benefit in addition to relieving symptoms. CONCLUSION: While there are identifiable trends in pessary use, there is no clear consensus regarding the indications for support pessaries compared with space-filling pessaries, or the use of a single pessary for all support defects compared with tailoring the pessary to the specific defect. Randomized clinical trials are needed to define optimal pessary use.

Adult↗
PubMed1997

A simplified protocol for pessary management.

OBJECTIVE: To evaluate a simplified protocol for pessary management. METHODS: Women with symptomatic pelvic organ prolapse who opted for pessaries were enrolled in a prospective simplified protocol for pessary management. After the initial pessary fitting, they were seen at 2 weeks for reexamination and thereafter at 3- to 6-month intervals. RESULTS: One hundred ten women (mean age 65 years) were enrolled, and 81 (74%) of them were fitted successfully with a pessary. Life-table analysis showed that 66% of those who used a pessary for more than 1 month were still users after 12 months and 53% were still users after 36 months. The severity of pelvic prolapse did not predict the likelihood of pessary failure except in cases of complete vaginal eversion. Patients complaining of stress incontinence were less likely to have a successful pessary fitting and more likely to opt for surgery. Current hormone use and substantial perineal support do not predict greater likelihood of pessary fitting success. No serious complications from using the pessary were observed in the study sample. CONCLUSION: Stringent guidelines calling for frequent pelvic examinations during pessary use can be relaxed safely. Pessaries can be offered as a safe long-term option for the management of pelvic prolapse.

Adult↗
PubMed2000

Pessaries for the treatment of incompetent cervix and premature delivery.

The purpose of this study was to review published articles about using pessaries in women with an incompetent cervix or who are at risk for preterm delivery. A MEDLINE search was performed from 1966 to 2000, with articles published before 1966 being extracted from the reference lists of articles obtained. Foreign articles were translated into English. Key words included pessary, incompetent cervix, and preterm labor. All studies that included patient data were included. A variety of studies suggest that pessaries can increase the percentage of full-term deliveries when used in women with an incompetent cervix or at risk for preterm delivery. When looking at women thought to have an incompetent cervix, the studies are mostly old case series. One prospective, randomized trial demonstrated no difference between women treated with a pessary and a cerclage. However, 27 weeks was the average gestational age at which therapy was started. In women at risk for preterm delivery, retrospective studies show an increase in full-term pregnancy rates with pessary use. One prospective, nonrandomized study also shows an increase in full-term pregnancy rate. However, in this study, lower risk patients received the pessary. Because of the poor nature of most of the studies, pessaries should not replace cerclage use at this time in women with an incompetent cervix. However, pessary use should be considered as adjuncts to cerclage or in women who are not candidates for cerclage. Also, pessary use may be considered in some women at risk for preterm delivery. Randomized perspective controlled trials are in progress to address the use of pessaries in these situations. Vaginal pessaries have been reported to be useful in women at risk for preterm delivery since 1959. Bedrest and cervical cerclage has become standard therapy in the United States for women with an incompetent cervix. However, cerclage is not without risk. Furthermore, advances in ultrasound have allowed us to identify women potentially at risk for preterm delivery by detecting cervical shortening before dilatation. This ability has raised questions concerning how to manage patients with subtle ultrasound changes. This article reviews the published literature concerning the use of pessaries in women with an incompetent cervix or at risk for early delivery.

Female↗
PubMed2001

Gynecologists' patterns of prescribing pessaries.

OBJECTIVE: To determine how gynecologists in the United States prescribe pessaries. STUDY DESIGN: A 34-question (long) survey was sent to 2,000 gynecologists. Those who did not respond were then sent a five-question (short) survey. RESULTS: Nine hundred forty-seven (47.3%) long and short questionnaires were returned. Eighty-six percent of gynecologists prescribe pessaries. Most received minimal or no training in pessaries in their residencies. The most common pessaries used were the ring and doughnut. Uterine prolapse was treated most often with the Gellhorn and doughnut pessaries. The cube and Gellhorn pessaries were thought to be the most effective for vaginal vault prolapse. The Gehrung and ring pessaries were thought to be most effective for correction of cystocele. However, the ring pessary was considered the easiest to use. Follow-up visits were most often performed at one week, one month and then every three months. Estrogen was used in most cases. CONCLUSION: Most gynecologists prescribe pessaries. The ring pessary is used most often and is deemed the easiest to use. Pessaries are thought to work for all pelvic organ prolapse defects but are thought to be less effective for posterior defects. Follow-up of patients differs from manufacturers' recommendations.

