Recommendation ID
CG129/4
Question
Preventing preterm birth:- What interventions are effective in preventing spontaneous preterm birth in women with twin and triplet pregnancies, especially in those at high risk of preterm birth?
Any explanatory notes
(if applicable)
Why this is important:- The guideline review considered several interventions aimed at preventing spontaneous preterm birth in women with twin and triplet pregnancies, including cervical cerclage, tocolytic drugs and sexual abstinence. The existing evidence for the effectiveness of cervical cerclage is of low quality (mostly originating from observational studies). The existing evidence in relation to tocolytics is also limited: there is evidence for the effectiveness of betamimetics, but no randomised controlled trials were identified for the effectiveness of ritodrine, magnesium sulphate or nifedipine. No evidence was identified for the effectiveness of sexual abstinence alone in preventing preterm birth.
Further research in the form of randomised controlled trials is, therefore, needed to evaluate the effectiveness of cervical cerclage, tocolytics other than betamimetics, and sexual abstinence. Future research should place particular emphasis on women at high risk of preterm birth in twin and triplet pregnancies. Some evidence suggested that a cervical length of less than 25 mm at 18–24 weeks of gestation in twin pregnancies or 14–20 weeks of gestation in triplet pregnancies, or a history of preterm labour in singleton pregnancies, increases the risk of spontaneous preterm birth in twin and triplet pregnancies. The evidence was limited in quality and additional research into the predictive accuracy of these factors would inform future NICE guidance. All research into the prevention of preterm birth should report spontaneous preterm birth separately from other preterm births. Data should also be reported separately for twin and triplet pregnancies, for different chorionicities, and for different gestational ages at birth (that is, less than 28 weeks, between 28 and less than 32 weeks, and 32–37 weeks).

Source guidance details

Comes from guidance
Multiple pregnancy: antenatal care for twin and triplet pregnancies
Number
CG129
Date issued
September 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No