Download PDF
Am J Perinatol 2023; 40(01): 068-073
DOI: 10.1055/s-0041-1727277
Original Article

Latency Period after Preterm Premature Rupture of Membranes: Singletons versus Twins

Nigel Madden
1   Department of Obstetrics and Gynecology, New York Presbyterian Hospital–Columbia University Irving Medical Center, New York, New York
,
Maria Andrikopoulou 
1   Department of Obstetrics and Gynecology, New York Presbyterian Hospital–Columbia University Irving Medical Center, New York, New York
,
Eve Overton
1   Department of Obstetrics and Gynecology, New York Presbyterian Hospital–Columbia University Irving Medical Center, New York, New York
,
Cynthia Gyamfi-Bannerman
1   Department of Obstetrics and Gynecology, New York Presbyterian Hospital–Columbia University Irving Medical Center, New York, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Several studies have evaluated the differences in duration of latency and clinical outcomes between singleton and twin pregnancies after preterm premature rupture of membranes (PPROM); however, these data are limited to single-institution analyses and based on small sample sizes. The aim of this study was to assess differences in latency and clinical outcomes in singletons versus twin gestations affected by PPROM in a large, diverse cohort of women.

Study Design This is a secondary analysis of a multicenter trial of magnesium for neuroprotection in women at high risk of preterm birth. Our study included women with PPROM ≥ 24 weeks with singleton and twin gestations. We compared singleton versus twin gestation and our primary outcome was duration of latency after PPROM. Secondary outcomes included selected perinatal and neonatal outcomes including long-term neurodevelopmental outcomes. We fit a linear regression model to assess independent risk factors for latency duration.

Results Our study included 1,753 women, 1,602 singleton gestations (91%) and 151 twin gestations (9%). The median latency period was significantly shorter in twins (4 [interquartile range, IQR: 1–10] vs. 7 [IQR: 3–16] days, p < 0.001) and gestational age at delivery was significantly earlier (29.3 vs. 30.1 weeks, p = 0.001). Twins were more likely to develop neonatal sepsis (20.1 vs. 13.4%, p = 0.004), but rates of chorioamnionitis and abruption did not differ. Twins were more likely to suffer from adverse short-term neonatal outcomes, had higher rates of neonatal demise (7.9 vs. 3.8%, p = 0.002), and had higher rates of cerebral palsy (7.3 vs. 3.7, p = 0.005). When adjusting for confounders, twin gestation remained an independent risk factor for shorter latency (p < 0.001).

Conclusion Twin gestations affected by PPROM had shorter latency, earlier delivery, and higher rates of short- and long-term morbidity. Despite having longer latency, singleton gestations did not have higher rates of complications associated with expectant management.

Key Points

  • Twins affected by PPROM had shorter latency duration and earlier gestational at delivery.

  • Twins with PPROM had higher rates of both short- and long-term perinatal morbidity.

  • Rates of chorioamnionitis and abruption did not differ between twins and singletons with PPROM.

