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Review
. 2018 Jan;20(1):57-63.
doi: 10.1111/tog.12460. Epub 2018 Jan 28.

Spontaneous preterm birth prevention in multiple pregnancy

Sarah R Murray  1 , Sarah J Stock  1 , Shona Cowan  2 , Elizabeth Sarah Cooper  2 , Jane E Norman  1
Affiliations
Review

Spontaneous preterm birth prevention in multiple pregnancy

Sarah R Murray et al. Obstet Gynaecol. 2018 Jan.

Abstract

Key content: Twin pregnancies are associated with a three-fold greater perinatal mortality than singleton pregnancies. Prematurity is a main contributor, with 50% of twin pregnancies delivering before 37 weeks and 10% delivering before 32 weeks of gestation.The aetiology of preterm delivery in twin pregnancies is likely multifactorial and different from that of singletons.Cervical cerclage reduces preterm birth rates in singletons but has mixed results in twins with some studies showing harm.The use of progesterone to prevent preterm birth in singletons has conflicting results and has not been proven to prevent preterm birth in twins. Studies continue to determine whether the cervical pessary is effective in preventing preterm birth in multiple pregnancies.There is a paucity of data available on the prevention of preterm birth in triplets/higher order multiples but similar principles to twin pregnancy apply.

Learning objectives: To review the burden of preterm birth in multiple pregnancy.To understand the methods available for preventing preterm birth in multiple pregnancies and the evidence surrounding the use of each one.To be aware of the use of the Arabin pessary.

Keywords: Arabin pessary; cerclage; multiple pregnancy; twins; vaginal progesterone.

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Figures

Figure 1
Figure 1
a) The Arabin cervical pessary; b) the position of the Arabin cervical pessary.
Figure 2
Figure 2
Risk of preterm birth <34 weeks of gestation in twin pregnancies with a cervical length <25 mm.37
See this image and copyright information in PMC

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