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Outcomes of twin pregnancies complicated by prelabor rupture of membranes before 26 weeks of gestation: systematic review and meta-analysis.

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.

Item Type: Article
Additional Information: © 2024 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: PROM, Peri-viability, Pre-viability, Prelabor rupture of membranes, Preterm, Twin pregnancy, Twins, Viability, pPROM, Humans, Pregnancy, Fetal Membranes, Premature Rupture, Female, Pregnancy, Twin, Pregnancy Outcome, Infant, Newborn, Gestational Age, Premature Birth, Humans, Fetal Membranes, Premature Rupture, Premature Birth, Pregnancy Outcome, Gestational Age, Pregnancy, Infant, Newborn, Female, Pregnancy, Twin, Twins, Twin pregnancy, Prelabor rupture of membranes, pPROM, PROM, Preterm, Viability, Pre-viability, Peri-viability, Female, Fetal Membranes, Premature Rupture, Gestational Age, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Pregnancy, Twin, Premature Birth, Peri-viability, pPROM, Prelabor rupture of membranes, Preterm, Pre-viability, PROM, Twin pregnancy, Twins, Viability, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Cardiovascular & Genomics Research Institute
Academic Structure > Cardiovascular & Genomics Research Institute > Vascular Biology
Journal or Publication Title: Eur J Obstet Gynecol Reprod Biol
ISSN: 1872-7654
Language: eng
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 39426018
Web of Science ID: WOS:001341069400001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/117042
Publisher's version: https://doi.org/10.1016/j.ejogrb.2024.10.008

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