open access

Vol 93, No 12 (2022)
Research paper
Published online: 2022-02-01
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Results of expectant management in singleton and twin pregnancies complicated by preterm premature rupture of membranes

Joanna Kacperczyk-Bartnik1, Pawel Bartnik1, Justyna Teliga-Czajkowska2, Aneta Malinowska-Polubiec1, Agnieszka Dobrowolska-Redo1, Ewa Romejko-Wolniewicz1, Patryk Rudzinski3, Krzysztof Czajkowski1
·
Pubmed: 35106749
·
Ginekol Pol 2022;93(12):999-1005.
Affiliations
  1. 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
  2. Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Poland
  3. Students’ Scientific Group affiliated to 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland

open access

Vol 93, No 12 (2022)
ORIGINAL PAPERS Obstetrics
Published online: 2022-02-01

Abstract

Objectives: This study aimed to examine whether expectant management in twin pregnancies with preterm premature rupture of membranes (pPROM) is as safe as in singleton pregnancies.

Material and methods: It was a retrospective cohort study comparing pregnancy course and outcome in singleton (n = 299) and twin pregnancies (n = 49) complicated by preterm premature rupture of membranes. Analysed factors included maternal diseases, gestational age at premature rupture of membranes (PROM), management during hospitalization, latency periods between PROM and delivery, gestational age at delivery, neonatal management and outcome.

Results: The difference in the proportion of patients with latency up to 72 hours, latency between 72 hours and seven days, and latency exceeding seven days were insignificant. The percentage of patients who received intravenous tocolysis and antenatal corticosteroids were similar; however, patients in twin pregnancies more often received incomplete steroids dose (p = 0.01). The occurrence of the positive non-stress test result and signs of intrauterine infection were similar between the groups. No statistically significant differences in the prevalence of neonatal complications except transient tachypnoea of the newborn were identified (24% in the singleton vs 13% in the twin group, p = 0.03).

Conclusions: Expectant management of pPROM in singleton and twin pregnancies results in similar perinatal and neonatal outcome. Consequently, in case of no evident contraindications, expectant management of twin pregnancies seems to be equally as safe as in singleton pregnancies. Patients in twin pregnancies may be at higher risk of delivery before administration of full antenatal corticosteroids dose, therefore require immediate management initiation and transfer to a tertiary referral centre.

Abstract

Objectives: This study aimed to examine whether expectant management in twin pregnancies with preterm premature rupture of membranes (pPROM) is as safe as in singleton pregnancies.

Material and methods: It was a retrospective cohort study comparing pregnancy course and outcome in singleton (n = 299) and twin pregnancies (n = 49) complicated by preterm premature rupture of membranes. Analysed factors included maternal diseases, gestational age at premature rupture of membranes (PROM), management during hospitalization, latency periods between PROM and delivery, gestational age at delivery, neonatal management and outcome.

Results: The difference in the proportion of patients with latency up to 72 hours, latency between 72 hours and seven days, and latency exceeding seven days were insignificant. The percentage of patients who received intravenous tocolysis and antenatal corticosteroids were similar; however, patients in twin pregnancies more often received incomplete steroids dose (p = 0.01). The occurrence of the positive non-stress test result and signs of intrauterine infection were similar between the groups. No statistically significant differences in the prevalence of neonatal complications except transient tachypnoea of the newborn were identified (24% in the singleton vs 13% in the twin group, p = 0.03).

Conclusions: Expectant management of pPROM in singleton and twin pregnancies results in similar perinatal and neonatal outcome. Consequently, in case of no evident contraindications, expectant management of twin pregnancies seems to be equally as safe as in singleton pregnancies. Patients in twin pregnancies may be at higher risk of delivery before administration of full antenatal corticosteroids dose, therefore require immediate management initiation and transfer to a tertiary referral centre.

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Keywords

pregnancy outcome; pregnancy; twin; premature birth; preterm premature rupture of the membranes

About this article
Title

Results of expectant management in singleton and twin pregnancies complicated by preterm premature rupture of membranes

Journal

Ginekologia Polska

Issue

Vol 93, No 12 (2022)

Article type

Research paper

Pages

999-1005

Published online

2022-02-01

Page views

3794

Article views/downloads

681

DOI

10.5603/GP.a2021.0211

Pubmed

35106749

Bibliographic record

Ginekol Pol 2022;93(12):999-1005.

