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International experts show varied practices in managing preterm birth in twin pregnancies, but reach consensus on routine transvaginal cervical length screening, use of vaginal progesterone for short cervix, and cerclage for asymptomatic cervical dilation.
A new international Delphi consensus study has portrayed considerable variation in how healthcare professionals across the globe approach the diagnosis and prevention of preterm birth in twin pregnancies, especially in complex cases involving twin-to-twin transfusion syndrome (TTTS) or cervical shortening and dilation.
Issued in "Ultrasound in Obstetrics & Gynecology", the study aimed to capture expert opinions on strategies for preventing, monitoring, and tackling preterm birth in twin gestations. A total of 117 experts—selected for their academic contributions or organizational affiliations—took part in the first round, with 94 (80.3%) completing all 3 rounds. Respondents represented at least 22 countries across 5 continents, with the majority based in the USA (50.4%) and the UK (12%).
Using a structured three-round Delphi method, the study gathered expert opinions via multiple-choice questions and Likert-scale responses. A predefined threshold of ≥70% agreement was employed to establish consensus.
Key findings
The study reveals a gap between real-world clinical practice and existing national and international guidelines. While some areas, such as cervical length screening and the use of vaginal progesterone in non-dilated cervix cases, showed strong agreement, other scenarios—especially those involving TTTS or cervical dilation—lacked unified approaches. This study underscores the complexity and variability in tackling preterm birth risk in twin pregnancies.
Ultrasound in Obstetrics & Gynecology
Prevention of preterm birth in twin pregnancy: international Delphi consensus
H J Mustafa et al.
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