Estradiol Congeners↗
PubMed1990

[The Arabin cerclage pessary--an alternative to surgical cerclage].

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix. The bowl-shaped pessary is inserted with the curvature upwards and the cervix is fixed in the central opening of the cerclage pessary. Thus a constriction, reconfiguration, and elongation of the incompetent cervix is obtained as evidenced by ultrasonography. The only side effect of the pessary treatment is an increase in cervical secretion and subsequent vaginal discharge. No infectious complications occurred. In 92% of the treated gravidae the cerclage pessary could be removed after the 36th week of gestation. Cerclage pessary can be recommended as a favourable alternative to surgical procedures as prophylactic or therapeutic approach, reducing surgical treatment significantly to less than 0.5%.

Cervix Uteri↗
PubMed1992

An intravaginal controlled-release prostaglandin E2 pessary for cervical ripening and initiation of labor at term.

The purpose of this randomized, double-blind study was to evaluate the efficacy and safety of a new controlled-release hydrogel pessary for ripening the cervix and initiating labor. Subjects had an entry Bishop score of 4 or less and gestational age of 37 or more weeks. One hundred fourteen women received a placebo pessary and 101 received the hydrogel pessary, containing 10 mg of prostaglandin (PG) E2. Compared with the placebo group, those given the PGE2 pessary were more likely to have an increase in Bishop score of 3 or more (60 or 59% versus 21 or 18%; P less than .0001), change to a Bishop score of 6 or higher (59 or 58% versus 18 or 16%; P less than .0001), and active labor (68 or 67% versus 15 or 13%; P less than .0001). Including the crossover study, uterine hyperstimulation (28 of 182, 15%) and fetal heart rate abnormalities (18 of 182, 10%) in PGE2-treated subjects were reversed on removal of the pessary with no apparent harm to the mother or fetus. These temporary adverse effects appeared while the pessary was in place and after the onset of active labor. Oxytocin was unnecessary in 89 of 182 (49%) of the PGE2-treated cases and was used more often to augment than to induce labor. We conclude that the described controlled-release PGE2 vaginal pessary induces appreciable cervical ripening and frequently initiates active labor with little or no need for oxytocin. The pessary may cause uterine hyperstimulation or fetal heart rate abnormalities, but these would be expected to reverse on removal of the pessary.

Delayed-Action Preparations↗
PubMed2000

Bacterial vaginosis increases in pessary users.

The purpose of this study was to examine the association between pessary use, smoking and changes in the vaginal flora. Patients using pessaries were age matched with non-pessary using controls. All candidates examined were women attending the Mount Sinai Hospital, Toronto, for genitourinary problems. Vaginal cultures were routinely performed on all women attending the unit, irrespective of symptoms. Forty-four pessary users were age matched with 176 controls (4 controls per case). The mean age was 60.1 +/- 12.6 years, and 15% of these were premenopausal. The duration of pessary use ranged from 0.5 to 8 years (mean 3.3 +/- 1.7). Weight, parity, smoking status, diabetes mellitus, thyroid disease, UTI and postvoid residual urine volume were not significantly different between pessary users and controls. Bacterial vaginosis (BV) was noted in 32% of pessary users, versus 10% of controls. The relative risk of developing BV in pessary users was 3.3 (OR, 4.37; 95% CI, 2.15-9.32), P = 0.0002. Smoking independently affected the vaginal flora, increasing the relative risk of developing BV to 2.9 (OR, 3.78; 95% CI, 2.05-8.25), P = 0.0013. It was concluded that pessary use is a very effective and conservative method for the treatment of genital prolapse. However, we found that the presence of a foreign body was associated with changes in the vaginal flora, thereby increasing the odds of developing bacterial vaginosis to 4.37; this was further compounded by smoking.

