Clinics in Mother and Child Health

Abstract

Evaluation of Patient Preferences for Treatments to Prevent Preterm Births in Singleton and Twin Pregnancies with a Short Cervix

Sabrina de Andrade Fernandes Collier Perrusi, Maria de Lourdes Brizot, Sckarlet Ernandes Biancolin Garavazzo, Camila Luiza Meira Pucci, Ursula Trovato Gomez, Stela Verzinhasse Peres, Juliana Valente Codato Marinelli, Rossana Pulcineli Vieira Francisco and Mario Henrique Burlacchini de Carvalho*

Background: Prematurity is the primary cause of neonatal morbidity and mortality. Despite some treatment methods, the preferences and concerns of women regarding the prevention of premature births have not yet been elucidated. Thus, this study analyzed singleton and twin pregnancies with an increased risk of prematurity to evaluate patient preferences for treatment and the factors that may influence such preferences.

Methods: Self-administered questionnaires in Portuguese were administered to pregnant women to collect data about their knowledge and concerns regarding prematurity and treatment methods (pessary, progesterone ovules and combination of a pessary and progesterone) as well as their preferred methods. Questionnaires were also used to assess the anxiety and quality of life of the participants. The chi-square, Fisher’s Exact, and Linear-by-Linear association tests were used to compare qualitative independent variables and qualitative outcomes. The Student’s t-test and Analysis of Variance (ANOVA) were used to compare the quantitative independent variables and qualitative outcomes. The Mann–Whitney or Kruskal–Wallis tests were used for non-parametric data.

Results: The study included 123 pregnant women with a short cervix (twin pregnancies, n=61; singleton pregnancies, n=62) from May 2009 to January 2022. As for their preferences, women with singleton pregnancies preferred to use a pessary (53.2%), but with no significant difference (P=0.703) compared to progesterone (46.8%). Women with twin pregnancies preferred the combination of a pessary and progesterone (P+P) (60.7%), followed by ovules (26.2%) and a pessary (8%), with a significant difference in this choice (P<0.001). Previous knowledge of the pessary by pregnant women with twins resulted in a significantly higher preference for the use of the pessary alone compared to P+P (37.5% vs. 5.7%; P=0.04), and no patients chose ovules.

Conclusion: The higher risk of prematurity in twin pregnancies and the lack of studies showing effective treatments for twin pregnancies may have contributed to the higher preference for the combined use of P+P. Women with singleton pregnancies showed no preference between the methods. This may be due to the fact that use of pessary and progesterone has already been proven to be effective in singleton pregnancies.

Published Date: 2023-08-21; Received Date: 2023-07-20