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- Title
Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis.
- Authors
Jarde, A; Lutsiv, O; Park, CK; Barrett, J; Beyene, J; Saito, S; Dodd, JM; Shah, PS; Cook, JL; Biringer, AB; Giglia, L; Han, Z; Staub, K; Mundle, W; Vera, C; Sabatino, L; Liyanage, SK; McDonald, SD; Park, C K; Dodd, J M
- Abstract
<bold>Background: </bold>About half of twin pregnancies deliver preterm, and it is unclear whether any intervention reduces this risk.<bold>Objectives: </bold>To assess the evidence for the effectiveness of progesterone, cerclage, and pessary in twin pregnancies.<bold>Search Strategy: </bold>We searched Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ISI Web of Science, without language restrictions, up to 25 January 2016.<bold>Selection Criteria: </bold>Randomised controlled trials of progesterone, cerclage, or pessary for preventing preterm birth in women with twin pregnancies, without symptoms of threatened preterm labour.<bold>Data Collection and Analysis: </bold>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.<bold>Main Results: </bold>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%).<bold>Conclusion: </bold>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.<bold>Tweetable Abstract: </bold>Vaginal progesterone may be beneficial in twin pregnancies, but not 17-OHPC, cerclage, or pessary.
- Subjects
PREMATURE labor prevention; MULTIPLE pregnancy; CERVICAL cerclage; PESSARIES; PROGESTERONE; META-analysis; THERAPEUTICS; GESTATIONAL age; PREMATURE infants; PROGESTATIONAL hormones; VAGINAL medication; SYSTEMATIC reviews; TREATMENT effectiveness; PREVENTION
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2017, Vol 124, Issue 8, p1163
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14513