Cohort Studies↗
PubMed2000

Review of vaginal pessaries.

Pessaries have been used to treat pelvic organ prolapse throughout history, although with advances in the field of anesthesia and in surgical technique during the past century, pessary use declined. Current indications for pessary use include women awaiting definitive surgical repair, treatment for an unsuccessful surgical repair, treatment for women who are not surgical candidates, and for those who prefer medical management. In addition pessary use is gaining popularity among women with stress urinary incontinence, as well as in younger women interested in maintaining child bearing capabilities. Neonatal pelvic organ prolapse has also been treated successfully with pessaries. Many physicians have limited experience with pessary selection and fitting. This review article attempts to provide a basic overview of pessary selection and management.

Female↗
PubMed1984

Induction of labour using prostaglandin E2 pessaries.

199 patients were used in a double blind placebo controlled trial testing the efficacy of prostaglandin E2 3 mg pessaries in the induction of labour. The trial showed that prostaglandin E2 pessaries were effective in the induction of labour but that with only a 55% success rate the results were less than that quoted by others. It was felt that the success rate could be increased by either reducing the time interval between insertion of the pessaries or by using a slow release vehicle for the prostaglandin. Surprisingly no significant shortening in the duration of labour was found between the prostaglandin group and the placebo group, despite a significant increase in the favourability of the cervix in the prostaglandin pessary group. Also no factors were found which definitely distinguished between the success or failure of induction of labour using prostaglandin pessaries. It was felt that prostaglandin pessaries were a safe and reasonably effective method of induction of labour and that, with reduction in the time interval between insertion of pessaries or the use of a slow release vehicle for the prostaglandin, the efficacy would be greatly increased.

Adolescent↗
PubMed1993

Vaginal pessaries and their use in pelvic relaxation.

To evaluate the therapeutic usefulness of pessaries in patients with pelvic relaxation, a retrospective study was performed identifying 107 patients who had been fitted with a pessary for symptomatic pelvic relaxation. Of this group, 101 returned or were available for follow-up. Ninety-one had at least one pelvic organ protruding to or beyond the hymen. Specific reasons for using the pessary are cited. Group 1 included 19 patients who were thought to be medically unfit for surgery. Twenty-one percent of this group died within one year of their evaluation for pelvic relaxation. Group 2 was composed of 24 patients who chose to use the pessary only temporarily while awaiting a suitable time for surgery. Group 3 consisted of 58 patients who were offered the option of definitive surgical repair but initially declined. Fifty of the 101 patients have continued to use the pessary. Twenty-six had repairs, and four have died. Only 21 patients have discontinued the pessary, had no surgical repair and thus continue without treatment of their pelvic relaxation. No major complications were associated with use of the pessary.

Adult↗
PubMed1984

A comparison of three dosages of prostaglandin E2 pessaries for ripening the unfavourable cervix prior to induction of labor.

A study was planned to evaluate the effect of Prostaglandin E2 pessaries in three different dosages in ripening the unfavourable cervix prior to the induction of labor. A single dose of PGE2 as pessary in the three different dosages was administered into the posterior vaginal fornix to ripen an unfavourable cervix with a Bishop score less than or equal to 4 in 101 primigravid and 79 multigravid patients. The pessary containing 2 mgm was as effective as 3 mgm and 5 mgm PGE2 pessary in ripening the cervix, and the outcome of labor and fetal status were similar with the different dosages of PGE2. However, two multigravid patients who received 5 mg of PGEs pessary and one multigravid patient who received 3 mg of PGE2 pessary developed hypertonic uterine activity. None of the patients who received 2 mg PGE2 pessary developed any adverse effect on uterine activity.

Adolescent↗
PubMed1997

Vaginal lever pessary in patients with multiple gestation, preterm labor and low fetal station. A report of three cases.

