[Preterm prolong rupture of membrane in twin : prognosis factors of neonatal survival].

Abstract

Objective: To evaluate and identify factors influencing neonatal survival of twins in twin pregnancies with prolonged preterm premature rupture of membranes (PPROM) affecting one twin before 37 weeks of gestation.

Methods: A retrospective multicenter cohort study (2015-2021) including: 1/ twin pregnancies with PPROM between 13 and 37 weeks of gestation, 2/ two live fetuses at the time of rupture, and 3/ delayed delivery (>48 hours after rupture). The primary outcome was the survival of the affected twin. The secondary outcome was the survival of the co-twin. Univariate and multivariate analyses were performed.

Results: Among 402 cases of preterm prelabor rupture of membranes (PPROM), 132 patients were included. Survival at hospital discharge was 79.5% for twins with membrane rupture and 84.1% for their co-twins. Survival was correlated with a higher gestational age at the time of rupture (p=0.03) and at delivery (p<0.01). Improved survival was associated with dichorionic pregnancies (aOR 2.98; 95% CI: 1.06-8.34), a normal amniotic fluid volume, and a shorter latency period. The same was observed with the administration of corticosteroids and antibiotic prophylaxis. The prognosis of the unborn child is primarily associated with gestational age at delivery.

Conclusion: The survival of twins with prolonged PPROM is high. Dichorionic chorionicity and factors such as gestational age at delivery, normal amniotic fluid levels, and shorter duration of rupture improve survival.