Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York.
Am J Perinatol. 2023 Jan;40(1):68-73. doi: 10.1055/s-0041-1727277. Epub 2021 Apr 20.
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.
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.
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, < 0.001) and gestational age at delivery was significantly earlier (29.3 vs. 30.1 weeks, = 0.001). Twins were more likely to develop neonatal sepsis (20.1 vs. 13.4%, = 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%, = 0.002), and had higher rates of cerebral palsy (7.3 vs. 3.7, = 0.005). When adjusting for confounders, twin gestation remained an independent risk factor for shorter latency ( < 0.001).
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.
· 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..
有几项研究评估了未足月胎膜早破（PPROM）后单胎妊娠和双胎妊娠潜伏期和临床结局的差异；然而，这些数据仅限于单机构分析，且基于小样本量。本研究旨在评估在一大群高危早产的妇女中，PPROM 对单胎和双胎妊娠潜伏期和临床结局的影响是否存在差异。
这是一项多中心镁治疗早产高危妇女神经保护作用的临床试验的二次分析。我们的研究纳入了妊娠 24 周及以上的 PPROM 单胎和双胎妊娠妇女。我们比较了单胎妊娠和双胎妊娠，主要结局是 PPROM 后的潜伏期持续时间。次要结局包括选择围产儿和新生儿结局，包括长期神经发育结局。我们拟合了线性回归模型来评估潜伏期持续时间的独立危险因素。
我们的研究纳入了 1753 名妇女，其中 1602 名单胎妊娠（91%）和 151 名双胎妊娠（9%）。双胞胎的中位潜伏期明显较短（4[四分位间距，IQR：1-10]vs.7[IQR：3-16]天， < 0.001），分娩时的胎龄明显较早（29.3 周 vs.30.1 周， = 0.001）。双胞胎更易发生新生儿败血症（20.1% vs.13.4%， = 0.004），但绒毛膜羊膜炎和胎盘早剥的发生率无差异。双胞胎更易出现不良短期新生儿结局，新生儿死亡率更高（7.9% vs.3.8%， = 0.002），脑瘫发生率更高（7.3% vs.3.7%， = 0.005）。调整混杂因素后，双胎妊娠仍是潜伏期较短的独立危险因素（ < 0.001）。
PPROM 影响的双胎妊娠潜伏期更短，分娩更早，且短期和长期发病率更高。尽管潜伏期较长，但单胎妊娠的期待治疗相关并发症发生率并没有更高。
·PPROM 影响的双胎妊娠潜伏期更短，分娩更早。·PPROM 的双胞胎有更高的短期和长期围产期发病率。·PPROM 的双胞胎和单胎的绒毛膜羊膜炎和胎盘早剥发生率无差异。