BACKGROUND: The vaginal pessary has been utilized previously in patients with cervical incompetence, resulting in improvement in pregnancy outcome. The mechanical advantages generated by the vaginal lever pessary could theoretically be applied to patients in preterm labor with low station of the presenting part to prevent cervical dilatation. CASES: One patient with twins and two with triplet pregnancies presented in preterm labor with advanced cervical dilatation and low fetal station. They were treated with tocolytic drugs, and a vaginal lever pessary was placed. The gestational age at delivery was delayed with the addition of the vaginal pessary. Based on previous experience with these difficult cases, it was judged that the use of the pessary achieved a delay in delivery that would not have occurred without the device. CONCLUSION: Vaginal pessaries can be used as mechanical adjuvants in the treatment of preterm labor. These devices work by altering the pressure dynamics on the cervix and lower uterine segment. They may also help limit cervical change by preventing engagement of the presenting part into the maternal pelvis. In these cases, a vaginal pessary appears to be beneficial in delaying delivery in multiple gestations presenting with advanced cervical dilatation and low station of the presenting part.

Adult↗
PubMed1998

Double pessary use in grade 4 uterine and vaginal prolapse.

BACKGROUND: Certain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition. TECHNIQUE: With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first. EXPERIENCE: We have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief. CONCLUSION: In women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.

Aged↗
PubMed1993

The efficacy of povidone-iodine pessaries in a short, low-dose treatment regime on candidal, trichomonal and non-specific vaginitis.

Povidone-iodine pessaries (Betadine vaginal pessaries) containing 200 mg of povidone-iodine (PVP-I) in a water soluble base, are a widely used gynaecological preparation for treatment of vaginitis. We conducted a study on PVP-I pessaries at the reduced dose of one pessary daily for 7 days to suit conditions in Macau where patients are eager for a simple, short treatment course with confirmed clinical efficacy benefiting their professional and household essential requirements. Thirty-eight cases were selected for this particular clinical trial. These consisted of housewives, factory workers and professional girls (a sexually high risk group) who were suffering from vaginitis and complaining of vaginal discharge and irritation due to trichomonas, candida or non-specific vaginitis. After routine examination, including the collection of samples for microbiology, patients were treated with PVP-I pessaries 200 mg once a day for 7 days. The second microbiology samples were collected after the 7 day treatment period. Among the 38 cases, we had 30 cases with a complete record to allow us to make a summary and analysis of the trial. There were 14 cases of vaginitis due to yeasts and fungi infection, 3 cases of protozoa (trichomonas), and 13 cases due to non-specific pathogenic infections. 73.3% of cases had a complete symptomatic and microbiological cure and a further 16.7% had a microbiological cure with a good improvement in symptoms. No complications or side effects were found in the 7 days consecutive treatment course and inflammation quickly subsided during the course of treatment. PVP-I pessaries, used once daily for 7 days, seem to be an ideal treatment for cases who are likely to be unable to follow a longer treatment course.

Candidiasis, Vulvovaginal↗
PubMed1983

Pre-operative cervical dilatation in termination of first trimester pregnancies using 16, 16-dimethyl-trans-delta 2 PGE1 methyl ester vaginal pessaries.

The effect of a prostaglandin E1 analogue on the cervix prior to termination of first trimester pregnancy was studied in a double-blind placebo-controlled trial with 70 primigravid and 125 multigravid patients in the Hong Kong University Gynaecological Unit. One mg of 16, 16-dimethyl-trans-delta 2-prostaglandin E1 methyl ester (ONO 802) in the form of vaginal pessary was inserted 3 hours before vacuum aspiration. The cervical dilatation in patients receiving ONO 802 pessaries was significantly greater than that in patients who received no treatment or placebo pessaries but the difference in dilatation between patients who received no treatment or placebo was not significant. The blood loss during operation in patients receiving ONO 802 pessaries was also significantly less than that in patients receiving placebo pessaries. The side effects due to ONO 802 pessaries were mild and infrequent.

Abortifacient Agents↗