Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks

Abstract

Objective To determine obstetric and neonatal outcomes of expectantly managed multi-fetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks. Study Design A retrospective cohort of all multi-fetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single Maternal-Fetal Medicine practice between 7/4/2002 and 9/1/2013. Neonatal and maternal outcomes were assessed and comparisons made between the fetus with ruptured membranes and the first fetus to deliver with intact membranes. Results 23 pregnancies (46 fetuses) were analyzed with a median gestational age at PPROM of 22.9 weeks; 74% experienced PPROM < 24 weeks gestation. A median latency of 11 days was achieved with expectant management. Of the 46 neonates, 20 (43%) survived to hospital discharge. Of these, 12 (60%) experienced severe neonatal morbidity defined as defined as grade III or IV intraventricular hemorrhage, bronchopulmonary dysplasia, pulmonary hypoplasia, necrotizing enterocolitis requiring surgical intervention, and/or grade 3 or 4 retinopathy of prematurity. Eight neonates survived to hospital discharge without severe neonatal morbidity. The multiple with ruptured membranes was more likely to experience intrauterine demise but otherwise had similar outcomes as the multiple with intact membranes. Maternal morbidity was considerable, with 7/23 (30%) pregnancies complicated by clinical chorioamnionitis, 12/23 (52%) delivering by cesarean, of which 3/12 (25%) were classical cesarean deliveries. Conclusion Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multi-fetal gestation complicated by very early PPROM.

The Effect of Birth Order on Neonatal Morbidity and Mortality in Very Preterm Twins

“…Furthermore, the absolute differences in our outcome between the second-and first-born twins are quite small, thus one can argue regarding the direct clinical implications for the individual twin neonate. Our findings may be explained by the fact that many preterm twins are born following preterm premature rupture of membranes (PPROM) 12,13 with the possibility of intrauterine infection being the etiology of PPROM. 14 We suspect that the risk of mortality is higher for the twin whose amniotic sac ruptured, most commonly the presenting first twin with closer proximity to the "infected" environment.…”

A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM

“…Premature rupture of the membranes (PROM) occurs in 10% of pregnancies [1–5] and is a risk factor for adverse pregnancy and neonatal outcomes [6–24]. Preterm PROM is a major complication of pregnancy [25–39], and accounts for 30% of spontaneous preterm births [40–42].…”

Successful Management of Preterm Premature Rupture of Membrane in Second Trimester: A Case Report and Literature Review

“…PPROM is defined as rupture of the fetal membranes prior to 37 weeks gestation and prior to the onset of labor [4] [5]. The main consequence of PPROM is the onset of premature labor and delivery.…”