New research published recently in Ultrasound in Obstetrics & Gynecology finds that vaginal progesterone, long prescribed to women with singleton pregnancies at risk for preterm labor, is useful for reducing the risk of preterm labor in women with twins, triplets, etc, in addition to cerclage.

What does this mean for mothers of multiples?

Research has shown that women with multiple gestations are at higher risk of preterm birth because of a combination of factors. The simplest explanation is that the increased weight of multiple gestations places pressure on the cervix, which can then prematurely open and cause preterm premature rupture of membranes (PPROM), which necessitates delivery. This new research offers the potential for an intervention to reduce the risk of prematurity-related disability and other negative health outcomes.

Vaginal Progesterone in the 2nd Trimester Reduces Health Risks to the Baby

This research finds that vaginal progesterone is effective in reducing the risk of preterm birth occurring between 30-35 weeks in women with twins and with a short cervix (as determined by ultrasound testing). It also decreased the risk of neonatal mortality (death) and some measures of morbidity (poor health outcomes), without any negative effects on childhood development. These outcomes included:

• Risk of neonatal or perinatal death
• Respiratory Distress Syndrome (RDS)
• Birth weight <1500g
• The need for mechanical ventilation

Overall, vaginal progesterone reduces the risk of preterm birth <33 weeks by 31%, and reduces the risk of neonatal death by 47%.

Currently, there are three more trials underway testing the impact of vaginal progesterone in women with short cervix and twin gestations (NCT02697331, NCT02518594, and NCT02329535). These findings are promising in finding methods of reducing the risk of preterm birth and associated risks of prematurity-related disability.

This finding is particularly noteworthy because of the way the analysis was carried out. This study, conducted as a meta-analysis of individual patient data, is considered the ‘gold standard’ in the hierarchy of scientific evidence when it comes to answering clinical questions. This paper provides strong evidence for the use of progesterone in twin pregnancies with short cervix. If adopted into clinical practice, it would be the first intervention considered effective in preventing preterm birth in mothers carrying twins.

References

• Romero, R., Conde-Agudelo, A., El-Refaie, W., Rode, L., Brizot, M. L., Cetingoz, E., Serra, V., Da Fonseca, E., Abdelhafez, M. S., Tabor, A., Perales, A., Hassan, S. S. and Nicolaides, K. H. (2017), Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol, 49: 303–314. doi:10.1002/uog.17397 (http://onlinelibrary.wiley.com/doi/10.1002/uog.17397/abstract)
• In the news: http://www.news-medical.net/news/20170307/Vaginal-progesterone-decreases-preterm-birth-infant-mortality-in-twin-gestations-with-short-cervix.aspx

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