Review questionWhat interventions are effective in preventing spontaneous preterm delivery in multiple pregnancy, including bed rest, progesterone and cervical cerclage?

No.Bibliographic informationReason for exclusion
570Katz M, Robertson PA, and Creasy RK. Cardiovascular complications associated with terbutaline treatment for preterm labor. American Journal of Obstetrics and Gynecology 1981; 139:(5)605–8.Study did not focus on the prevention of preterm delivery (but on cardiovascular side effects associated with terbutaline use)
571Nassar AH, Sakhel K, Maarouf H et al. Adverse maternal and neonatal outcome of prolonged course of magnesium sulfate tocolysis. Acta Obstetricia et Gynecologica Scandinavica 2006; 85:(9)1099–103.Study included women in labour
572van Dijk KG, Dekker GA, and Van Geijn HP. Ritodrine and nifedipine as tocolytic agents: a preliminary comparison. Journal of Perinatal Medicine 1995; 23:(5)409–15.Study included women in labour
573Plank K, Mikulaj V, Stencl J et al. Prevention and treatment of prematurity in twin gestation. Journal of Perinatal Medicine 1993; 21:(4)309–13.Study did not have a comparative control group
574de HR, Mol BW, Erwich JJ et al. Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study. [see comment]. British Medical Journal 2009; 338:b744.Study included women in labour
575King JF, Flenady V, Papatsonis D et al. Calcium channel blockers for inhibiting preterm labour. Cochrane Database of Systematic Reviews 2009;(4).Study did not report results specifically for twin and/or triplet pregnancies
576de la TL, Istwan NB, Desch C et al. Management of recurrent preterm labor in twin gestations with nifedipine tocolysis. American Journal of Perinatology 2008; 25:(9)555–60.Study included women in labour
577Lam F, Bergauer NK, Jacques D et al. Clinical and cost-effectiveness of continuous subcutaneous terbutaline versus oral tocolytics for treatment of recurrent preterm labor in twin gestations. Journal of Perinatology 2001; 21:(7)444–50.Study included women in labour
578Kosasa TS, Nakayama RT, Hale RW et al. Ritodrine and terbutaline compared for the treatment of preterm labor. Acta Obstetricia et Gynecologica Scandinavica 1985; 64:(5)421–6.Study did not report results specifically for twin and/or triplet pregnancies
579Kupferminc M, Lessing JB, Yaron Y et al. Nifedipine versus ritodrine for suppression of preterm labour. British Journal of Obstetrics and Gynaecology 1993; 100:(12)1090–4.Study included women in labour
580Centre for Reviews and Dissemination. Nifedipine versus ritodrine for suppression of preterm labor: a meta-analysis (Structured abstract). Database of Abstracts of Reviews of Effects 2009;(4).Study is a structured abstract from a systematic review that has been excluded579
581Pittrof R. The effects of hospitalization for rest on fetal growth, neonatal morbidity and length of gestation in twin pregnancy. British Journal of Obstetrics and Gynaecology 1991; 98:(4)416–7.Letter to the editor
582Progesterone does not appear to prevent twin preterm birth. Contemporary Ob/Gyn 2009; 54:(7)16.Short report of study that has already been included
583Dudenhausen JW. Tocolysis in the management of multiple pregnancy. BJOG: an International Journal of Obstetrics and Gynaecology 2003; 110:(SUPPL.;#20)107.Brief narrative review
493Sullivan SA and Newman R. Prediction and prevention of preterm delivery in multiple gestations. Clinical Obstetrics & Gynecology 2004; 47:(1)203–15.Narrative review
584Lim AC, Bloemenkamp KW, Boer K et al. Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial. BMC Pregnancy and Childbirth 2007; 7:7.Protocol of a planned randomised trial only
585Moutquin JM, Sherman D, Cohen H et al. Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety study. American Journal of Obstetrics and Gynecology 2000; 182:(5)1191–9.Study included women in labour
586Scott-Findlay S. Days of waiting. Bedrest with a twin pregnancy. AWHONN Lifelines 2004; 8:(5)480–9.Study describes a single patient’s experience