Keywords

PPROM - latency period - cerebral palsy - twin gestation


Publication History

Received: 10 July 2020

Accepted: 02 March 2021

Article published online:
20 April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Manuck TA, Rice MM, Bailit JL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215 (01) 103.e1-103.e14
    CrossrefPubMedGoogle Scholar
  • 2 Gyamfi-Bannerman C, Ananth CV. Trends in spontaneous and indicated preterm delivery among singleton gestations in the United States, 2005-2012. Obstet Gynecol 2014; 124 (06) 1069-1074
    CrossrefPubMedGoogle Scholar
  • 3 Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol 2017; 41 (07) 387-391
    CrossrefPubMedGoogle Scholar
  • 4 Melamed N, Hadar E, Ben-Haroush A, Kaplan B, Yogev Y. Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2009; 22 (11) 1051-1056
    Google Scholar
  • 5 Pakrashi T, Defranco EA. The relative proportion of preterm births complicated by premature rupture of membranes in multifetal gestations: a population-based study. Am J Perinatol 2013; 30 (01) 69-74
    PubMedGoogle Scholar
  • 6 Bianco AT, Stone J, Lapinski R, Lockwood C, Lynch L, Berkowitz RL. The clinical outcome of preterm premature rupture of membranes in twin versus singleton pregnancies. Am J Perinatol 1996; 13 (03) 135-138
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Ehsanipoor RM, Arora N, Lagrew DC, Wing DA, Chung JH. Twin versus singleton pregnancies complicated by preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2012; 25 (06) 658-661
    CrossrefPubMedGoogle Scholar
  • 8 Esin S, Gyimadu A, Atak Z. et al. Preterm premature rupture of membranes in singleton vs twin pregnancies: the latency periods and the clinical outcomes revisited. J Obstet Gynaecol 2014; 34 (07) 593-597
    CrossrefPubMedGoogle Scholar
  • 9 Hsieh YY, Chang CC, Tsai HD, Yang TC, Lee CC, Tsai CH. Twin vs. singleton pregnancy. Clinical characteristics and latency periods in preterm premature rupture of membranes. J Reprod Med 1999; 44 (07) 616-620
    PubMedGoogle Scholar
  • 10 Jacquemyn Y, Noelmans L, Mahieu L, Buytaert P. Twin versus singleton pregnancy and preterm prelabour rupture of the membranes. Clin Exp Obstet Gynecol 2003; 30 (2-3): 99-102
    PubMedGoogle Scholar
  • 11 Kibel M, Barrett J, Tward C, Pittini A, Kahn M, Melamed N. The natural history of preterm premature rupture of membranes in twin pregnancies. J Matern Fetal Neonatal Med 2017; 30 (15) 1829-1835
    CrossrefPubMedGoogle Scholar
  • 12 Mercer BM, Crocker LG, Pierce WF, Sibai BM. Clinical characteristics and outcome of twin gestation complicated by preterm premature rupture of the membranes. Am J Obstet Gynecol 1993; 168 (05) 1467-1473
    CrossrefPubMedGoogle Scholar
  • 13 Myles TD, Espinoza R, Meyer W, Bieniarz A. Preterm premature rupture of membranes: comparison between twin and singleton gestations. J Matern Fetal Med 1997; 6 (03) 159-163
    PubMedGoogle Scholar
  • 14 Quist-Nelson J, de Ruigh AA, Seidler AL. et al; Preterm Premature Rupture of Membranes Meta-analysis (PPROMM) Collaboration. Immediate delivery compared with expectant management in late preterm prelabor rupture of membranes: an individual participant data meta-analysis. Obstet Gynecol 2018; 131 (02) 269-279
    CrossrefPubMedGoogle Scholar
  • 15 Rouse DJ, Hirtz DG, Thom E. et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (09) 895-905
    CrossrefPubMedGoogle Scholar
  • 16 Nelson KB, Ellenberg JH. Childhood neurological disorders in twins. Paediatr Perinat Epidemiol 1995; 9 (02) 135-145
    CrossrefPubMedGoogle Scholar
  • 17 Pharoah PO. Risk of cerebral palsy in multiple pregnancies. Clin Perinatol 2006; 33 (02) 301-313
    CrossrefPubMedGoogle Scholar
  • 18 Scher AI, Petterson B, Blair E. et al. The risk of mortality or cerebral palsy in twins: a collaborative population-based study. Pediatr Res 2002; 52 (05) 671-681
    CrossrefPubMedGoogle Scholar
  • 19 Drassinower D, Friedman AM, Običan SG, Levin H, Gyamfi-Bannerman C. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis. Am J Obstet Gynecol 2016; 214 (06) 743.e1-743.e6
    CrossrefPubMedGoogle Scholar
  • 20 Gratacós E, Carreras E, Becker J. et al. Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic umbilical artery flow. Ultrasound Obstet Gynecol 2004; 24 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 21 Hack KE, Derks JB, Elias SG. et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG 2008; 115 (01) 58-67
    CrossrefPubMedGoogle Scholar
  • 22 Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol 1997; 104 (10) 1203-1207
    CrossrefPubMedGoogle Scholar