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Subject Area

Family Medicine

Article Type

Original Study

Abstract

Objective The aim of this study was to eva lu ate the effectiveness of vaginal progesterone, cervical cerclage, and combination in preventing preterm labor (PTL) in twin pregnancy and impact on perinatal outcome. Background Several studies showed the efficacy of vaginal progesterone and cervical cerclage or both in prevention of PTL in twin pregnancy. Patients and methods A sample size of 75 patients has been taken from outpatient clinic at Menoufia University Hospital. All fulfilled eligibility criteria of having a twin pregnancy with a history of spontaneous PTL, a sonographic short cervical length of less than 25 mm in mid-trimester. The participants were randomly assigned to three groups: group 1 (N = 25) received vaginal progesterone; group 2 (N = 25) were remedied with cervical cerclage; and group 3 (N = 25) received both vaginal progesterone and cervical cerclage. The primary outcome measure was spontaneous delivery between 34 and 37 weeks of gestation. Secondary outcomes were delivery before 34 weeks of gestation. Results There were no significant differences between the three studied groups concerning their demographic data. There were no statistical significant differences between the three studied groups regarding the transvaginal sonographic cervical length (P > 0.05). There was a statistically significant higher gestational age in the combination group than the progesterone group or cerclage group (P < 0.001). Comparison between progesterone and cerclage groups did not reach statistical significance (P=−0.85). Both demonstrated significantly lower birth weights, lower APGAR scores, and a higher NICU admission rate than in the combination group (P < 0.001). Conclusion Combination of vaginal progesterone and cervical cerclage can prevent PTL in twin pregnancy and improve perinatal morbidity and mortality.

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