[Prevention of prematurity in 842 consecutive twin pregnancies]

To evaluate the effects of a specific management in prevention of prematurity in twin pregnancies.

The parameters involved in obstetrical follow-up of twin pregnancies were evaluated in a retrospective study of 842 twin pregnancies between 1979-1992.

Five-hundred-and-fifteen pregnancies were spontaneous. Two-hundred followed treatment with ovulation induction agents and 127 were due to in vitro fertilization. Early diagnosis of twin pregnancies allowed preventive measures against prematurity. Management of twin pregnancies included rest at home and regular clinical examination of the cervix. Monthly consultations and monthly ultrasounds were performed at hospital. Weekly consultations were made by midwives at home. Hospitalization was not systematic, but was necessary in cases of maternal complications. The diagnosis of twin pregnancy was made before 16 weeks in 82.4% of the cases. The mean gestational age at delivery was 36.2 weeks. The prematurity rate was 45.96%. The mean weight of the neonates was 2,376 +/- 533 g for the first twin and 2,297 +/- 547 g for the second twin. The mean Apgar score at 5 minutes was 9.7 and 9.3, respectively for the first and the second twin. The perinatal mortality was 39.3 per 1,000. The main neonatal complications resulted from prematurity. Twins were hospitalized in the intensive care unit in 20.7 cases.

The present study supports early diagnosis of multiple pregnancies with systematic ultrasound at 11-13 weeks for each pregnancy, information of the patients, rest at home and regular clinical examination of the cervix.