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Cervical incompetence during pregnancy

cerclage pessary

cervical pessary


This pessary is used to treat pregnant women with cervical incompetence in order to support the cervix and turn it backward towards the sacrum (arrow).

It may be indicated in pregnancies with a history of premature labor, multiple pregancies or mothers who are exposed to physical strain (e.g. standing for a long time). It may also be indicated in pregnant women suffering from prolapse of the genital organs.

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 cervical 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

RecumbentStanding
gestational weeks + days
RecumbentStanding
gestational weeks + days


internal os (funneling) in mm

RecumbentStanding
gestational weeks + days
RecumbentStanding
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 cervical 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).


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