PELVIC ORGAN PROLAPSE & PESSARY EDUCATION
PELVIC ORGAN PROLAPSE & PESSARY EDUCATION

Cerclage pessary

Application: The cerclage pessary consists of flexible comfortable silicone. Like all silicone pessaries it is elastic, it can be folded and thus be inserted without pain. The cerclage pessary is designed for the treatment of pregnant women, to support the cervix mainly in patients with additional complaints of prolapse (painful “downwards” pressure during standing and walking), pregnant women who are exposed to physical strain (e.g. standing for a long time), increased intrauterine pressure, e.g. multiple pregnancies or ultrasound signs of an incompetent cervix.

Before insertion bacterial swabs should be performed to exclude bacterial colonization. The treatment should start before the cervix might be effaced. If used on a therapeutic basis it is meanwhile indicated when trans- vaginal sonography reveals cervical shortening and/or a dilatation of the internal os, usually between 15 and 20 weeks. The pessary is not meant to close the cervix but rather to support it and to shift the cervix towards the sacrum.

Use: The cerclage pessary is inserted in the recumbent position by the obstetrician. It is vital that the curvature of the pessary shows upwards so that the larger diameter is supported by the pelvic floor. The pessary can be folded and then preferably be placed into the vaginal fornix. Thereby the cervix should be located within the upper ring diameter. The obstetrician may control whether the cervix is not surrounded too firmly by the upper ring of the pessary. After the insertion the patient is asked to get up. Normally patients indicate “relief of prolapse complaints” immediately after placement. The insertion of the pessary can be facilitated by spreading a gliding compound, preferably antibiotic creams not destroying the natural flora.

The pessary should be removed before delivery at around 37 weeks in asymptomatic patients. In cases of increased discharge it may be changed and cleaned in between, but it is not mandatory if manipulations have to be better avoided. In all patients with premature rupture of membranes, vaginal blood loss and severe painful contractions the pessary should be removed to avoid cervical lesions or ascending infection. Vaginal sonographic examinations can help to identify the cervical shape and length but the visualization of transvaginal sonography may be impaired by the pessary. The position of the pessary can easily be controlled manually during routine controls.

Side Effects/Complications: The right position of the pessary (with the curvature and the smaller diameter upwards) is the key in the success of treatment. Otherwise the supporting effect is insufficient. There might be some increase of abacterial discharge. However, the composition of the vaginal flora will not be substantially altered.

The product must not be used by other patients and be stored by room temperature. The pessary may be cleaned under warm running water without using any disinfectant. The material can be cleaned and disinfected preferably with aldehyd-containing solutions (Gigasept FF). The pessary can also be sterilized by steam (134ºC /3,8 bar) or hot air (250ºC).

It can be sterilized with Pessary & Probe disinfectant. This disinfectant has a 30 second contact time, saving costs for the clinics and patients.

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