Prevention and treatment of prematurity in twin gestation.

Abstract

Early prenatal diagnosis, intensive prenatal care, bed rest, cerclage, and preventive in-patient management are discussed. The authors present the management and outcome of 83 twin pregnancies in a 5-year retrospective study. The frequency of twin pregnancy wa 1.08%, the mean gestational age at the time of delivery was 37.5 weeks. Mean birth weight of the first fetus was 2453 grams, second 2406 grams. The incidence of preterm deliveries was 31.3% and perinatal mortality of twins came up to 54.2%. The early prenatal diagnosis of a twin pregnancy is the most important step in prenatal management. The centralization of prenatal care in the out-patient department designated for "high risk pregnancies" is recommended. Ultrasound scanning is recommended as a screening examination. Bed rest before the 25th gestational week is recommended on an individual basis though it is recommended in all cases after the 25th gestational week. Cerclage was indicated in 28.9% cases with unfavourable cervical findings. The mean gestational age of 38 weeks and the birth weight of 2659 grams found in the group who had in-patient management should be compared with 35.8 weeks and 2120.0 grams in the group managed on an out-patient basis. Perinatal mortality before 32nd week--300/1000, between 33-37th week--62.5/1000, and after 37th week--8.7/1000. The authors recommend in-patient management before the 32nd week of pregnancy in twins.