Background: The rate of prematurity in twin pregnancies is higher than 50%.\nDue to its multifactorial nature, different strategies are necessary to reduce\nthe incidence of premature birth or to increase the gestational age at birth of\npregnancies at risk. In this context, cervical pessary may be indicated in twin\npregnancies with short cervix. Methods: In this case series, we describe six\ntwin pregnancies that were considered as high-risk for preterm labor due to\nshort cervix (CL < 30 mm) at second trimester and multiple risk factors for\nprematurity. Several strategies were associated for the goal of delaying gestational\nage at birth. The main strategies were: removal of labor activities,\ntreatment of infections, vaginal micronized progesterone 400 mg/day and vaginal\npessary insertion (Ingamed_ Brazil). Results: The gestational age of insertion\nof the pessary ranged from 16 to 24 weeks. The gestational age of birth\nranged from 26 to 34 weeks. Three of the pregnancies were delivered due to\nspontaneous onset of labor, and three were delivered due to medical reasons.\nThe mean length of pregnancy since pessary insertion to birth was 9 weeks\n(range 2 to 17 weeks). All infants without severe fetal malformation were\ndischarged from the hospital without major sequelae. Conclusion: The use of\ncervical pessaries associated to micronized progesterone at a dose of 400\nmg/day may be an option in the management of twins at risk for preterm\nbirth. More controlled studies are needed to evaluate the simultaneous use of\ncervical pessary and progesterone on twin pregnancies.
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