587Endl J and Baumgarten K. Results of oral prophylactic longterm tocolysis and cerclage in management of twin pregnancies (Multicenter study). Zeitschrift fur Geburtshilfe und Perinatologie 1982; Vol.186, pp.319–325, 1982.:-325.Study is not reported in the English language
588Doyle LW. Antenatal progesterone to prevent preterm birth. The Lancet 2009; 373:(9680)–2002.Study did not report results specifically for twin and/or triplet pregnancies
589Swaby C. Pilot randomized controlled trial of vaginal progesterone to prevent preterm birth in multiple pregnancy. JOGC: Journal of Obstetrics and Gynaecology Canada 2007; 29:(6 Suppl 1)S47, 2007.Study is an update on an ongoing pilot trial
590Sureau C and Breart G. The prevention of premature birth. Annales Nestle 1989; 47:(2)89–96.Study is a narrative review of women in labour
591Progesterone treatment does not reduce early preterm birth in twin pregnancy. Nurse Prescribing 2009; 7:(7)330–1.Brief report of study that has already been included
592Crowther CA. Prevention of preterm birth in multiple pregnancy. Baillieres Clinical Obstetrics and Gynaecology 1998; 12:(1)67–75.Study included women in labour
593Gummerus M and Halonen O. [The value of bed rest and beta-sympathomimetic treatment in multiple pregnancies]. Duodecim; laaketieteellinen aikakauskirja 1985; 101:(20)1966–71.Study is not in English language
594You be the judge. Should steroids, tocolytics have been given to stop premature birth of twins? Ob-Gyn Malpractice Prevention 1999; 6:(8)61.Case report
595Tita ATN and Rouse DJ. Progesterone for preterm birth prevention: an evolving intervention. American Journal of Obstetrics and Gynecology 2009; #200:(3)219–24.Study included women in labour
596Dodd JM, Flenady VJ, Cincotta R et al. Progesterone for the prevention of preterm birth: A systematic review. Obstetrics and Gynecology 2008; 112:(1)127–34.Study included women in labour
597Dodd JM, Flenady V, Cincotta R et al. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database of Systematic Reviews 2009;(4).Study included women in labour
598Pincus R. Salbutamol infusion for premature labour--the Australian trials experience. Australian and New Zealand Journal of Obstetrics and Gynaecology 1981; 21:(1)1–4.Study included women in labour
599Cetrulo CL and Freeman RK. Ritodrine HCL for the prevention of premature labor in twin pregnancies. Acta Geneticae Medicae et Gemellologiae 1976; 25:321–4.Brief report on an ongoing trial
600Cetrulo CL and Freeman RK. Ritodrine HCL for the prevention of premature labor in twin pregnancies. Acta Geneticae Medicae et Gemellologiae 1976; 25:321–4.Study included women who had had an episode of preterm labour
601Crowther CA. Selected Cochrane systematic reviews. Bed rest in hospital for multiple pregnancy. Birth: Issues in Perinatal Care 1999; 26:(3)201–2.Summary of a Cochrane review by the same author which is already included for this question
602Maloni JA, Margevicius SP, and Damato EG. Multiple gestation: side effects of antepartum bed rest. Biological Research for Nursing 2006; 8:(2)115–28.Study did not include a control group
472Hartikainen-Sorri AL. Is routine hospitalization in twin pregnancy necessary? A follow-up study. Acta Geneticae Medicae et Gemellologiae 1985; 34:(3–4)189–92.Study did not include a control group
603Dodd JM and Crowther CA. Hospitalisation for bed rest for women with a triplet pregnancy: an abandoned randomised controlled trial and metal-analysis. BMC Pregnancy and Childbirth 2005; 5:(1)8, 2005.Report of an abandoned trial that failed to recruit participants (recruited only seven participants in seven years, 1996–2003)
604Jorgensen AL, Alfirevic Z, Tudur S et al. Cervical stitch (cerclage) for preventing pregnancy loss: Individual patient data meta-analysis. BJOG: an International Journal of Obstetrics and Gynaecology 2007; 114:(12)1460–76.Study population consisted of women with cervical incompetence
605Odibo AO, Elkousy M, Ural SH et al. Prevention of preterm birth by cervical cerclage compared with expectant management: A systematic review. Obstetrical and Gynecological Survey 2003; 58:(2)130–6.Study population consisted of women with cervical incompetence
