Preterm labour in twin pregnancies: can it be prevented by hospital admission?

Article Abstract:

Preterm delivery, birth before the 37th week of pregnancy, is associated with a poor fetal outcome. Many fetuses born preterm develop multiple complications. Twin pregnancies, which are often delivered early, carry a high fetal death rate. Predicting and identifying twin pregnancies at risk for early labor could help to develop therapeutic treatment plans to prevent early delivery. Many suggest hospitalization of women at risk to maintain strict bed rest, close monitoring, and fetal assessments. However, the value of this intervention has been disputed. The onset of labor is signaled by changes in the opening of the mouth of the uterus, the cervix. A method of examining changes the cervix of pregnant women was developed. A score calculated by subtracting cervical dilatation from the length of the cervix (in centimeters) can identify women at risk for preterm delivery. To see whether preterm delivery can be predicted by cervical scores, 223 women carrying twin pregnancies were evaluated. Women having scores of minus two or less (139 women) before the 34th week of pregnancy were at risk for early labor. These women were assigned to remain in the hospital and receive strict bed rest (70 women), or to return home for continued outpatient care (69 women). Strict hospital bed rest did not offer any additional benefit with respect to prolonging pregnancy or improving fetal outcome of twin pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Measurement, Prevention, Risk factors, Premature labor, Twins, Uterus, Pregnant, Pregnant uterus

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The implications of introducing the symphyseal-fundal height-measurements: a prospective randomized controlled trial

Article Abstract:

A major goal of prenatal care is to detect and prevent fetal growth retardation, which leads to small-for-gestational-age (SGA) infants. These infants, whose weights are in the lowest 10th percentile, have increased neonatal illness and death and impaired development. Fewer than half of SGA fetuses are identified prenatally. It has been thought that measuring the uterine fundus height, the portion of the uterine body above fallopian tube openings, is a good way to screen for SGA, and the method is simple and easy to learn. Studies of this technique have reached varied conclusions as to its effectiveness, and to better determine its sensitivity, the relation between fundal height and pregnancy outcome of 1,639 women was studied. The results showed that measurement of fundal height did not improve diagnosis of SGA fetuses. Measured and unmeasured groups showed no differences in extent of medical intervention, use of additional diagnostic procedures, or condition of the infants. Further research to identify these at-risk infants is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Fetus, Fetal growth retardation, Prenatal diagnosis

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