Prevention of spontaneous preterm birth in asymptomatic twin pregnancies

Objectives. - To determine prenatal methods to predict and prevent spontaneous preterm birth in asymptomatic twin pregnancies. Methods. - Articles were searched using PubMed, Embase and Cochrane library. Results - Uterine activity monitoring and bacterial vaginosis screening are not useful to predict preterm birth (EL2 and ED respectively). Current literature data are contradictory and insufficient to determine whether fetal fibronectin and digital cervical assessment are predictors of preterm birth. History of preterm birth (EL4), and cervical length measurement by transvaginal ultrasonography (EL2) predict preterm birth. Nevertheless, there are no intervention studies that have evaluated cervical length measurement in the prevention of preterm birth. Hospital bedrest, prophylactic tocolytic and progesterone therapy, and prophylactic cervical cerclage in patients with or without short cervix have not been shown to be effective in preventing preterm birth. Conclusions. - Prenatal methods to prevent spontaneous preterm birth in asymptomatic twin pregnancies are currently very limited. (C) 2009 Elsevier Masson SAS. All rights reserved.