Spontaneous preterm birth prevention in multiple pregnancy

Area of Science:

• Maternal-Fetal Medicine
• Obstetrics
• Perinatology

Background:

• Multiple pregnancies, particularly twins, face significantly higher perinatal mortality rates compared to singleton gestations.
• Preterm birth is a primary driver of this increased mortality, with a substantial proportion of twins delivering prematurely.
• The causes of preterm birth in multiple pregnancies are complex and distinct from those in singletons.

Purpose of the Study:

• To comprehensively review the incidence and impact of preterm birth in multiple pregnancies.
• To critically evaluate existing and emerging interventions for preventing preterm birth in these high-risk pregnancies.
• To specifically examine the evidence and application of the Arabin cervical pessary in managing multiple gestations.

Main Methods:

• Systematic review of existing literature on preterm birth prevention in multiple pregnancies.
• Analysis of clinical trial data and observational studies.
• Focus on interventions including cervical cerclage, progesterone supplementation, and cervical pessaries.

Main Results:

• Cervical cerclage has demonstrated inconsistent efficacy and potential harm in twin pregnancies, unlike its established role in some singleton cases.
• Progesterone's effectiveness in preventing preterm birth in twins remains unproven, with conflicting data from singleton studies.
• The efficacy of the cervical pessary for preventing preterm birth in multiple pregnancies is an active area of ongoing research.

Conclusions:

• There is a critical need for evidence-based strategies to reduce preterm birth in multiple pregnancies.
• Current interventions require further investigation to establish their safety and efficacy in twin and higher-order multiples.
• The role of the Arabin pessary warrants continued study to determine its potential benefit in preventing iatrogenic prematurity.