Clinical Analysis Of Preterm Premature Rupture Of The Membranes In Twin Pregnancy

Objective: To determine whether there is any difference between maternal and neonatal outcomes of twin and singleton gestations complicated by preterm premature rupture of membranes and evaluate the effect of gestational week on the maternal and neonatal outcome.Methods: A total number of 84 Non-anomalous twin and 1383 singleton gestations complicated by PROM >28 weeks of gestation from the period January 2013 to December 2016 were identified.Outcomes were obtained reviewing maternal and neonatal charts.Groups were compared for gestational age at premature rupture of membrane,latency from premature rupture of membrane to delivery;whether conception was spontaneous or with in-vitro fertilization embryo transfer(IVF-ET),number of longitudinal segment caesarean section(LSCS),indications of caesarean section,rate of clinical chorioamnionitis and neonatal complications.Results: Advanced maternal age was seen in twin compared to singleton pregnant women with premature rupture of membranes(PROM)(p<0.05).There is also a significant difference between the WOG at rupture ofmembranes(ROM)and delivery for twin vs.singleton pregnancies with PROM(p<0.01).Preterm premature rupture of membranes(PPROM)occurs more frequently in twin than singleton gestations(p<0.01).The incidence of IVF-ET with PPROM was seen more in twins compared to singletons(p<0.01).In <34weeks' white blood cell(WBC)count at the time of rupture of membrane(ROM)was significant in singletons compared to twin gestations(p<0.01)whereas indication for LSCS was significant in twin gestations compared to singleton gestations(p<0.01).The incidences of NICU stay,RDS is more seen in twin gestations compared to singleton gestations in <34weeks '(p<0.01).There was significant difference noted between the WOG at ROM and delivery at 34-36+6 weeks ' in twin and singleton pregnancies(p<0.01).Moreover,In 34-36+6 weeks' number of LSCS and indication for LSCS was significantly higher in twin gestations compared to singleton gestations(p<0.01).In 34-36+6 weeks' significant differences were noted in neonates with respect to birth weight,NICU admission and NICU stay in twin and singleton neonates(p<0.01).Latency was prolonged with PPROM <34 weeks' versus34-36+6 weeks' in twin gestation(p<0.001).Additionally,the number of LSCS performed in 34-36+6 weeks' was more than <34 weeks'(p<0.01).In twin neonates <34 weeks' gestation had longer neonatal intensive care unit(NICU)stay(p<0.001)and increased incidence of respiratory distress syndrome(RDS),infection(p<0.001)and Transient myocardial ischemia(MI)(p<0.01)compared to neonates 34-36+6 weeks' gestation.Gestational age of rupture of membranes,delivery,latency periods,number of LSCS and indication of LSCS were comparable between spontaneous twin pregnancies and twin pregnancies after IVF-ET.However,women conceived with IVF-ET were reported to have highbirth weight neonates(p<0.05),less NICU stay(p<0.001),decreased rate of RDS and infection(p<0.001)compared to women conceived naturally.Conclusion: According to many studies,using 34 weeks' as drawn line for treatment,twin pregnancy with PPROM had shown significantly improved neonatal outcome similar to singleton pregnancy with PPROM.However,neonatal outcome for similar gestational age in twin pregnancy with PPROM is still worse than singleton pregnancy.Prolongation of gestational weeks may be beneficial for neonatal outcomes.These results suggests that neonatal birth weight may be an important risk factor for neonatal outcomes.IVF-ET twin pregnancy with preterm premature rupture of membranes does not increase the risk of adverse outcomes of mothers or newborns.