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Current Practice of Maternal–Fetal Medicine Specialists Regarding the Prevention and Management of Preterm Birth in Twin Gestations

Published:November 20, 2020DOI:https://doi.org/10.1016/j.jogc.2020.10.015

      Abstract

      Objective

      To investigate the current practices of maternal–fetal medicine (MFM) specialists regarding the prevention and management of preterm birth (PTB) in twin pregnancies.

      Methods

      This was a cross-sectional study of Canadian MFM specialists. Participants responded to an anonymous survey regarding the prevention and management of PTB in twins, including lifestyle and gestational weight gain recommendations, cervical length screening, PTB prevention, and labour and delivery practices.

      Results

      Of 137 MFM specialists surveyed, 95 (69%) responded. Most MFM specialists recommend against activity restriction (77.9%), avoidance of sexual activity (96.7%), routine progesterone (97.8%), routine prophylactic cerclage (98.9%), and routine administration of antenatal corticosteroids (95.6%). There were considerable inconsistencies with respect to gestational weight gain management. Despite lack of support by guidelines, most MFM specialists reported using routine cervical length screening (97.8%) and progesterone for short cervix (92.3%). Over half (52.7%) of MFM specialists recommend cervical cerclage when the cervix is <15mm. In cases of PTB, most MFM specialists recommend vaginal delivery when twins are in vertex presentation (63%–75%). MFM specialists are less likely to recommend vaginal delivery when twin B is non-vertex (35%–41%).

      Conclusion

      There is a considerable variation among MFM specialists regarding the prevention and management of PTB in twins, and the practice of many MFM specialists differs from that recommended by professional societies’ guidelines. These findings underscore the necessity for high-quality studies and up-to-date recommendations.

      Résumé

      OBJECTIF

      Étudier les pratiques actuelles des spécialistes en médecine fœto-maternelle en matière de prévention et de prise en charge de l'accouchement prématuré en contexte de grossesse gémellaire.

      MÉTHODOLOGIE

      Il s'agit d'une étude transversale menée auprès de spécialistes canadiens en médecine fœto-maternelle. Les participants ont répondu à un sondage anonyme sur les méthodes de prévention et de prise en charge de l'accouchement avant terme en contexte de grossesse gémellaire, notamment les recommandations relatives au mode de vie et au gain de poids gestationnel, le dépistage du col court, la prévention de l'accouchement prématuré et les pratiques d'accouchement.

      RÉSULTATS

      Sur les 137 spécialistes de médecine fœto-maternelle interrogés, 95 (69 %) ont répondu. La plupart des spécialistes de médecine fœto-maternelle ne recommandent pas la restriction des activités (77,9 %) et l’évitement de l'activité sexuelle (96,7 %), l'administration systématique de progestérone (97,8 %), le cerclage prophylactique systématique (98,9 %) et la corticothérapie prénatale systématique (95,6 %). Des incohérences considérables ont été observées en ce qui concerne la gestion du gain de poids gestationnel. Malgré le manque de soutien par des directives cliniques, la plupart des spécialistes en médecine fœto-maternelle ont déclaré recourir au dépistage systématique du col court (97,8 %) et à l'administration de progestérone en cas de col court (92,3 %). Plus de la moitié (52,7 %) des spécialistes en médecine fœto-maternelle recommandent un cerclage cervical lorsque le col mesure < 15 mm. En cas d'accouchement prématuré, la plupart des spécialistes de médecine fœto-maternelle recommandent l'accouchement par voie vaginale lorsque les jumeaux sont en présentation du sommet (63–75 %). Les spécialistes en médecine fœto-maternelle sont moins susceptibles de recommander un accouchement par voie vaginale lorsque le jumeau B n'est pas en position du sommet (35–41 %).

      CONCLUSION

      On observe une variation considérable chez les spécialistes en médecine fœto-maternelle en matière de prévention et de prise en charge de l'accouchement prématuré en contexte de grossesse gémellaire; de même, les pratiques diffèrent des recommandations des directives cliniques des sociétés professionnelles. Ces observations soulignent la nécessité d’études de haute qualité et de recommandations à jour.

      Keywords

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