Spontaneous Preterm Birth in Multiples

Biggio, Joseph R.; Anderson, Steven J.

doi:10.1097/grf.0000000000000120

Cited by 17 publications

(20 citation statements)

References 73 publications

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“…A proposed hypothesis regarding the disparate results between twin and singleton pregnancies is that there are differing etiologies of PTB in twins or multiples, such as uterine distention, contractions, or preterm labor. 56 Several of the putative etiologies for PTB in multiples may lead to cervical change that is distinct from structural cervical insufficiency, so it stands to reason that interventions that were developed around prevention of cervical insufficiency may have limited impact on PTB prevention in multiple gestations. In addition, the available evidence for management of multiple gestations with short cervical length is limited by analysis of relatively unselected populations and the data on high-risk patients are from secondary analyses.…”

Section: Special Cases: Multiple Pregnancymentioning

confidence: 99%

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Management of Short Cervix during Pregnancy: A Review

Gilner

Biggio

2016

Amer J Perinatol

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Sonographic evaluation of the uterine cervix has evolved as one of the best clinical tools available for the prediction of subsequent spontaneous preterm birth (PTB), particularly when combined with prior poor obstetric history. There is a growing body of evidence describing interventions for short cervix that reduce the risk of preterm delivery and improve neonatal outcomes. Yet, given the significant heterogeneity in the pathways that lead to PTB, understanding the specific clinical characteristics of women who may benefit from a given intervention is critical to appropriate implementation. The three primary management strategies that have demonstrated improvement in obstetric and/or perinatal outcomes for appropriately selected women with a sonographically short cervix (vaginal progesterone, cervical cerclage, and pessary) are the subject of this review. In addition, the unique considerations of multiple pregnancies are discussed separately from singletons.

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Section: Special Cases: Multiple Pregnancymentioning

confidence: 99%

“…The twin groups within these study populations were small, but the results draw attention to a potential twin gestation patient who may benefit from administration of vaginal progesterone. 56…”

Section: Progesterone-multiple Gestationsmentioning

confidence: 99%

Management of Short Cervix during Pregnancy: A Review

Gilner

Biggio

2016

Amer J Perinatol

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“…6,7 Sadly, there are no interventions that have been conclusively proven to reduce the rate of preterm birth (PTB) or improve neonatal outcomes for multiple gestations. 8 In 1990, the Institute of Medicine (IOM) developed guidelines for maternal weight gain in pregnancy. These guidelines provided specific goals for women in separate body mass index (BMI) categories for singletons, but advised women pregnant with twins to gain 35 to 45 lbs regardless of their prepregnancy BMI.…”

mentioning

confidence: 99%

Achievement of Body Mass Index Specific Weight Gain Recommendations: Impact on Preterm Birth in Twin Pregnancies

et al. 2017

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Objective To determine whether achievement of body mass index specific weight gain recommendations is associated with reduced preterm birth or neonatal morbidity among twin gestations. Study Design This was a retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 2000 to 2010. In total, 588 women in all prepregnancy body mass index categories who delivered ≥24 weeks' gestation were included. Women were grouped as achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups. Results Body mass index specific weight gain goals were achieved by 59.9% of women. The achieved group had a 1.5-fold reduction in the rate of preterm birth <32 weeks (18.8 vs. 30.5%; p = 0.001). Achievers had larger mean birthweights (2,146 ± 584 g vs. 1,859 ± 593 g; p < 0.001) and were significantly less likely to deliver either twin with a birthweight less than the 10th percentile for gestational age (larger twin 0.6 vs. 4.7%, p = 0.001; smaller twin 12.2 vs. 21.6%, p = 0.002). Composite neonatal morbidity, days on the respirator, length of hospital stay, and rate of neonatal intensive care unit admission were significantly decreased in the achieved group. Conclusion Achievement of body mass index specific weight gain goals improves preterm birth rates, neonatal birthweights, and composite neonatal outcomes in women carrying twins.

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“…Hence, twin pregnancies which are 'stretched' to a greater extent at an equivalent time point in gestation compared to singleton pregnancies, are associated with an increased risk of preterm labour and delivery [46]. Undoubtedly, duration of pregnancy is shorter with increasing numbers of fetuses [47]. A recent large Swedish retrospective cohort study also supports uterine distention playing a causal role in determining the Table 6.…”

Section: Discussionmentioning

confidence: 97%

Comparison of the myometrial transcriptome from singleton and twin pregnancies by RNA-Seq

2020

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Preterm birth is recognized as the primary cause of infant mortality worldwide. Twin pregnancies are significantly more at risk of preterm birth than singleton pregnancies. A greater understanding of why this is and better modes of treatment and prevention are needed. Key to this is determining the differing pathophysiological mechanisms of preterm birth in twins, including the role of the myometrium and premature uterine contraction.We performed RNA sequencing (RNA-Seq) of human myometrium from singleton and twin pregnancies at term (> 37 +0 weeks) and preterm (< 37 +0 weeks), collected during prelabour Caesarean Section. RNA-Seq libraries were prepared from polyA-selected RNA and sequenced on the Illumina HiSeq 4000 platform. Differentially expressed genes (DEGs), GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichment were conducted using R software. Significance was determined with a false discovery rate-adjusted P value of <0.05. Only 3 DEGs were identified between gestational age-matched singleton and twin myometrium and only 1 DEG identified between singleton term and twin preterm tissues. Comparison of singleton preterm myometrium with twin term myometrium however, revealed 75 down-regulated and 24 up-regulated genes in twin myometrium. This included genes associated with inflammation and immune response, T cell maturation and differentiation and steroid biosynthesis. GO and KEGG enrichment analyses for biologically relevant processes and functions also revealed several terms related to inflammation and immune response, as well as cytokine-cytokine receptor interaction and chemokine receptor signalling. Data indicate that little or no differences exist in the transcriptome of singleton and twin myometrium when matched for gestational age. The significant up-and down-regulation of genes identified between preterm singleton and twin myometrium at term may point to transcriptome changes associated with the chronic levels of uterine stretch in twin pregnancy or genes associated with the myometrium transitioning to labour onset.

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Spontaneous Preterm Birth in Multiples

Cited by 17 publications

References 73 publications

Management of Short Cervix during Pregnancy: A Review

Management of Short Cervix during Pregnancy: A Review

Achievement of Body Mass Index Specific Weight Gain Recommendations: Impact on Preterm Birth in Twin Pregnancies

Comparison of the myometrial transcriptome from singleton and twin pregnancies by RNA-Seq

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