title: Neonatal and infant outcomes in twin gestations with preterm premature rupture of membranes at 24-31 weeks of gestation.
abstract: OBJECTIVE
  To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes (PROM) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to 2 years of age.
  
  
  METHODS
  This was a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy. Inclusion criteria were twin gestation with preterm PROM diagnosed between 24 0/7 and 31 6/7 weeks of gestation and planned expectant management. Latency (time from membrane rupture to delivery) and perinatal outcomes were evaluated by gestational age at membrane rupture. Long-term neonatal outcomes were also analyzed.
  
  
  RESULTS
  Among 151 women who met inclusion criteria, the median gestational age at preterm PROM was 28.1 weeks (range 24.1-31.6 weeks). Approximately one-third of women achieved a latency of at least 1 week. Gestational age at preterm PROM (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.63-0.90 for each week after 24 weeks of gestation) and cervical dilation at admission (OR 0.66, 95% CI 0.49-0.90 for each centimeter of dilation) were inversely associated with a latency period of at least 1 week. There were no stillbirths (95% CI 0-1%), but the rate of neonatal mortality was 90 per 1,000 newborns (95% CI 57-112) with a 7.3% cerebral palsy rate among survivors (95% CI 4.4-10.3%).
  
  
  CONCLUSIONS
  In twin pregnancies, preterm PROM from 24 to 31 weeks of gestation is associated with a neonatal mortality rate of 9.0% and an overall cerebral palsy rate of 7.3%. A longer latency period is associated with less advanced cervical dilation and later gestational age at PROM. LEVEL OF EVIEDENCE: II.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Hector
authors.initials: H
authors.lastname: Mendez-Figueroa
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Dahlke
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Viteri
authors.forename: Suneet P
authors.initials: SP
authors.lastname: Chauhan
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Sean C
authors.initials: SC
authors.lastname: Blackwell
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D055815:Young Adult; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000517:prevention & control; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy / Q000401:mortality; D005500:Follow-Up Studies; D005865:Gestational Age; D007226:Infant Mortality; D015931:Intensive Care, Neonatal; D007747:Labor Stage, First; D007902:Length of Stay; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000401:mortality; D011446:Prospective Studies; D012121:Respiration, Artificial; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D013997:Time Factors; D000094422:Secondary Data Analysis