606Vergani P, Ghidini A, Bozzo G et al. Prenatal management of twin gestation. Experience with a new protocol. Journal of Reproductive Medicine 1991; 36:(9)667–71.Study evaluated a protocol for twin pregnancies in which women (with twin pregnancies) were referred to special twin clinic and which stressed the importance of early recognition of uterine contractile activity and work leave from 28 weeks’ gestation
607Allbert JR, Wise CA, Lou CH et al. Subcutaneous tocolytic infusion therapy for patients at very high risk for preterm birth. Journal of Perinatology 1992; 12:(1)28–31.Study addresses the review question but sufficient evidence was available from a higher quality study608
609O'Leary JA. Prophylactic tocolysis of twins. American Journal of Obstetrics and Gynecology 1986; 154:(4)904–5.Study addresses the review question but sufficient evidence was available from a higher quality study608
610Raja RL. Prevention of preterm delivery in twins. A neurohormonal approach. Progress in Clinical and Biological Research 1978; 24 Pt C:117–21.Study addresses the review question but sufficient evidence was available from a higher quality study608
611Tambyraja RL, Atputharajah V, and Salmon Y. Prevention of prematurity in twins. Australian and New Zealand Journal of Obstetrics and Gynaecology 1978; 18:(3)179–81.Study addresses the review question but sufficient evidence was available from a higher quality study608
612Nakamura Y, Sada I, Tomiura K et al. Management of twin pregnancy--for the prevention of preterm delivery. Nippon Sanka Fujinka Gakkai Zasshi - Acta Obstetrica et Gynaecologica Japonica 1983; 35:(3)335–8.Study addresses the review question but sufficient evidence was available from a higher quality study613
614Jeffrey RL, Bowes WA, Jr., and Delaney JJ. Role of bed rest in twin gestation. Obstetrics and Gynecology 1974; 43:(6)822–6.Study addresses the review question but sufficient evidence was available from a higher quality study613
615DUNN B. Bed rest in twin pregnancy. Journal of Obstetrics and Gynaecology of the British Empire 1961; 68:685–7.Study addresses the review question but sufficient evidence was available from a higher quality study613
616JONAS EG. The value of prenatal bed-rest in multiple pregnany. Journal of Obstetrics and Gynaecology of the British Empire 1963; 70:461–4.Study addresses the review question but sufficient evidence was available from a higher quality study613
617Komaromy B and Lampe L. The value of bed rest in twin pregnancies. International Journal of Gynaecology and Obstetrics 1977; 15:(3)262–6.Study addresses the review question but sufficient evidence was available from a higher quality study613
618Pulkkinen MO and Gronroos M. Bed rest did not prevent prematurity in twins because the etiology lies in the stretch and poor progesteronegenesis. Acta Obstetricia et Gynecologica Scandinavica 1979; 58:(6)569–70.Study addresses the review question but sufficient evidence was available from a higher quality study613
619Laursen B. Twin pregnancy. The value of prophylactic rest in bed and the risk involved. Acta Obstetricia et Gynecologica Scandinavica 1973; 52:(4)367–71.Study addresses the review question but sufficient evidence was available from a higher quality study613
620van der Pol JG, Bleker OP, and Treffers PE. Clinical bedrest in twin pregnancies. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1982; 14:(2)75–80.Study addresses the review question but sufficient evidence was available from a higher quality study613
476Skrablin S, Kuvacic I, Jukic P et al. Hospitalization vs. outpatient care in the management of triplet gestations. International Journal of Gynaecology and Obstetrics 2002; 77:(3)223–9.Study addresses the review question but sufficient evidence was available from a higher quality study613
621Eskandar M, Shafiq H, Almushait MA et al. Cervical cerclage for prevention of preterm birth in women with twin pregnancy. International Journal of Gynaecology and Obstetrics 2007; 99:(2)110–2.Study addresses the review question but sufficient evidence was available from a higher quality study622
