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Hugs for keeps: A case report of pessary insertion in preterm twin gestation in the Philippines

Koleen C. Pasamba, MD and Regina Rosario M. Panlilio Vitriolo, MD, FPOGS, FPSUOG
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines - Manila

Preterm birth accounts to 35 % of deaths in a year. Twin gestation, around 7.2 per 1000 births in the Philippines, is a known risk factor that increases likelihood of preterm birth compared to singletons. Most studies that addresses preterm births are focused on singleton pregnancies. There have been no established recommendations to control preterm labor in twin pregnancies. Pessary insertion is among these recommendations. There are no reported cases of pessary insertion to control preterm birth among twins in the Philippines. This study presents a case of twin gestation in preterm labor and no functional cervix on transvaginal ultrasound. Hodge pessary was inserted at 28 weeks age of gestation. She delivered at 36 weeks to live baby girls, both 2,200 grams and were directly roomed-in. Further studies are recommended to establish stronger evidence supporting pessary use in multiple gestation to improve outcome of neonates.