[Special management for threatened preterm delivery in multiple pregnancies]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatology

Context:

• Multiple pregnancies have a higher incidence of spontaneous preterm birth compared to singleton pregnancies.
• Preterm delivery in multiple gestations is often preceded by uterine contractions.
• Current management strategies for threatened preterm delivery (TPD) in multiple pregnancies are based on limited evidence.

Purpose:

• To review the current evidence and provide recommendations for managing preterm labor in multiple pregnancies.
• To assess the efficacy of various interventions, including tocolysis, cervical ultrasound, and antenatal corticosteroids.
• To discuss specialized practices like in utero transfer and delayed-interval delivery.

Summary:

• Spontaneous prematurity is significantly more frequent in multiple than singleton pregnancies.
• Cervical ultrasound shows predictive value for preterm delivery in TPD, but home tocodynamometry lacks demonstrated benefits in asymptomatic twin pregnancies.
• Tocolysis efficacy appears similar to singletons, with caution advised for beta-mimetics due to pulmonary edema risk. Antenatal corticosteroids may be less beneficial, with current doses potentially insufficient.
• In utero transfer to specialized facilities is encouraged. Delayed-interval delivery is a rare option for specific cases, requiring tocolysis and antibiotics.

Impact:

• Highlights the need for further research into optimal management of preterm labor in multiple pregnancies.
• Informs clinical practice regarding the use of diagnostic tools and therapeutic interventions.
• Emphasizes the importance of specialized care and timely interventions for improving outcomes in multiple gestations.