- What can we change in the prevention of preterm birth in women with multiple pregnancies?
What can we change in the prevention of preterm birth in women with multiple pregnancies?
PERINATOLOGY AND PEDIATRIC. UKRAINE. 2018.4(76):49-53; doi 10.15574/PP.2018.76.49
Bulavenko О. V., Vozniuk A. V., Kostyuchenko А. V., Tytarenko N. V., Balabueva S. V., Mykhalchuk M. A., Prolygina O. V., Lovkina O. L.
National Pirogov Memorial Medical University, Vinnytsya
Purpose — to determine the clinical efficacy of the preventive combination of obstetric pessary with a vaginal form of micronized progesterone in women with multiple pregnancies with a cervical length <25 mm in comparison to other preventive methods of spontaneous preterm labor in women of this category.
Patients and methods. A prospective study was conducted with 219 women having a twin pregnancy and a sonographically short cervix <25 mm. Strategy of awaiting was used in the 1st group (control), (n=36). The obstetrical pessary in combination with a vaginal form of micronized progesterone was applied in the 2nd group (n=65). The 3rd group obtained vaginal progesterone (n=49) and the 4th group received a pessary (n=69).
Results. Women with twin pregnancy and an asymptomatic short cervix <25 mm, who used only pessary had a prolongation of pregnancy by 14.86±4.2 weeks. Additional progesterone prescription to the pessary prolongated pregnancy by 14.91±5.09 weeks, whereas single progesterone prescription postponed the pregnancy only by 13.18±4.04 weeks (p=0.011). The use of progesterone was associated with a decrease of the absolute risk of birth of children with a low body weight (<2500 g) and a decrease of frequencies of neonatal complications (p<0,05). Comparing to a strategy of awaiting, the use of a combination of pessary and progesterone contributed to a reduction in the proportion of spontaneous preterm birth up to 34 weeks by 22.4%, the birth of children with a critically small body weight (<1500 g) by 12%, respiratory failure syndrome by 14.1%.
Conclusions. Based on the possible summation of the positive effects of each intervention, the use of a combination of pessary with vaginal progesterone is a more effective option to prevent spontaneous pretem births in women with a twin pregnancy and an asymptomatic short cervix <25 mm.
Key words: twin pregnancies, short cervix, preterm birth, pessary, progesterone.
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Article received: Jul 20, 2018. Accepted for publication: Nov 28, 2018.