The Association Between Early Membrane Rupture, Latency, Clinical Chorioamnionitis, Neonatal Infection, and Adverse Perinatal Outcomes in Twin Pregnancies Complicated by Preterm Prelabour Rupture of Membranes

Abstract

T he objective of this study was to evaluate associations between adverse outcomes in twin pregnancies and preterm prelabour rupture of membranes (PPROM). A chart review of 246 consecutive twin pregnancies with confirmed PPROM was conducted. Regression analysis (β [natural log of the odds ratio] and odds ratio [OR]) was performed to identify independent predictors. Two hundred and forty-six twin pregnancies, 492 liveborns, and 20 neonatal deaths. Mean (SD) PPROM gestational age (GA): 31.3 (3.8) wk; delivery GA: 32.0 (3.3) wk. PPROM < 30wk was associated with increased parity (OR: 2.66), and log (admission leukocyte count) (OR: 9.99). Shortened latency was associated with PPROM GA (β = -0.17) and chorioamnionitis (β = 0.95). Neonatal sepsis was predicted by lower delivery GA (OR: 2.04). Adverse perinatal outcomes were protected against by older GA at PPROM (OR 0.53) and shortened latency (OR 0.73). It was concluded that increased leukocytosis and parity implies an infectious aetiology in earlier PPROM. Increased risk for neonatal sepsis at earlier delivery GA is consistent with gestation-dependent fetal immunocompetence. Early PPROM and long latencies were associated with increased adverse perinatal outcomes. BackgroundPreterm prelabour rupture of membranes (PPROM) complicates 2-4% of singleton pregnancies (Duff, 1996), and 3-7% of twin pregnancies (Kovacs et al., 1989;Sassoon et al., 1990b). Specific concerns attach themselves to PPROM in multiple pregnancies, as these pregnancies are predisposed to premature delivery (Skupski & Chevernak, 1996), and, increasingly frequent, result from assisted reproduction technologies following a period of subfertility (Gall, 1996;von Dadelszen et al., 1999). Both multiple pregnancy and PPROM are independent predictors of neonatal intensive care admission, with multiple pregnancy alone contributing 19% of all neonatal intensive care unit days (Ross et al., 1999). In addition, the presence of an intact sac with a normal amniotic fluid volume for fetal growth and development, but at risk for infection, provides the clinician with a series of clinical (Lewis & Mercer, 1996), sometimes ethical (De Catten et al., 1998), challenges.For singletons at term, the International Multicentre Term PROM Study Group (Seaward et al., 1997;Seaward et al., 1998b) identified independent predictors of chorioamnionitis, postpartum fever, and neonatal infection (Table 1). PPROM in twin pregnancies has been associated with both shorter (Bianco et al., 1996) and the same (Hsieh et al., 1999) PPROM to labour latency than in singleton pregnancies, but similar perinatal outcomes (Bianco et al., 1996;Seaward et al., 1998b).This retrospective study was performed to identify the important associations between membrane rupture before 34 weeks' gestation, the latent interval between PPROM and labour onset, clinical chorioamnionitis, neonatal sepsis, and adverse perinatal outcomes in twin pregnancies complicated by PPROM. Although PPROM is known to increase the risk of infectious morbidity, not all patients wi...