Premature rupture of the membranes in twin pregnancies: Maternal and fetal outcomes

Aim: To analyse outcomes of twin pregnancies complicated by membranes rupture between 24 and 37 weeks of gestation. Methods: Retrospective matched cohort study on twin pregnancies with premature membranes rupture, through review of clinical records at the Policlinico S. Orsola di Bologna, a tertiary hospital, between 2010 and 2020. Results: 171 twin pregnancies were admitted, over 10 years, with a diagnosis of premature rupture of membranes PPROM (fluid pooling on speculum and/or Insulin Growth Factor Binding Protein1 positive on vaginal secretions and oligohydramnios at ultrasound). The maternal and fetal outcomes of these pregnancies were compared to those of uneventful 178 twin pregnancies. There was no difference on risk factors. The mean gestational age at PROM was 33.9 weeks. PPROM newborns showed a lower birth weight (2072 ± 515 g vs. 2384 ± 454, p < 0.001), a higher rate of admission to neonatal intensive care unit (45.6% vs 22.2%, p < 0.001), and a higher rate of adverse outcomes, even if it did not achieve statistical significance (crude OR: 3.05, 95% CI: 2.04-4.56; adjusted OR: 1.45, 95% CI: 0.87-2.41). No cases of sepsis were found. Conclusion: In our cohort of twin pregnancies no significative risk factors for premature rupture of membranes were found. Although PROM is known to increase infectious morbidity, not all patients will develop these complications. PROM in twin pregnancies does not appear to be an independent risk factor for adverse maternal or neonatal outcomes when the effect of prematurity is accounted fo. Strategies to prolong pregnancy, when feasible, may mitigate adverse neonatal outcomes associated with PPROM in twin pregnancies.