Current practices in the prediction and prevention of preterm birth in twin pregnancies

Abstract

<h3>Objectives</h3> Preterm birth (PTB) remains the leading cause of neonatal morbidity and mortality and is more common in twin pregnancies. We aimed to explore the current practice of maternal–fetal medicine specialists (MFMs) and Obstetricians (OBs) across Canada regarding prevention of PTB in twin pregnancies. <h3>Methods</h3> An anonymous online survey was sent to MFMs and Obstetricians across Canada (n=90), that focused on their practice regarding the prediction and prevention of PTB in twin gestations. The following interventions were addressed: bed rest, screening with cervical length (CL) measurement, progesterone, cerclage, pessary and corticosteroids use. Data were stratified by MFM vs. Non-MFM OBs. <h3>Results</h3> Overall, 71 (78.8%) participated in the survey, of them 48 (67.6%) were MFMs. Most care providers did not routinely recommend activity restriction (81.7%), avoidance of sexual activity (88.9%), routine progesterone (95.6%), cerclage (100%), or pessary (98.5%). Screening with cervical length was recommended more often by MFMs compared with OBs (97.9% vs. 81.8%, <i>p</i>=0.015). In the case of short cervix, most (91.5%) recommend progesterone, about half (54.2%) recommended cerclage, and only 2.9% recommended pessary. There was a considerable variation with regard to the CL cutoff below which progesterone and cerclage were recommended. Routine administration of corticosteroids for lung maturation was recommended by 31.8% of OBs as compared to only 4.1% of MFMs (<i>p</i>=0.001). <h3>Conclusions</h3> There is a considerable variation among MFMs and OBs across Canada with regard to screening and prevention of PTB in twin pregnancies. This highlights the need for up-to-date guidelines to optimize and standardize the care of twin gestations in Canada.