Previable PPROM in twin pregnancies: What can we expect?

The aim of this study is to describe the perinatal outcomes of twin pregnancies complicated with previable PPROM (PV-PPROM) and expectant management. Retrospective review including women with twin pregnancy complicated with PPROM before 24+0 weeks and ongoing pregnancy, between 2015-2022, in our center. Exclusion criteria were: intrauterine fetal demise (IUFD) of one fetus before PPROM diagnosis, clinical chorioamnionitis at PPROM presentation, monoamniotic pregnancies or triplets and higher order pregnancies. Selective termination (ST) or termination of the entire pregnancy was considered on parental request in fetuses with severe and prolonged oligohydramnios before 23+0 weeks. Perinatal and maternal outcomes of pregnancies managed expectantly were evaluated. Over the study period, 45 women were admitted with a diagnosis of PV-PPROM in our center. Demographic and gestational characteristics are shown in Table 1. Median (25th;75th percentile) gestational age (GA) at PPROM was 19.3 (16.4-21.6) weeks. Seven (15.6%) women presented an immediate delivery within the first 24 hours since PPROM. Two patients (4.4%) requested a ST of the affected twin. In the 36 ongoing pregnancies that opted for expectant management, GA and latency to delivery were 25.4 (22.1-28.6) weeks and 37.5 (18-67) days, respectively. Overall survival rate was 35/72 (48.6%). In 21/36 (58.3%) of PV-PPROM cases there was at least 1 survivor and in 14/36 (38.9%) of the cases both fetus survived. There were 25/36 (69.4%) women who delivered after 23+0 weeks of pregnancy. When periviability was achieved, neonatal survival increased up to 80% (35/44). Perinatal and maternal complications related to PV-PPROM are shown in Table 2. Overall survival rate in twin pregnancies complicated with PV-PPROM is around 50%, similar to singleton pregnancies. Once viability is reached, survival increases up to 80%. This data may help prenatal counselling in twin pregnancies complicated with PV-PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)