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

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.

• Authors: A Jarde, O Lutsiv, C K Park, J Barrett, J Beyene, S Saito, J M Dodd, P S Shah, J L Cook, A B Biringer, L Giglia, Z Han, K Staub, W Mundle, C Vera, L Sabatino, S K Liyanage, S D McDonald
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 124 Issue 8 Pg. 1163-1173 (Jul 2017) ISSN: 1471-0528 [Electronic] England
• PMID: 28176485 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2017 Royal College of Obstetricians and Gynaecologists.

Chemical References

• Progestins
• Progesterone

Topics

• Administration, Intravaginal
• Cerclage, Cervical (statistics & numerical data)
• Female
• Gestational Age
• Humans
• Pessaries (statistics & numerical data)
• Pregnancy
• Pregnancy, Twin
• Premature Birth (epidemiology, prevention & control)
• Progesterone (administration & dosage)
• Progestins (administration & dosage)
• Randomized Controlled Trials as Topic
• Risk Factors
• Treatment Outcome