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Ultraschall Med 2020; 41(04): e17-e22
DOI: 10.1055/a-1176-0919
Original Article

Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13–20 Weeks: Is Selective Termination an Appropriate Management Option?

Perinataler Outcome von Zwillingsschwangerschaften mit vorzeitigem Blasensprung zwischen 13–20 Wochen: Ist ein selektiver Fetozid eine angemessene Behandlungsoption?
Michal Zajicek
1   ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
,
Simcha Yagel
2   ObGyn, Hadassah Medical Center, Jerusalem, Israel
,
Dan Valsky
2   ObGyn, Hadassah Medical Center, Jerusalem, Israel
,
Moshe Ben-Ami
3   ObGyn, Poriya Medical Center, Tiberias, Israel
,
Yoav Yinon
1   ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
,
Boaz Weisz
1   ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
,
Alina Weissmann-Brenner
4   Obstetrics and Gynecology, Chaim Sheba medical center, Ramat Gan, Israel
,
Shlomo Lipitz
1   ObGyn, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Abstract

Objective To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13–20 weeks of gestation and were managed by expectant management or by selective termination.

Methods A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13–20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included.

Results 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups.

Conclusion Selective termination in twin pregnancies complicated by rupture of membranes at 13–20 weeks has a favorable outcome and should be offered.

Zusammenfassung

Ziel Bewertung des Outcomes von Zwillingsschwangerschaften mit vorzeitigem Blasensprung („rupture of membranes“) zwischen 13–20 Schwangerschaftswochen, die durch abwartendes Management oder selektiven Schwangerschaftsabbruch behandelt wurden.

Methoden Eine retrospektive Kohortenstudie aller bichorionischen Zwillingsschwangerschaften, die zwischen 2001 und 2016 aufgrund eines Blasensprungs zwischen 13–20 Schwangerschaftswochen an 3 Pränatalzentren überwiesen wurden. Eingeschlossen wurden Frauen ohne klinischen Hinweis auf eine Infektion, die sich für ein abwartendes Management oder den selektiven Fetozid entschieden.

Ergebnisse Zwanzig Patientinnen erfüllten die Einschlusskriterien, davon wurden 7 abwartend behandelt und bei 13 erfolgte ein selektiver Fetozid. In der Gruppe mit abwartendem Management gab es einen intrauterinen Fruchttod und 2 neonatale Todesfälle, was eine Überlebensrate von 79 % ergab. Das mediane Gestationsalter bei Entbindung betrug 30 Wochen, 3 Neugeborene hatten frühgeburtliche Komplikationen und 2 Kinder orthopädische Komplikationen bedingt durch Oligohydramnie. Nach selektivem Abbruch betrug die Überlebensrate 50 % (alle nichtreduzierten Föten), das mediane Gestationsalter bei Entbindung betrug 39 Wochen und der neonatale Outcome war günstig. In beiden Gruppen war der maternale Outcome gut.

Schlussfolgerung Der selektive Fetozid bei Zwillingsschwangerschaften mit vorzeitigem Blasensprung zwischen 13–20 Schwangerschaftswochen hat einen günstigen Outcome und sollte angeboten werden.

Key words

premature preterm rupture of membranes - selective termination - expectant management - twin pregnancy


