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BJOG. 2017 Jul;124(8):1163-1173. doi: 10.1111/1471-0528.14513. Epub 2017 Feb 8.

Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis.

Author information

1
Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
2
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
3
Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
4
Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan.
5
Department of Obstetrics and Gynecology, University of Adelaide, Adelaide, Australia.
6
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
7
The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada.
8
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
9
Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
10
The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
11
Canadian Premature Babies Foundation, Sherwood Park, AB, Canada.
12
Maternal Fetal Medicine Clinic, Windsor Regional Hospital, Windsor, ON, Canada.
13
Division of Obstetrics and Gynecology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
14
Midwifery Education Program, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND:

About half of twin pregnancies deliver preterm, and it is unclear whether any intervention reduces this risk.

OBJECTIVES:

To assess the evidence for the effectiveness of progesterone, cerclage, and pessary in twin pregnancies.

SEARCH STRATEGY:

We searched Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ISI Web of Science, without language restrictions, up to 25 January 2016.

SELECTION CRITERIA:

Randomised controlled trials of progesterone, cerclage, or pessary for preventing preterm birth in women with twin pregnancies, without symptoms of threatened preterm labour.

DATA COLLECTION AND ANALYSIS:

Two independent reviewers extracted data using a piloted form. Study quality was appraised with the Cochrane Risk of Bias tool. We performed pairwise inverse variance random-effects meta-analyses.

MAIN RESULTS:

We included 23 trials (all but three were considered to have a low risk of bias) comprising 6626 women with twin pregnancies. None of the interventions significantly reduced the risk of preterm birth overall at <34 or <37 weeks of gestation, or neonatal death, our primary outcomes, compared to a control group. In women receiving vaginal progesterone, the relative risk (RR) of preterm birth <34 weeks of gestation was 0.82 (95% CI 0.64-1.05, seven studies, I2  36%), with a significant reduction in some key secondary outcomes, including very low birthweight (<1500 g, RR 0.71, 95% CI 0.52-0.98, four studies, I2  46%) and mechanical ventilation (RR 0.61, 95% CI 0.45-0.82, four studies, I2  22%).

CONCLUSION:

In twin gestations, although no overarching intervention was beneficial for the prevention of preterm birth and its sequelae, vaginal progesterone improved some important secondary outcomes.

TWEETABLE ABSTRACT:

Vaginal progesterone may be beneficial in twin pregnancies, but not 17-OHPC, cerclage, or pessary.

KEYWORDS:

Cerclage; pessary; preterm birth; progesterone; randomised controlled trials; twin

PMID:
28176485
DOI:
10.1111/1471-0528.14513
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