Evaluation of the Role of Vaginal Progesterone in Prevention of Preterm Labour in Twin Gestation with Short Cervix Randomized Controlled Trial

Abstract

In order to reach a sufficiently comprehensive definition of multiple pregnancy, one should put in mind the number of zygotes at the beginning of pregnancy, the production time of the zygotes, the location of the pregnancy and the final number of the fetuses. With the explosion in the reproductive technology available to couples experiencing infertility, the number of multiple gestations has increased dramatically. Preterm delivery with its associated morbidity and mortality still represents one of the major unsolved problems in Obstetrics. In multiple pregnancies, there is an increased incidence of preterm delivery which represents a life threatening situation for the twins. It has been calculated that the mean duration of twin pregnancies is 37 weeks, so premature birth defined as delivery before 37 week of gestation, is the leading cause of perinatal mortality and short and long term fetal morbidity. Obviously, preterm deliveries present a problem because of the severe neonatal complications that often occur afterwards. These complications are worse for the smaller newborn with earlier gestational age. These complications include respiratory distress syndrome, intraventricular hemorrhage, sepsis and necrotizing enterocolitis. This has led various authors to search for a method that can reliably predict the occurrence of preterm birth. Various methods have been investigated as the use of biochemical markers. Finally, the use of ultrasound has been suggested and studied extensively as a widely available, non invasive, inexpensive method which can be used for this purpose. Progesterone is a steroid hormone that helps to maintain pregnancy. Removal of progesterone, or blockage of its receptors, reliably ends pregnancy at all gestational ages, and in many non-human species, falling levels precipitate natural labour.