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Updated: Jul 2, 2026
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
[Prematurity in multiple pregnancies]
Elisabeth Krampl1, Katharina Klein
1Medizinische Universität Wien, Universitätsklinik fur Frauenheilkunde, Wien, Osterreich. elisabeth.krampl@meduniwien.ac.at
Insights
Twin pregnancies significantly increase the risk of preterm birth, especially monochorial twins. While progesterone effectively reduces preterm delivery in singleton pregnancies, its impact on twins remains unproven.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Maternal-Fetal Medicine
Context:
- Twin pregnancies constitute 1.5% of all pregnancies but contribute to 25% of premature births.
- Monochorial twins face higher risks of preterm birth (9% vs. 5.5%), intrauterine growth restriction, and perinatal mortality compared to dichorial twins.
Purpose:
- To review the current understanding of preterm birth risks in twin pregnancies.
- To evaluate the efficacy of interventions for preventing preterm birth in multiple gestations.
Summary:
- Chorionicity is a key factor in preterm birth risk for twins.
- Tocolysis with oxytocin antagonists is recommended for imminent preterm labor until fetal lung maturity.
- Prophylactic bed rest, home uterine activity monitoring, and cervical cerclage have not demonstrated improved outcomes; progesterone's efficacy in twin pregnancies is yet to be established.
Impact:
- Highlights the increased risks associated with twin pregnancies, particularly monochorial types.
- Informs clinical practice regarding interventions for preterm labor in twins.
- Identifies areas for future research, specifically the role of progesterone in preventing preterm birth in multiple gestations.
Abstract:
At present, 1.5% of all pregnancies are twin pregnancies, but twin pregnancies account for 25% of all premature infants. The chorionicity plays an important role: the risk of preterm birth before 32 weeks is 5.5% in dichorial twins and almost double (9%) in monochorial twins. The rate of intrauterine growth restriction and also the perinatal mortality are twice as high in monochorial compared to dichorial twins. In cases of imminent preterm labour, tocolysis is recommended until lung maturity has been achieved. The preferred drugs, are oxytocin antagonists because of the increased cardiorespiratory strain in multiple pregnancies. Prophylactic bed rest and 'home uterine activity monitoring' have not been shown to improve the outcome, and a recent review (2005) demonstrated a twofold increase in preterm labour after cervical cerclage. In two large placebo-controlled studies, the rate of preterm delivery in high-risk singleton pregnancies was significantly reduced by the regular application of progesterone. A potential effect on multiple pregnancies is yet to be shown.
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