Outcome of Twin Pregnancies Complicated By Early Second Trimester Rupture of Membranes in One Sac

Zajicek, M.; Ben‐Ami, Moshe; Weisz, Boaz; Keselman, Leandro; Lipitz, Shlomo

doi:10.1375/twin.13.6.604

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…Of these, 38 were selected for full text article review. Finally, 18 articles [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] were included in the review. Figure 1 shows the whole process of study selection, using PRISMA flow diagram [26].…”

Section: Resultsmentioning

confidence: 99%

Perinatal Outcomes of Pre-viable Preterm Premature Rupture of Membranes

Mukhtar¹

2018

J Gyn Obs Bul

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Objective: To assess the maternal and neonatal outcomes after expectant management of pre-viable preterm premature rupture of membranes (PPROM). Data Sources:We searched PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science databases for publications from 2008 to 2018 and ClinicalTrials.gov. Methods of Study Selection:All studies that reported pregnancy outcomes of pre-viable PPROM were included. Excluded were the review articles, case reports, and studies that exclusively included patients with a particular characteristic (oligohydramnios/prolonged latency), those evaluating the effect of a specific intervention, or the ones providing aggregate data from which information for patients with PPROM <24 weeks could not be delineated.Tabulation, Integration, and Results: Eighteen studies were reviewed that examined the outcomes of 1,372 pre-viable PPROM women following expectant management. Data was extracted in the form of predesigned tables. We used Microsoft Excel to integrate the results of included studies. The overall neonatal survival to discharge was 41.5%. Of these, 48.8% neonates survived without a major morbidity. Respiratory morbidity was the most common morbidity among surviving neonates: 49.5% neonates suffered from respiratory distress syndrome, 30% from bronchopulmonary dysplasia, and 10.7% from pulmonary hypoplasia. Chorioamnionitis was the most frequently observed maternal morbidity, complicating 49.3% pre-viable PPROM. The predictors for favorable outcomes included a later gestational age at PPROM and delivery, absence of oligohydramnios, and iatrogenic PPROM. Of note, 21.6% of pre-viable PPROM women opted for the termination of pregnancy. Conclusion:The neonatal survival rate of pre-viable PPROM after expectant management is 4 of 10 affected neonates, and nearly half of them survive without any major morbidity. Maternal morbidity remains substantial, however, serious maternal complications are rare.

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Section: Resultsmentioning

confidence: 99%

Perinatal Outcomes of Pre-viable Preterm Premature Rupture of Membranes

Mukhtar¹

2018

J Gyn Obs Bul

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“…8 Other repotted alternative includes selective termination of pregnancy with leakage of amniotic fluid and expectant management. Gestational age is most important predictor of Neonatal survival in infant delivered before 25 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

Prolonged latency period of 70 days in a diamniotic and dichorionic twin pregnancy complicated by early second trimester rupture of membrane in one sac and its outcome

2015

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A patient with diamniotic dichorionic twin (DADC) pregnancy was on regular antenatal checkup from conception, admitted to emergency department at 21 weeks with leaking PV. On per speculum and pervaginal examination it was found that clear liquor was draining from os & cervix was long and os was closed. USG revealed twin A sac having live fetus of 20 weeks with no liquor and twin B sac having live fetus with plenty of liquor. Considering the emotional aspect of parents we decided for conservative management which includes combination of antibiotics, micronized progesterone as tocolytic, probiotics, L- arginine and absolute bed rest. Caesarean section was performed at 31 weeks as she entered in labour and had cord prolapse. She delivered two live twin babies after a long latency period of 70 days. Twin ‘A’ baby could not be saved because of lung hypoplasia due to prolonged Oligohydraminous but twin ‘B’ was discharged safely along with mother. Since last decade assisted reproduction technique has increased in numbers of twin pregnancies and its complications. The most important are preterm labour and PPROM. On literature review there is no clear cut guide line for management of PPROM in early second trimester in twin pregnancies. This case is reported because of its long latency period of 70 days from PPROM in early 2<sup>nd</sup> trimester in a twin pregnancy to delivery by conservative management and can save the baby in intact sac. Also we can add our experience to currently available limited literature regarding management of such patient.

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“…Women without clinical signs of infection, who did not deliver within a week and chose expectant management or selective termination of the fetus with ruptured membranes over TOP, were included. Nine of the cases included in the current series have been previously reported [17].…”

Section: Methodsmentioning

confidence: 99%

“…Several case reports and small series suggest favorable outcome for expectant management or selective termination in twins with EPPROM occurring before 20 weeks of gestation [11][12][13][14][15][16]. We previously reported on nine sets of twins complicated by EPPROM who were managed either expectantly or by selective termination and were delivered between 27-40 weeks [17]. The current study aims to determine the perinatal outcome of a larger series of twin pregnancies complicated by EPPROM at less than 20 weeks of gestation managed by selective termination vs. expectant management.…”

Section: Introductionmentioning

confidence: 99%

Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13–20 Weeks: Is Selective Termination an Appropriate Management Option?

et al. 2020

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Objective To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13–20 weeks of gestation and were managed by expectant management or by selective termination. Methods A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13–20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included. Results 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups. Conclusion Selective termination in twin pregnancies complicated by rupture of membranes at 13–20 weeks has a favorable outcome and should be offered.

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Outcome of Twin Pregnancies Complicated By Early Second Trimester Rupture of Membranes in One Sac

Cited by 11 publications

References 15 publications

Perinatal Outcomes of Pre-viable Preterm Premature Rupture of Membranes

Perinatal Outcomes of Pre-viable Preterm Premature Rupture of Membranes

Prolonged latency period of 70 days in a diamniotic and dichorionic twin pregnancy complicated by early second trimester rupture of membrane in one sac and its outcome

Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13–20 Weeks: Is Selective Termination an Appropriate Management Option?

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