Sorrenti, S;
Khalil, A;
Giancotti, A;
Zullo, F;
D'alberti, E;
Sasanelli, A;
D'ambrosio, V;
Mappa, I;
D'antonio, F;
Rizzo, G;
et al.
Sorrenti, S; Khalil, A; Giancotti, A; Zullo, F; D'alberti, E; Sasanelli, A; D'ambrosio, V; Mappa, I; D'antonio, F; Rizzo, G; Di Mascio, D
(2024)
Outcomes of twin pregnancies complicated by prelabor rupture of membranes before 26 weeks of gestation: systematic review and meta-analysis.
Eur J Obstet Gynecol Reprod Biol, 303.
pp. 70-77.
ISSN 1872-7654
https://doi.org/10.1016/j.ejogrb.2024.10.008
SGUL Authors: Khalil, Asma
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Abstract
OBJECTIVE: To investigate the rate of obstetric and perinatal outcomes of premature rupture of membranes (PROM) occurring before 26 weeks in twin pregnancies. DATA SOURCE: Medline, Embase, Cinahl and Web of Science databases were searched electronically up to January 2024. STUDY ELIGIBILITY CRITERIA: The selection criteria included both prospective and retrospective studies of twin pregnancies with PROM before 26 weeks of gestation. Case reports, case series with fewer than 5 cases, review articles, letters to the editor and editorials were excluded. Studies including both singletons and twin pregnancies were also excluded. STUDY APPRAISAL AND SYNTHESIS METHOD: We used meta-analyses of proportions to combine data and assess the pooled proportions. We used a random-effect model to perform the pooled data analyses. The study was registered with the PROSPERO database (CRD 42022368057). Quality assessment of the included studies was performed usingthe Newcastle-Ottawa Scale for cohort studies. RESULTS: Eight studies including 227 twin pregnancies were included in the analysis. The pooled proportion of termination of pregnancy (TOP) was 4.6 % (95 % CI 1.5-13.4), while the rate of selective TOP (sTOP) was 24.5 % (95 % CI 7.1-57.7). After the exclusion of cases of TOP, the overall rate of spontaneous miscarriage or fetal demise was 20.9 % (95 % CI 11.1-35.8), whereas the live birth rate of at least one twin was 71.6 % (95 % CI 61.2-80.1) of the ongoing pregnancies. The mean gestational age at delivery was 26.5 (95 % CI 25.1-28.0) weeks and the mean latency between PROM and delivery was 5.4 weeks (95 % CI 4.8-5.9) in all cases including those with fetal deaths. Neonatal outcomes showed that the overall neonatal mortality was 26.4 % (95 % CI 16.7-39.2). When focusing only on pregnancies undergoing sTOP, the observed livebirth rate was 87.7 %. The gestational age at rupture of membranes in these cases was 16.8 (95 % CI 14.9-18.6) weeks and the latency between PROM and delivery was significantly longer (19.9 (95 % CI 18.0-21.7) weeks) than that observed in unterminated pregnancies, with a mean gestational age at delivery nearly in the range of term (36.9 weeks). CONCLUSIONS: PROM in twins before 26 weeks is associated with overall high rates of adverse obstetric and neonatal outcomes, and it represents a clinical challenge for both counseling and management. Larger prospective studies unified objective protocols in terms of antenatal surveillance and management are needed.
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