A Comparison of Severe Maternal Morbidity After Pre- and Periviable Premature Prelabor Rupture of Membranes in Multiple Gestations: Expectant Management versus Pregnancy Termination.

Abstract

Objective: To compare severe maternal morbidity (SMM) and mortality after pre- or periviable prelabor rupture of membranes (pPPROM) in multiple gestation pregnancies among individuals choosing expectant management (EM) or termination of pregnancy (TOP).

Study design: A retrospective cohort study of multiple gestations with pPPROM between 14 ^0/7 and 23 ^6/7 at five hospitals within a large health system from 2011 to 2024. The primary outcome was SMM by the Centers for Disease Control (CDCs), 21 indicators compared between the two cohorts. Continuous outcomes were compared with Mann-Whitney U tests. Chi-square/Fisher's exact tests were used for categorical outcomes. Data was analyzed using R.

Results: Forty-five twin and 1 triplet gestations were included ( n  = 37 EM, n  = 9 TOP). There were no differences in gestational age at PPROM, age, race, and history of PPROM. There were no maternal deaths and no differences in chorioamnionitis, sepsis, ICU admission, blood loss, or hospital readmission. Seventy point three percent of patients undergoing EM experienced some form of maternal morbidity, and 27.0% experienced at least one CDC SMM indicator, but this was not different between groups.

Conclusion: One in four individuals with multiple gestations undergoing EM of pPPROM experienced at least one adverse maternal outcome by CDC criteria. There were no significant differences identified between EM and TOP, likely due to the study's limited size.

Key points: More than 70% of multiples with pPPROM electing EM experienced an adverse maternal outcome.There was no difference in maternal morbidity detected between EM and termination.One in four multiples with pPPROM electing EM had a severe adverse maternal outcome.Given disparities in access to termination, understanding maternal risks of pPPROM is critical.