Pessary Compared With Vaginal Progesterone for the Prevention of Preterm Birth in Women With Twin Pregnancies and Cervical Length Less Than 38 mm: A Randomized Controlled Trial: In Reply

We read the article by Dang et al1 published in the March 2019 issue. It is
a well-designed study. We congratulate
the authors. From Table 3, it is evident
that 45% of women in the pessary
group and 36% of women in the progesterone group had prelabor elective
cesarean delivery. It is not clear the indications were for elective cesarean
delivery. Presence of discordance or
small for gestational age as indications
could affect the perinatal outcome. The
emergency cesarean delivery rate in the
progesterone group was higher than
that in the pessary group in the total population as well as the in the subgroup
with cervical length less than 28 mm.
Emergency cesarean delivery has been
recognized to be associated with poorer
perinatal outcome.2 Though the total
cesarean delivery rates were not significantly different in the two groups, analysis for any significance of difference in
elective and emergency cesarean deliveries in the two groups is not mentioned.