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Spontaneous preterm birth prevention in multiple pregnancy
Author(s) -
Murray Sarah R,
Stock Sarah J,
Cowan Shona,
Cooper Elizabeth Sarah,
Norman Jane E
Publication year - 2018
Publication title -
the obstetrician and gynaecologist
Language(s) - English
Resource type - Journals
eISSN - 1744-4667
pISSN - 1467-2561
DOI - 10.1111/tog.12460
Subject(s) - obstetrics , medicine , twin pregnancy , pregnancy , pessary , premature birth , preterm delivery , etiology , multiple birth , gestation , cervical insufficiency , population , environmental health , psychiatry , biology , genetics
Key content Twin pregnancies are associated with a three‐fold greater perinatal mortality than singleton pregnancies. Prematurity is a main contributor, with 50% of twin pregnancies delivering before 37 weeks and 10% delivering before 32 weeks of gestation. The aetiology of preterm delivery in twin pregnancies is likely multifactorial and different from that of singletons. Cervical cerclage reduces preterm birth rates in singletons but has mixed results in twins with some studies showing harm. The use of progesterone to prevent preterm birth in singletons has conflicting results and has not been proven to prevent preterm birth in twins. Studies continue to determine whether the cervical pessary is effective in preventing preterm birth in multiple pregnancies. There is a paucity of data available on the prevention of preterm birth in triplets/higher order multiples but similar principles to twin pregnancy apply.Learning objectives To review the burden of preterm birth in multiple pregnancy. To understand the methods available for preventing preterm birth in multiple pregnancies and the evidence surrounding the use of each one. To be aware of the use of the Arabin pessary.