Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13–20 Weeks: Is Selective Termination an Appropriate Management Option?

Abstract

Objective To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13–20 weeks of gestation and were managed by expectant management or by selective termination.

Methods A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13–20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included.

Results 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups.

Conclusion Selective termination in twin pregnancies complicated by rupture of membranes at 13–20 weeks has a favorable outcome and should be offered.

Zusammenfassung

Ziel Bewertung des Outcomes von Zwillingsschwangerschaften mit vorzeitigem Blasensprung („rupture of membranes“) zwischen 13–20 Schwangerschaftswochen, die durch abwartendes Management oder selektiven Schwangerschaftsabbruch behandelt wurden.

Methoden Eine retrospektive Kohortenstudie aller bichorionischen Zwillingsschwangerschaften, die zwischen 2001 und 2016 aufgrund eines Blasensprungs zwischen 13–20 Schwangerschaftswochen an 3 Pränatalzentren überwiesen wurden. Eingeschlossen wurden Frauen ohne klinischen Hinweis auf eine Infektion, die sich für ein abwartendes Management oder den selektiven Fetozid entschieden.

Ergebnisse Zwanzig Patientinnen erfüllten die Einschlusskriterien, davon wurden 7 abwartend behandelt und bei 13 erfolgte ein selektiver Fetozid. In der Gruppe mit abwartendem Management gab es einen intrauterinen Fruchttod und 2 neonatale Todesfälle, was eine Überlebensrate von 79 % ergab. Das mediane Gestationsalter bei Entbindung betrug 30 Wochen, 3 Neugeborene hatten frühgeburtliche Komplikationen und 2 Kinder orthopädische Komplikationen bedingt durch Oligohydramnie. Nach selektivem Abbruch betrug die Überlebensrate 50 % (alle nichtreduzierten Föten), das mediane Gestationsalter bei Entbindung betrug 39 Wochen und der neonatale Outcome war günstig. In beiden Gruppen war der maternale Outcome gut.

Schlussfolgerung Der selektive Fetozid bei Zwillingsschwangerschaften mit vorzeitigem Blasensprung zwischen 13–20 Schwangerschaftswochen hat einen günstigen Outcome und sollte angeboten werden.

Key words

premature preterm rupture of membranes - selective termination - expectant management - twin pregnancy

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