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

J Obstet Gynaecol Can. 2021 Jul;43(7):831-838. doi: 10.1016/j.jogc.2020.10.015. Epub 2020 Nov 20.


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.

Keywords: cervical cerclage; gestational weight gain; multiple pregnancy; progesterone; twin pregnancy.

MeSH terms

  • Canada
  • Cerclage, Cervical*
  • Cervix Uteri
  • Cross-Sectional Studies
  • Female
  • Humans
  • Infant, Newborn
  • Perinatology
  • Pregnancy
  • Pregnancy, Twin
  • Premature Birth* / prevention & control
  • Specialization