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Cervical incompetence during pregnancy cerclage pessary

Using transvaginal sonography in recumbent or upright position we have established normal values for the cervical length and the opening of the cervical os for singleton and twin pregnancies. Low values of the cervical length and high values of the opening of the cervical os (funneling) help identify patients who may benefit from pessary placement (see graphs below).

The cerclage pessary can easily be folded and inserted without pain. Before the application, it is recommended to exclude and if neccessary to treat cervical or vaginal infections.
In general, cerclage pessaries should have a height of 21-25 mm in singleton pregnancies and a height of 25-30 mm in multiple pregnancies or pregnant patients with complaints of prolapse. The width of the upper and lower diameter should be chosen depending on the individual constitution of the pregnant patient.
Cerclage pessaries can be ordered in a non-perforated or perforated version. The perforations facilitate discharge to pass.

Sizes and Models:

Cerclage pessaries are classified according to ...

• The lower larger diameter (65 or 70 mm)
• The height (17, 21, 25, 30 mm)
• The upper smaller diameter (32 or 35 mm)

Normal values (transvainal sonography) of cervical length and internal os (funneling) in the recumbent or uprigth position.
Singleton Pregnancy	Multiple Pregnancy
Cervical length in mm
Recumbent Standing gestational weeks + days	Recumbent Standing gestational weeks + days
internal os (funneling) in mm
Recumbent Standing gestational weeks + days	Recumbent Standing gestational weeks + days
The blue columns represent the distribution of normal values between 25th and 75th centile. There may be an indication to place a cerclage pessary in cases where values of the cervical length are (far) below the 25th centile or values of the width of the internal os are (far) above the 75th centile (mainly before 32 weeks).