Keywords

pregnancy outcome
pregnancy
twin
premature birth
preterm premature rupture of the membranes

Authors

Joanna Kacperczyk-Bartnik
Pawel Bartnik
Justyna Teliga-Czajkowska
Aneta Malinowska-Polubiec
Agnieszka Dobrowolska-Redo
Ewa Romejko-Wolniewicz
Patryk Rudzinski
Krzysztof Czajkowski

References (26)
  1. Martin JA, Hamilton BE, Osterman MJ. Three decades of twin births in the United States, 1980-2009. 2012. https://stacks.cdc.gov/view/cdc/11675.
  2. Blondel B, Kaminski M. Trends in the occurrence, determinants, and consequences of multiple births. Semin Perinatol. 2002; 26(4): 239–249.
  3. Imaizumi Y. Trends of twinning rates in ten countries, 1972-1996. Acta Genet Med Gemellol (Roma). 1997; 46(4): 209–218.
  4. Reynolds MA, Schieve LA, Martin JA, et al. Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000. Pediatrics. 2003; 111(5 Pt 2): 1159–1162.
  5. Chandra A, Stephen EH. Infertility service use among U.S. women: 1995 and 2002. Fertil Steril. 2010; 93(3): 725–736.
  6. Mercer B, Crocker L, Pierce W, et al. Clinical characteristics and outcome of twin gestation complicated by preterm premature rupture of the membranes. Am J Obstet Gynecol. 1993; 168(5): 1467–1473.
  7. Maggio L, Carr SR, Watson-Smith D, et al. Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery. Fetal Diagn Ther. 2015; 38(1): 29–34.
  8. Beck V, Lewi P, Gucciardo L, et al. Preterm prelabor rupture of membranes and fetal survival after minimally invasive fetal surgery: a systematic review of the literature. Fetal Diagn Ther. 2012; 31(1): 1–9.
  9. Papanna R, Molina S, Moise KY, et al. Chorioamnion plugging and the risk of preterm premature rupture of membranes after laser surgery in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2010; 35(3): 337–343.
  10. Papanna R, Block-Abraham D, Mann LK, et al. Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014; 43(1): 48–53.
  11. Stirnemann J, Djaafri F, Kim A, et al. Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases. BJOG. 2018; 125(9): 1154–1162.
  12. Buchanan SL, Crowther CA, Levett KM, et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2010(3): CD004735.
  13. Li Z, Umstad MP, Hilder L, et al. Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010. BMC Pediatr. 2015; 15: 148.
  14. ANANTH C, VINTZILEOS A, SHEN-SCHWARZ S, et al. Standards of Birth Weight in Twin Gestations Stratified by Placental Chorionicity. Obstetrics & Gynecology. 1998; 91(6): 917–924.
  15. Glinianaia SV, Skjaerven R, Magnus P. Birthweight percentiles by gestational age in multiple births. A population-based study of Norwegian twins and triplets. Acta Obstet Gynecol Scand. 2000; 79(6): 450–458.
  16. Derbent A, Tatli MM, Duran M, et al. Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies. Arch Gynecol Obstet. 2011; 283(5): 947–951.
  17. Bianco AT, Stone J, Lapinski R, et al. The clinical outcome of preterm premature rupture of membranes in twin versus singleton pregnancies. Am J Perinatol. 1996; 13(3): 135–138.
  18. Jacquemyn Y, Noelmans L, Mahieu L, et al. Twin versus singleton pregnancy and preterm prelabour rupture of the membranes. Clin Exp Obstet Gynecol. 2003; 30(2-3): 99–102.
  19. Ekin A, Gezer C, Taner CE, et al. Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation. Arch Gynecol Obstet. 2014; 290(3): 449–455.
  20. Ehsanipoor RM, Arora N, Lagrew DC, et al. Twin versus singleton pregnancies complicated by preterm premature rupture of membranes. J Matern Fetal Neonatal Med. 2012; 25(6): 658–661.
  21. Esin S, Gyimadu A, Atak Z, et al. Preterm premature rupture of membranes in singleton vs twin pregnancies: The latency periods and the clinical outcomes revisited. J Obstet Gynaecol. 2014; 34(7): 593–597.
  22. Kibel M, Barrett J, Tward C, et al. The natural history of preterm premature rupture of membranes in twin pregnancies. J Matern Fetal Neonatal Med. 2017; 30(15): 1829–1835.
  23. Trentacoste SV, Jean-Pierre C, Baergen R, et al. Outcomes of preterm premature rupture of membranes in twin pregnancies. J Matern Fetal Neonatal Med. 2008; 21(8): 555–557.
  24. Kenyon SL, Taylor DJ, Tarnow-Mordi W. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. The Lancet. 2001; 357(9261): 979–988.
  25. Kenyon S, Pike K, Jones DR, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial. The Lancet. 2008; 372(9646): 1310–1318.
  26. Sela HY, Simpson LL. Preterm premature rupture of membranes complicating twin pregnancy: management considerations. Clin Obstet Gynecol. 2011; 54(2): 321–329.

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