Pessary or Cerclage to prevent preterm delivery in women with short cervical length with and a history of preterm birth.

Preterm birth is a major problem within obstetrics and accounts for the
majority of perinatal morbidity and mortality. When a women had a preterm
delivery the risk of recurrence is increased. According to national guidelines
women with a history of preterm birth are closely monitored with regular visits
to the outpatient clinic and are treated with progesteron. During these
2-weekly prenatal visits the cervical length is measured. In case a cervical
length of 25 millimetres or less is measured, women receive a cerclage. In
women with a history of multiple preterm births a cerclage is offered early in
pregnancy (before 16 weeks) irrespectable of cervical length.
Placing a cercalge is an invasive surgical procedure requiring hospital
admission.
Recent studies have demonstrated that a pessary, a sillicone band folded around
the cervix, is effective in reducing preterm birth in women who have a short
cervical length. This is a non-invasive procedure which takes place at the
outpatient clinic and takes about 10 minutes. This is a patient-friendly
intervention and a much cheaper alternative compared to cerclage. Therefore it
is necessary to asses it's effectiveness in this group of patients.

Hypothesis: we estimate that a pessary is as effective as a cerclage against
lower costs.

To evaluate whether cervical pessary can replace cervical cerclage in women
with previous preterm birth and a short cervix or in women with a history of
multiple preterm births in terms of effectiveness and costs

Nationwide multicentre RCT with an economic analysis alongside it.

Pessary versus cerclage inserted for 23+6 weeks of pregnancy

In context of this research the burden for patients will be minimal. When
compared to the control group, who receive standard care, burden of the
intervention group is even less, because this group doesn't has to undergo an
invasive procedure.