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