(709) Immediate Delivery versus Expectant Management in Twin Pregnancies with Late Preterm Rupture of Membranes

In recent years, the management of late preterm premature rupture of membrane (PPROM) has changed from expedient delivery towards expected management. Current literature provides limited information on preferred management in twin pregnancy. We aimed to compare maternal and neonatal outcomes in twin pregnancies presented with PPROM at 34-36 weeks.   

Study Design:  

A retrospective study was conducted at a single tertiary care center between 2011 and 2024. All individuals with twin pregnancies who presented with PPROM between 34.0 to 36.0 weeks of gestation were included. We compared those who were dispositioned for immediate delivery versus those managed expectantly. Maternal and neonatal outcomes were evaluated using frequentist statistics. 

Results:

During the study period, 146 twin pregnancies presented with PPROM and met inclusion criteria; 37 (25.3%) were managed expectantly, and 109 (74.7%) were dispositioned for delivery. Baseline and pregnancy characteristics were similar between the groups (Table 1).  Expectant management was associated with a higher rate of intrapartum fever (8.1% vs. 0.9%, p=0.05) and Cesarean delivery due to arrest of dilatation (13.5% vs. 1.8% p= 0.01) compared to immediate delivery. Furthermore, expectant management was associated with a higher rate of NICU admission (36.5% vs 23.9%, p=0.03), respiratory distress syndrome (6.8% vs 1.4%, p=0.01), and need for antibiotic treatment (63.5% vs. 28.9%, p< 0.01) compared to immediate delivery (Table 2).  

Conclusion:

In our cohort, expectant management for individuals with twin pregnancies presenting with PPROM at 34-36 weeks of gestation was associated with a higher rate of maternal and neonatal outcomes compared to immediate delivery.