623Weekes AR, MENZIES DN, and de Boer CH. The relative efficacy of bed rest, cervical suture, and no treatment in the management of twin pregnancy. British Journal of Obstetrics and Gynaecology 1977; 84:(3)161–4.Study addresses the review question but sufficient evidence was available from a higher quality studies613, 622
624Marivate M, de Villiers KQ, and Fairbrother P. Effect of prophylactic outpatient administration of fenoterol on the time of onset of spontaneous labor and fetal growth rate in twin pregnancy. American Journal of Obstetrics and Gynecology 1977; 128:(7)707–8.Study is already included through inclusion of a Cochrane review608
625Skjaerris J and Aberg A. Prevention of prematurity in twin pregnancy by orally administered terbutaline. Acta Obstetricia et Gynecologica Scandinavica - Supplement 1982; 108:39–40.Study is already included through inclusion of a Cochrane review608
626O'Connor MC, Murphy H, and Dalrymple IJ. Double blind trial of ritodrine and placebo in twin pregnancy. British Journal of Obstetrics and Gynaecology 1979; 86:(9)706–9.Study is already included through inclusion of a Cochrane review608
627Ashworth MF, Spooner SF, Verkuyl DA et al. Failure to prevent preterm labour and delivery in twin pregnancy using prophylactic oral salbutamol. British Journal of Obstetrics and Gynaecology 1990; 97:(10)878–82.Study is already included through inclusion of a Cochrane review608
628Crowther CA, Verkuyl DA, Ashworth MF et al. The effects of hospitalization for bed rest on duration of gestation, fetal growth and neonatal morbidity in triplet pregnancy. Acta Geneticae Medicae et Gemellologiae 1991; 40:(1)63–8.Study is already included through inclusion of a Cochrane review613
629Crowther CA, Neilson JP, Verkuyl DA et al. Preterm labour in twin pregnancies: can it be prevented by hospital admission? British Journal of Obstetrics and Gynaecology 1989; 96:(7)850–3.Study is already included through inclusion of a Cochrane review613
471Hartikainen-Sorri AL and Jouppila P. Is routine hospitalization needed in antenatal care of twin pregnancy? Journal of Perinatal Medicine 1984; 12:(1)31–4.Study is already included through inclusion of a Cochrane review613
630Saunders MC, Dick JS, Brown IM et al. The effects of hospital admission for bed rest on the duration of twin pregnancy: a randomised trial. Lancet 1985; 2:(8459)793–5.Study is already included through inclusion of a Cochrane review613
631Cerclage in multiple gestations with short cervix. ACOG Clinical Review 2006; 11:(2)2.Article not obtainable from the British Library
632Sciscione, AC. Maternal activity restriction and the prevention of preterm birth American Journal of Obstetrics and Gynecology 2010 202 (3) p232–235Narrative review
633Norman JE, MacKenzie F, Owen P et al. Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis. Obstetrical and Gynaecological Survey p646–648Editorial
634Buchanan SL. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database of Systematic Reviews 2010 (3)Does not report the number of twin and triplet pregnancies included (if any). No subgroup analysis for twin and triplet pregnancies
635Berghella V, Baxter JK and Hendrix NW. Cervical assessment by ultrasound for preventing preterm delivery. Obstetrics and Gynaecology vol 114 (5) 2009 p1140–1141An abstract of a Cochrane Review that is not a prevention method outlined in the protocol
636Cochrane Database of Systematic Reviews
2009 (1)
Cervical assessment by ultrasound for preventing preterm delivery
Berghella, Vincenzo
Cochrane review, with only one included study reporting data on multiple pregnancies. Prevention method is cervical assessment which was not specified as a relevant intervention in the review protocol

From: Appendix G, Excluded studies

Cover of Multiple Pregnancy
Multiple Pregnancy: The Management of Twin and Triplet Pregnancies in the Antenatal Period.
NICE Clinical Guidelines, No. 129.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2011 Sep.
Copyright © 2011, National Collaborating Centre for Women’s and Children’s Health.

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