BACKROUND:

Preterm labor is one of the most common causes (up to 11 %) of neonatal deaths worldwide. It is related to an increase of perinatal mortality and long-term neonatal mobility such as psychomotor development. Due to the increase of preterm delivery, it is of interest to predict and detect high risk pregnant women who would benefit from regular follow up and treatment such as cervical pessary.

CASE PRESENTATION:

A thirty-two-year-old pregnant woman who was seenby a high risk consult due to twin pregnancy. In one of the consultations, irregular uterine activity was detected as well as short cervical length (11 mm) and funneling. She was admitted to hospital for tocolysis, and two doses of glucocorticoids were given to aid lung maturation before delivery. Before she was discharged, a cervical pessary was inserted. She attended hospital in active labor at week 33 gestation. As the second fetus was in breech position, an urgent cesarean section was performed. Prior to the surgery, when removing the pessary, complete necrosis of the cervix was observed, leaving only a flap hanging from the cervix by a small pedicle from the anterior lip. Two live males were delivered, whose Apgar were 9-9 and 6-9. At the end of the surgery, the cervical channel was revised and the who cervix was excised and sent for histopathology study.

FINDINGS:

Cervical pessary is known as an efficient and easy prevention of preterm birth in twin pregnancies; however, it is associated with certain risks. It is important to examine the correct placement during follow up.

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