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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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Spontaneous preterm birth prevention in multiple pregnancy.

Sarah R Murray1, Sarah J Stock1, Shona Cowan2

  • 1MRC Centre for Reproductive Health Queen's Medical Research Institute University of Edinburgh Edinburgh EH16 4TJ UK.

The Obstetrician & Gynaecologist : the Journal for Continuing Professional Development From the Royal College of Obstetricians & Gynaecologists
|July 17, 2018
PubMed
Summary

Preventing preterm birth in multiple pregnancies is crucial due to higher risks. Current methods like cervical cerclage and progesterone show mixed results in twins, necessitating further research into pessary use.

Keywords:
Arabin pessarycerclagemultiple pregnancytwinsvaginal progesterone

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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.