In Reply As Dr Thornton suggests, one of the strengths of our trial was the 100% follow-up and the 100% adherence to the treatment allocation in the pessary group. These high rates were obtained because all women included in the trial delivered at the study institution. Moreover, included women were extensively informed by the research staff about the risk of preterm delivery. We strongly believe that all women would keep a cervical pessary if clinicians clearly explained to them that the benefits of having a healthy full-term infant outweigh the risk of having discomfort. Indeed, almost all women in the pessary group experienced some adverse effects (86.7% had vaginal discharge and 3.3% had pelvic discomfort) but none of them had the device removed. Effective physician-patient communication is a central clinical function in building a therapeutic relationship.1
Martinelli P, Saccone G. Cervical Pessary and Spontaneous Preterm Birth—Reply. JAMA. 2018;319(17):1821–1822. doi:10.1001/jama.2018.1482
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