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Multiple gestations and preterm birth.

F Fuchs1, M-V Senat1

  • 1Departement de Gynécologie-Obstétrique, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin Bicêtre, France; INSERM, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, Villejuif, France; Université Paris-Sud, UMRS 1018, Villejuif, France.

Seminars in Fetal & Neonatal Medicine
|January 23, 2016
PubMed
Summary
This summary is machine-generated.

Predicting preterm birth in twin pregnancies is crucial. Cervical length and fetal fibronectin tests aid prediction in asymptomatic cases, but prevention strategies require further research.

Keywords:
CerclageFetal fibronectinPessaryPreterm birthProgesteroneShort cervix

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Neonatal Outcomes

Background:

  • Preterm birth is a significant concern in twin pregnancies, contributing to substantial newborn morbidity and mortality.
  • Twin gestations experience a high prevalence of preterm birth, accounting for nearly half of observed complications.

Purpose of the Study:

  • To review current literature on predicting and preventing preterm birth in twin pregnancies.
  • To evaluate diagnostic tests for asymptomatic and symptomatic twin pregnancies.
  • To assess the efficacy of various interventions for preterm birth prevention.

Main Methods:

  • Literature review of existing studies on preterm birth prediction and prevention in twin pregnancies.
  • Analysis of predictive accuracy for cervical length (CL) and cervicovaginal fetal fibronectin (fFN) testing.
  • Evaluation of interventions such as bed rest, tocolysis, progesterone, cerclage, and pessaries.

Main Results:

  • In asymptomatic twins, transvaginal cervical length (<25 mm) and negative cervicovaginal fetal fibronectin are effective predictors of spontaneous preterm birth.
  • Cervical length measurement is a strong predictor, with shorter lengths (<20 mm or <25 mm) indicating higher risk.
  • No current interventions, including progesterone or cerclage, have demonstrated effectiveness in preventing preterm birth in asymptomatic twins, though cervical pessaries show potential for short cervices.

Conclusions:

  • Cervical length and fetal fibronectin testing are valuable tools for predicting preterm birth risk in asymptomatic twin pregnancies.
  • Effective methods for preventing preterm birth in twin gestations remain limited, highlighting the need for further research into interventions.
  • Cervical pessaries warrant further investigation for preterm birth prevention in specific cases of short cervix in twin pregnancies.