Preterm Birth in Twins

Multiple pregnancy differs from singleton pregnancy in several aspects, including increased risk of preeclampsia, fetal malformation, maternal morbidity, and mortality. However, certainly, prematurity is a fundamental concern when twin gestation is approached, due to the frequency of this disease and also to the severity of preterm birth, which unfortunately can also occur near to the fetal viability limit. Labor in twin pregnancy generally occurs before singleton pregnancy. Nevertheless, another factor can contribute to raise even more preterm birth rates in this already high-risk gestation: the short cervix. Although only 1–2% of twin pregnancy present short cervix at transvaginal ultrasound, this association increases the chance of unfavorable outcome for the newborn, frequently causing death of one or both twins. So, many strategies were proposed to minimize this catastrophic situation: follow-up of cervical length to prevent preterm birth, pessary use, progesterone, tocolysis to postpone birth in 48 hours to 7 days in order to use corticosteroids in fetal pulmonary maturation, and magnesium sulfate use to neuroprotection

Amniotic fluid "sludge" is an independent risk factor for preterm delivery

Objective: To determine the prevalence and the clinical significance of amniotic fluid sludge (AFS) in asymptomatic patients at low and high risk for spontaneous preterm delivery.Method: A prospective cohort study was conducted on 195 singleton pregnancies at low or high risk for preterm birth (PTB) between the 16th and 26th weeks. Cervical length (CL) <25mm and the presence of AFS were evaluated. The risk for preterm delivery before 28, 32, 35 and 37 weeks were determined according to the presence of AFS, CL<25mm and history of high risk for PTB. Stepwise logistic regression was performed to compare variables.Results: AFS was an independent risk factor for PTB<35 weeks (OR: 3.08, 95% CI: 1.13-8.34, p=0.027) but not for PTB<28, 32 and 37 weeks. CL<25mm was an independent risk factor for PTB<28, 32 and 35 but not for PTB<37 weeks. High risk for PTB was not found as an independent risk factor for PTB.Conclusion: AFS is an independent risk factor for PTB before 35 weeks.Department of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , BrazilDepartment of Obstetrics , Paulista School of Medicine, Federal University of Sao Paulo (EPM-UNIFESP) , São Paulo , Brazil.Web of Scienc