This study by Jarde et al. (BJOG, 2017) aimed to determine if treating with progesterone, pessary, or cerclage was effective in preventing preterm birth in twin pregnancies.
Systematic Review and Meta-Analysis
23 trials including 6,626 women were reviewed. Risk of preterm birth (<34 or <37 weeks’ gestation) and neonatal death were not reduced in any of the treatment or intervention approaches. The authors also addressed secondary outcomes such as very low birthweight (< 1500 g) and mechanical ventilation and in both cases, there was a significant reduction when vaginal progesterone (not 17-OHPC) was administered. In an accompanying mini-commentary, Dr. JR Biggio Jr. suggests risk stratification, such as shortened cervix, rather than routine application of interventions “is paramount”.
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