**Author details**

proximal to delivery (<12 hours) seems to be related to more significant reduction of cerebral palsy when compared to the last infusion of this drug more than 12 hours before delivery [58]. In UNIFESP, this drug is administered intravenously, with a loading dose of 4 g in 20 minutes, followed by 1 g/h for up to 24 hours or until delivery [40]. Monitoring these pregnant women (by continuous evaluation of patellar reflex, respiratory frequency, urine output) is essential to prevent magnesium toxicity. Myasthenia gravis and myocardial compromise are contraindications for the use of magnesium sulfate, and adjusted dose should be used in

The evaluation of the clinical history of the previous preterm birth and the presence of short cervix (≤25 mm) are the best predictors of preterm delivery in twin pregnancy. Transvaginal ultrasonography for evaluation of the uterine cervix between the 18th and 24th week should

The use of isolated vaginal progesterone in multiple pregnancies with short cervix presents evidence that justifies its use; however, this evidence is to be confirmed by other clinical tests

Most guidelines do not recommend the use of prophylactic cerclage in patients with short

The use of a cervical pessary does not present solid evidence; however, some studies point

As the low index of complications and the absence of highly efficient intervention in twins justify the utilization of the association of progesterone and cervical pessary, for this author it

The use of corticosteroids, between 24th–25th and 34th week, must be indicated in pregnancy in the imminence of delivery or with a high risk of preterm birth and must be avoided in pregnancy with intermediate or low risk, as there are studies which point out undesired effects of

Tocolytics is to be used under the 34th week in order to gain time for carrying out corticoste-

The use of magnesium sulfate in deliveries under the 32nd week is recommended by the main

We thank the Ingamed® and Dr. Carlos Gilberto Almodin for developing, manufacturing, and offering without cost the cervical pessaries used in this study. We also thank Mr. Rudolf

roids. The first-option drugs in twin pregnancy are the calcium channel blockers.

scientific societies, for the purpose of neuroprotection in twin pregnancy.

Wiedemann for his help with the English language version of this article.

cervix; however, in selected cases of extreme severity, it can be considered.

out, although with a low level of evidence, that it may be beneficial.

seems to be better than observing the evolution of the clinical condition.

patients with renal insufficiency [59].

be indicated for its cost-effectiveness.

due to the potential bias of the most recent meta-analysis.

this treatment in the short and medium term.

**Acknowledgements**

**6. Conclusion**

202 Multiple Pregnancy - New Challenges

Marcelo Santucci Franca1 \*, Tatiana E. N. K. Hamamoto1 and Antônio Fernandes Moron2

\*Address all correspondence to: marcelosantucci.franca@gmail.com

1 Discipline of Fetal Medicine, Obstetrics Department, Federal University of São Paulo— UNIFESP, São Paulo, Brazil

2 Institute of Tropical Medicine, University of São Paulo (USP), São Paulo, Brazil
