title: The natural history of preterm premature rupture of membranes in twin pregnancies.
abstract: OBJECTIVE
  To compare the characteristics of preterm premature rupture of membranes (PPROM) between twin and singleton pregnancies.
  
  
  METHODS
  This was a retrospective study of all women with twin and singleton pregnancies admitted with PPROM between 24-34 weeks of gestation.
  
  
  RESULTS
  Overall 698 women with PPROM were eligible for the study: 101 (14.5%) twins and 597 (85.5%) singletons. Twins presented with PPROM at a more advanced gestational age compared with singletons (29.1 ± 2.7 vs. 28.5 ± 2.8 weeks, p = 0.03). The latency period was shorter in twins compared with singletons, especially for women presenting after 28 weeks of gestation (5.0 ± 0.8 vs. 7.0 ± 0.4 days, p = 0.01). Women with twins were more likely to deliver within 48 h (OR: 2.7; 95%CI: 1.7-4.2) and were less likely to deliver within 2-7 days (OR:  0.5; 95%CI: 0.3-0.9) following PPROM. The rate of clinical chorioamnionitis or placental abruption following PPROM was lower in twins compared with singletons (15.8% vs. 26.0%, p = 0.03).
  
  
  CONCLUSIONS
  PPROM in twin pregnancies tends to occur at a more advanced gestational age, is associated with a shorter latency period and is less likely to be complicated by chorioamnionitis or placental abruption compared with singletons. This information may be useful for counseling and management decisions in cases of PPROM in women with twins.
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto , Ontario , Canada.
authors.forename: Mia
authors.initials: M
authors.lastname: Kibel
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto , Ontario , Canada.
authors.forename: Jon
authors.initials: J
authors.lastname: Barrett
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto , Ontario , Canada.
authors.forename: Carly
authors.initials: C
authors.lastname: Tward
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto , Ontario , Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Pittini
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto , Ontario , Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Kahn
authors.affiliation: a Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto , Ontario , Canada.
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin / Q000502:physiology* / Q000706:statistics & numerical data; D047928:Premature Birth; D012189:Retrospective Studies; D014427:Twins
keywords: Preterm premature rupture of membranes; latency; twins