title: The influence of prolonged preterm premature rupture of the membranes on neonatal outcome of the presenting and non-presenting twin.
abstract: OBJECTIVE
  To compare the neonatal outcome in twin gestations complicated by prolonged preterm premature rupture of membranes (PPROM).
  
  
  METHODS
  Between the years 2000 and 2010 we identified 48 women with twin pregnancies who were diagnosed as having PPROM and a latency period to delivery >24h. We compared the neonatal morbidity and mortality between the presenting and non-presenting twins, assuming that the rupture occurred in the lower sac. Importantly, in 30 women we were able to identify the location of the ruptured sac by ultrasound examination demonstrating oligohydramnion. In these 30 cases, neonatal outcome of fetuses in the ruptured sac and those in the intact sac were compared.
  
  
  RESULTS
  The median gestational age was 31 weeks (range 28-33) with a median latency period between PPROM and delivery of 9 days (range 1-18). Of the identified ruptures 90% (27/30) occurred in the lower sac (presenting twin). There was no significant difference between the presenting and non-presenting twin in terms of neonatal morbidity and mortality. Moreover, no difference was found when fetuses with ruptured sac were compared to those with intact membrane sac. Importantly, the outcomes were not affected by the length of the latency period.
  
  
  CONCLUSIONS
  The current study results demonstrated that the outcome of fetuses exposed to prolonged preterm rupture of membranes is similar to that of fetuses with intact membranes. Our data suggest that rupture of membranes per se did not cause any deleterious clinical manifestations or lead to clinical discordant inflammation and poor neonatal outcome, supporting a conservative management of twin pregnancies with PPROM.
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 6423906, Israel(1). Electronic address: co.aviad@gmail.com.
authors.forename: Aviad
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 6423906, Israel(1).
authors.forename: Avital
authors.initials: A
authors.lastname: Skornick-Rapaport
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 6423906, Israel(1).
authors.forename: Yoni
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 6423906, Israel(1).
authors.forename: Dror
authors.initials: D
authors.lastname: Mandel
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv 6423906, Israel(1).
authors.forename: Eli
authors.initials: E
authors.lastname: Rimon
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000000981:diagnostic imaging / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000209:etiology*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014427:Twins; D014463:Ultrasonography
keywords: Preterm labor; Preterm premature rupture of membranes (PPROM); Twin pregnancy