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Decreasing Prematurity in Twin Gestations: Predicaments and Possibilities

Zork, Noelia MD; Biggio, Joseph MD; Tita, Alan MD, PhD; Rouse, Dwight MD, MSPH; Gyamfi-Bannerman, Cynthia MD

doi: 10.1097/AOG.0b013e31829b2dba
Current Commentary

The twin birth rate has been steadily increasing in the United States over the past 10 years attributable in large part to the increased use of reproductive technologies. Despite advancements in the prevention of preterm labor for singletons, the overall rate of preterm birth has decreased only minimally. Several interventions to prevent preterm birth in twins have been studied, but none has proven effective. Inpatient bedrest has not been shown to be effective and can cause significant maternal morbidity. Although intramuscular 17α-hydroxyprogesterone caproate is effective in decreasing the risk of recurrent preterm delivery in singletons, neither it nor cerclage is effective in twin gestations, even in those with a short cervix. However, small trials, subgroup analyses, and a meta-analysis suggest that vaginal progesterone and the Arabin cervical pessary may reduce rates of preterm birth in twins of mothers with a short cervix. Given the current lack of effective therapies to prevent preterm birth in twins, large multicenter trials are needed to assess the effectiveness of vaginal progesterone and pessary in twins of mothers with a short cervix.

Because there are no effective interventions to prevent prematurity in twin gestations, more research is needed urgently.

Department of Obstetrics and Gynecology, division of Maternal-Fetal Medicine, Columbia University, New York, New York; the University of Alabama at Birmingham, Birmingham, Alabama; and Brown University, Providence, Rhode Island.

Corresponding author: Noelia Zork, MD, Columbia University Medical Center, 622 W. 168th Street, PH16-66, New York, NY 10032; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

Dr. Rouse, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.