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Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks.
Am J Obstet Gynecol. 2015 Feb; 212(2):215.e1-9.AJ

Abstract

OBJECTIVE

The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks.

STUDY DESIGN

This was a retrospective cohort of all multifetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single maternal-fetal medicine practice between July 4, 2002, and Sept. 1, 2013. Neonatal and maternal outcomes were assessed and comparisons made between the fetus with ruptured membranes and the first fetus to deliver with intact membranes.

RESULTS

Twenty-three pregnancies (46 fetuses) were analyzed with a median gestational age at PPROM of 22.9 weeks; 74% experienced PPROM at less than 24 weeks' gestation. A median latency of 11 days was achieved with expectant management. Of the 46 neonates, 20 (43%) survived to hospital discharge. Of these, 12 (60%) experienced severe neonatal morbidity defined as defined as grade III or IV intraventricular hemorrhage, bronchopulmonary dysplasia, pulmonary hypoplasia, necrotizing enterocolitis requiring surgical intervention, and/or grade 3 or 4 retinopathy of prematurity. Eight neonates survived to hospital discharge without severe neonatal morbidity. The multiple with ruptured membranes was more likely to experience intrauterine demise but otherwise had similar outcomes as the multiple with intact membranes. Maternal morbidity was considerable, with 7 of 23 pregnancies (30%) complicated by clinical chorioamnionitis, 12 of 23 (52%) delivering by cesarean, of which 3 of 12 (25%) were classical cesarean deliveries.

CONCLUSION

Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multifetal gestation complicated by very early PPROM.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT. Electronic address: luchin.wong@hsc.utah.edu.Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25218125

Citation

Wong, Luchin F., et al. "Outcomes of Expectantly Managed Pregnancies With Multiple Gestations and Preterm Premature Rupture of Membranes Prior to 26 Weeks." American Journal of Obstetrics and Gynecology, vol. 212, no. 2, 2015, pp. 215.e1-9.
Wong LF, Holmgren CM, Silver RM, et al. Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks. Am J Obstet Gynecol. 2015;212(2):215.e1-9.
Wong, L. F., Holmgren, C. M., Silver, R. M., Varner, M. W., & Manuck, T. A. (2015). Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks. American Journal of Obstetrics and Gynecology, 212(2), e1-9. https://doi.org/10.1016/j.ajog.2014.09.005
Wong LF, et al. Outcomes of Expectantly Managed Pregnancies With Multiple Gestations and Preterm Premature Rupture of Membranes Prior to 26 Weeks. Am J Obstet Gynecol. 2015;212(2):215.e1-9. PubMed PMID: 25218125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks. AU - Wong,Luchin F, AU - Holmgren,Calla M, AU - Silver,Robert M, AU - Varner,Michael W, AU - Manuck,Tracy A, Y1 - 2014/09/16/ PY - 2014/06/05/received PY - 2014/07/22/revised PY - 2014/09/03/accepted PY - 2014/9/15/entrez PY - 2014/9/15/pubmed PY - 2015/4/9/medline KW - latency KW - multiple gestation KW - neonatal morbidity KW - periviable KW - preterm premature rupture of membranes SP - 215.e1 EP - 9 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 212 IS - 2 N2 - OBJECTIVE: The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks. STUDY DESIGN: This was a retrospective cohort of all multifetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single maternal-fetal medicine practice between July 4, 2002, and Sept. 1, 2013. Neonatal and maternal outcomes were assessed and comparisons made between the fetus with ruptured membranes and the first fetus to deliver with intact membranes. RESULTS: Twenty-three pregnancies (46 fetuses) were analyzed with a median gestational age at PPROM of 22.9 weeks; 74% experienced PPROM at less than 24 weeks' gestation. A median latency of 11 days was achieved with expectant management. Of the 46 neonates, 20 (43%) survived to hospital discharge. Of these, 12 (60%) experienced severe neonatal morbidity defined as defined as grade III or IV intraventricular hemorrhage, bronchopulmonary dysplasia, pulmonary hypoplasia, necrotizing enterocolitis requiring surgical intervention, and/or grade 3 or 4 retinopathy of prematurity. Eight neonates survived to hospital discharge without severe neonatal morbidity. The multiple with ruptured membranes was more likely to experience intrauterine demise but otherwise had similar outcomes as the multiple with intact membranes. Maternal morbidity was considerable, with 7 of 23 pregnancies (30%) complicated by clinical chorioamnionitis, 12 of 23 (52%) delivering by cesarean, of which 3 of 12 (25%) were classical cesarean deliveries. CONCLUSION: Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multifetal gestation complicated by very early PPROM. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/25218125/Outcomes_of_expectantly_managed_pregnancies_with_multiple_gestations_and_preterm_premature_rupture_of_membranes_prior_to_26_weeks_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(14)00924-7 DB - PRIME DP - Unbound Medicine ER -