Background In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). Objectives To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). Search strategy We searched international scientific databases, trial registration websites, and references of identified articles. Selection criteria Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. Data collection and analysis Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. Main results Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97–1.4, vaginal progesterone RR 0.97; 95% CI 0.77–1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47–0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42–0.75). Author’s conclusions In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.

We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at > or = 24 weeks' gestation were randomized to either an initial 25-microg dose of intravaginal misoprostol, followed by 50-microg intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 microg of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery. One hundred twenty-six women were randomized to vaginal misoprostol alone (group I) and 106 women to Foley and oral misoprostol (group II). The groups were similar in age, weight, gestational age, parity, indication for induction of labor, and oxytocin use. Cesarean delivery rates at 37% and cesarean indications were similar ( P = 0.25). The time from induction to delivery in group II (12.9 hours) was significantly shorter than that in group I (17.8 hours, P < 0.001). Uterine tachysystole occurred less often in the vaginal misoprostol group (21% versus 39%, P = 0.015). Compared with vaginal misoprostol, delivery within 24 hours was significantly more likely with a Foley balloon and oral misoprostol. The use of terbutaline and peripartum outcomes were similar in the two groups.

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Objective  The purpose of our investigation was to evaluate factor(s) associated with unexplained antepartum bleeding of unknown origin (ABUO) after 24 weeks of pregnancy and correlate unexplained haemorrhage with maternal and perinatal outcomes.Design  This is a retrospective observational study.Setting  King Edward Memorial Hospital (KEMH), Subiaco, Western Australia.Population  Singleton pregnancies delivering at KEMH between January 1998 and December 2004.Methods  ABUO was defined as bleeding after 20 weeks of gestation but before the onset of labour with no cause detected on vaginal examination or abdominal ultrasound. Outcomes of these pregnancies were collated and compared with those of pregnancies without ABUO.Main outcome measures  Antepartum complications assessed included pre‐eclampsia/eclampsia, gestational diabetes and preterm birth. Intrapartum evaluations included labour inductions, mode of delivery and gestational age at delivery. Neonatal outcomes evaluated included birthweight, Apgar scores, newborn intensive care unit (NICU) admission, neonatal complications and risk of perinatal/neonatal death.Results  Between January 1998 and December 2004, there were 26 583 deliveries without ABUO and 1431 with ABUO. Multivariable analyses of the ABUO effects revealed that ABUO was a simultaneously significant risk factor for term labour inductions (OR = 2.00, 95% CI: 1.72–2.32, P < 0.001), preterm delivery (OR = 4.31, 95% CI: 3.84–4.84, P < 0.001), NICU admission (OR = 1.23, 95% CI: 1.01–1.51, P = 0.042), hyperbilirubinaemia (OR = 1.29, 95% CI: 1.01–1.63, P = 0.041) and reduced birthweight (26 g, 95% CI: 3–50, P = 0.026).Conclusion  Women with ABUO are at greater risk of preterm delivery, term labour induction and their neonates are at greater risk for NICU admissions, hyperbilirubinaemia and a reduced birthweight.

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