Publication History

Received: 02 November 2019

Accepted: 28 April 2020

Article published online:
15 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Linehan LA, Walsh J, Morris A. et al. Neonatal and maternal outcomes following midtrimester preterm premature rupture of the membranes: a retrospective cohort study. BMC Pregnancy Childbirth 2016; 16: 25
    CrossrefPubMedSearch in Google Scholar
  • 2 Everest NJ, Jacobs SE, Davis PG. et al. Outcomes following prolonged preterm premature rupture of the membranes. Arch Dis Child Fetal Neonatal Ed 2008; 93: F207-F211
    CrossrefPubMedSearch in Google Scholar
  • 3 Mercer BM, Crocker LG, Pierce WF. et al. Clinical characteristics and outcome of twin gestation complicated by preterm premature rupture of the membranes. Am J Obstet Gynecol 1993; 168: 1467-1473
    CrossrefPubMedSearch in Google Scholar
  • 4 Pristauz G, Bauer M, Maurer-Fellbaum U. et al. Neonatal outcome and two-year follow-up after expectant management of second trimester rupture of membranes. Int J Gynaecol Obstet 2008; 101: 264-268
    CrossrefPubMedSearch in Google Scholar
  • 5 Falk SJ, Campbell LJ, Lee-Parritz A. et al. Expectant Management in Spontaneous Preterm Premature Rupture of Membranes between 14 and 24 Weeks’ Gestation. Journal of Perinatology 2004; 24: 611-616
    CrossrefPubMedSearch in Google Scholar
  • 6 Grisaru-Granovsky S, Eitan R, Kaplan M. et al. Expectant management of midtrimester premature rupture of membranes: A plea for limits. J Perinatol 2003; 23: 235-239
    CrossrefPubMedSearch in Google Scholar
  • 7 Dinsmoor MJ, Bachman R, Haney EI. et al. Outcomes after expectant management of extremely preterm premature rupture of the membranes. Am J Obstet Gynecol 2004; 190: 183
    CrossrefPubMedSearch in Google Scholar
  • 8 Waters TP, Mercer BM. The management of preterm premature rupture of the membranes near the limit of fetal viability. Am J Obstet Gynecol 2009; 201: 230-240
    CrossrefPubMedSearch in Google Scholar
  • 9 Lorthe E, Torchin H, Delorme P. et al. Preterm premature rupture of membranes at 22–25 weeks' gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2). Am J Obstet Gynecol 2018; 219: 298.e1-298.e14
    CrossrefPubMedSearch in Google Scholar
  • 10 Dotters-Katz SK, Panzer A, Grace MR. et al. Maternal Morbidity After Previable Prelabor Rupture of Membranes. Obstet Gynecol 2017; 129: 101-106
    CrossrefPubMedSearch in Google Scholar
  • 11 Borenstein R, Shoham Z. Premature rupture of the membranes in a single twin gestational sac. A case report. J Reprod Med 1990; 35: 270-271
    PubMedSearch in Google Scholar
  • 12 Bakos O, Cederholm M, Kieler H. Very prolonged membrane rupture and delayed delivery of the second twin. Fetal Diagn Ther 1998; 13: 147-149
    CrossrefPubMedSearch in Google Scholar
  • 13 De Catte L, Laubach M, Bougatef A. et al. Selective feticide in twin pregnancies with very early preterm premature rupture of membranes. Am J Perinatol 1998; 15: 149-153
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Jazayeri A, Mamlok V, Dorsett MM. et al. Prolonged-interval delivery between the first and second twin. A case report. J Reprod Med 2002; 47: 167-169
    PubMedSearch in Google Scholar
  • 15 Wu MY, Yang YS, Huang SC. et al. Prolongation of pregnancy and survival of both twins after preterm premature rupture of membrane of twin A at 19 weeks’ gestation. Acta Obstet Gynecol Scand 1996; 75: 299-301
    CrossrefPubMedSearch in Google Scholar
  • 16 Dorfman SA, Robins RM, Jewell WH. et al. Second trimester selective termination of a twin with ruptured membranes: Elimination of fluid leakage and preservation of pregnancy. Fetal Diagn Ther 1995; 10: 186-188
    CrossrefPubMedSearch in Google Scholar
  • 17 Zajicek M, Yagel S, Ben-Ami M. et al. Outcome of Twin Pregnancies Complicated By Early Second Trimester Rupture of Membranes in One Sac. Twin Res and Hum Genet 2010; 13: 604-608
    CrossrefPubMedSearch in Google Scholar
  • 18 Practice Bulletin No. 172: Premature Rupture of Membranes. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Obstetrics. Obstet Gynecol 2016; 128: e165-e177
    CrossrefPubMedSearch in Google Scholar