Preterm Premature Rupture of Membranes Complicating Twin Pregnancy: Management Considerations

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center New York, New York, USA.
Clinical obstetrics and gynecology (Impact Factor: 1.77). 06/2011; 54(2):321-9. DOI: 10.1097/GRF.0b013e318217d60d
Source: PubMed


Preterm premature rupture of membranes (PPROM) is more prevalent in twin gestations and is major contributor to preterm birth. The management of PPROM in twin pregnancies does not differ significantly from that of singletons. In general, antenatal steroids, latency antibiotics, magnesium sulpfate for neuroprotection, and tocolysis are all potential interventions to consider when PPROM complicates a twin gestation. Certain circumstances, such as PPROM following an invasive procedure, at a previable gestational age, or in a monochorionic gestation, warrant special attention as the implications of PPROM and subsequent recommendations for these twin pregnancies may differ. In general, the approach to PPROM in twins should be individualized based on gestational age, and the maternal and neonatal risks of delaying delivery to prolong the pregnancy.

Download full-text


Available from: Hen Sela, Oct 11, 2015
1,405 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Twin gestation poses in our time a great challenge for obstetricians as it is accompanied by various pathology including abortion, preterm labor, IUGR, preeclampsia, TTTS and other entities. Pregnancies of twins are considered as high risk and need intensive antenatal monitoring and care. The purpose of the present study was to retrospectively assess twin gestation rates among women delivered in our center as well as other demographic indices and mean Apgar scores at five minutes of neonates. We conducted a retrospective 20-year study of all pregnancies from January 1991 to December 2010, and collected 1954 twin gestations in a sum of 67 148 pregnancies (2.91%). Twin pregnancy rates delivered at our institution didn’t change despite the steady increment in use of ART the last five years. Furthermore gestational age at delivery and mean birth weight of neonates were also unchanged despite advances in antenatal care. However the percentage of first twins born with fifth minute Apgar scores less than seven has changed significantly. Lastly cesarean section rates are kept high throughout the last two decades.
    Archives of Perinatal Medicine 01/2013; 19(4):219-222.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Our objective was to compare the latency periods after preterm premature rupture of membranes (PPROM) and determine its subsequent impact on maternal and fetal outcomes for singleton and twin gestations > 24 weeks' and ≤ 34 weeks' gestation. Delivery in the first 72 h after the rupture of membranes was observed to be more frequent in the twin group (RR 1.98, 95% CI 1.06-3.73, p = 0.03); whereas the overall median latency periods were comparable (p = 0.06). Singleton pregnancies had shorter latency periods after 28 gestational weeks by comparison to the latency periods before 28 weeks. Gestational age of rupture of membranes and delivery and latency periods were comparable between spontaneous twin pregnancies and twin pregnancies after assisted reproductive technologies (ART). As a conclusion, singleton and twin pregnancies had similar outcomes after PPROM. The first 72 h is especially important for the outcome of twin pregnancies at when the delivery risk is high.
    Journal of Obstetrics and Gynaecology 06/2014; 34(7):1-5. DOI:10.3109/01443615.2014.920781 · 0.55 Impact Factor