Relative cervical incompetence in twin pregnancy. Assessment and efficacy of cervical suture

Randomized, double-blinded, placebo-controlled trial of amoxicillin/clavulanic acid to prevent preterm delivery in twin gestation

Objective: The objective of this study was to determine whether prophylactic treatment with oral broad-spectrum antimicrobial therapy improves pregnancy outcomes in twin gestations.

Methods: Patients with twin gestations between 24 and 32 weeks were randomized to receive amoxicillin/clavulanic acid or placebo. Those patients randomized before 24 weeks received a 1-week course at 24 and at 28 weeks gestation. Those patients entered later than 24 weeks received a 1-week course either at 28 weeks or at enrollment (up to 32 weeks). Other than antibiotic use, the management of the groups was identical and unchanged from the routine care of twin gestations.

Results: Of 149 twin pregnancies enrolled, 76 were randomized to the drug group and 73 to the placebo group. There was no significant difference in mean gestational age at delivery (35.9 vs. 35.7 weeks), birth weight (2,358 vs. 2,344 g), mean neonatal nursery stay (9.9 vs. 11.7 days), or respiratory distress syndrome (6/76 vs. 4/73) in the drug vs. placebo group, respectively.

Conclusions: The addition of prophylactic oral broad-spectrum antimicrobial therapy to the standard antepartum management of twin gestations had no demonstrable effect on the gestational age at delivery, birth weight, or neonatal complications. There did not appear to be any beneficial effect of the prophylactic use of amoxicillin/clavulanic acid in this clinical setting.

The risks confronting twins: a national perspective

OBJECTIVES

Our objectives were twofold: (1) to report the relative risks and population-attributable risks of twins compared with singletons for several adverse pregnancy outcomes and (2) to describe the association between having been of low or very low birth weight and death in the neonatal, postneonatal, and infant periods for twins compared with singletons.

STUDY DESIGN

We performed population-based analysis of all live births and infant deaths from 1985 to 1986 birth cohorts, as reported in the U.S. Linked Birth/Infant Death Data Sets.

RESULTS

With singletons as the referent group, twins of all races had relative risk for very low birth weight, low birth weight, and neonatal, postneonatal, and infant death of 9.97, 8.61, 7.06, 2.75, and 5.43, respectively. Although twins make up only 2.09% of live births, the population-attributable risks of twins (the proportion of the population's adverse outcome associated with being a twin) for very low birth weight, low birth weight, and neonatal, postneonatal, and infant death was 15.8%, 13.7%, 11.2%, 3.4%, and 8.4%, respectively.

CONCLUSIONS

These population-based data show that although twins are relatively infrequent they account for a disproportionately large share of adverse pregnancy outcomes. Given the relative ease with which twins can be identified early in the course of pregnancy, development and testing of interventions to postpone preterm delivery in twin pregnancy should become a national public health priority.

Multiple pregnancy

Most multiple pregnancies are diagnosed, but early diagnosis still presents some problems. Congenital malformation is commoner in multiple pregnancies, usually without concordance, which complicates decisions about pregnancy termination. Because of the higher perinatal mortality rates, women with multiple pregnancies should be offered extra antenatal care, with the specific objectives of early diagnosis and timely treatment of pre-eclampsia, preterm labour and growth retardation. If growth retardation affects only one fetus, intervention must be carefully judged. Measures such as bedrest, fetal monitoring and elective operative delivery are reviewed, and no evidence of benefit is found from their routine use. However, such interventions are valuable in selected cases.

Current concepts in management of obstetric problems for pediatricians. II. Modern concepts in the management of multiple gestation

The fetus in a multiple gestation is intrinsically at extreme risk. Modern obstetric management recognizes that cesarean section may lessen the risks associated with labor and delivery. A substantial percentage of cases, however, can safely deliver vaginally.