Ponce Júlia, Cobo Teresa, Murillo Clara, Gonce Anna, Domínguez Nadia, Crovetto Francesca, Guirado Laura, Palacio Montse, Bennasar Mar
BCNatal, Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, 08028 Barcelona, Spain.
Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
J Clin Med. 2023 Apr 18;12(8):2949. doi: 10.3390/jcm12082949.
Preterm prelabour rupture of membranes (PPROMs) before viability carries significant perinatal mortality and morbidity. Clinical management and prenatal counselling are a challenge, especially in twin pregnancies, due to scarce evidence on how previable PPROM affects this population. The aim of this study was to describe pregnancy outcomes of twin pregnancies complicated with previable PPROM and evaluate potential prognostic factors that may predict perinatal mortality. A retrospective cohort including dichorionic and monochorionic diamniotic twin pregnancies complicated with PPROM before 24 + 0 weeks of pregnancy was evaluated. Perinatal outcomes of pregnancies managed expectantly were described. Factors predicting perinatal mortality or reaching periviability (defined from 23 + 0 weeks onwards) were evaluated. Of the 45 patients included, 7 (15.6%) spontaneously delivered within the first 24 h after diagnosis. Two patients (5.3%) requested selective termination of the affected twin. In the 36 ongoing pregnancies that opted for expectant management, the overall survival rate was 35/72 (48.6%). There were 25/36 (69.4%) patients who delivered after 23 + 0 weeks of pregnancy. When periviability was achieved, neonatal survival increased up to 35/44 (79.5%). Gestational age at delivery was the only independent risk factor of perinatal mortality. The overall survival rate of twin pregnancies complicated with previable PPROM is poor but similar to singletons. No prognostic factors, apart from achieving periviability, were identified as individual predictors of perinatal mortality.
未足月胎膜早破（PPROMs）发生在胎儿可存活之前会导致显著的围产期死亡率和发病率。临床管理和产前咨询是一项挑战，尤其是在双胎妊娠中，因为关于未足月PPROM如何影响这一人群的证据很少。本研究的目的是描述双胎妊娠合并未足月PPROM的妊娠结局，并评估可能预测围产期死亡率的潜在预后因素。对一个回顾性队列进行了评估，该队列包括妊娠24 + 0周前合并PPROM的双绒毛膜和单绒毛膜双羊膜囊双胎妊娠。描述了期待治疗的妊娠的围产期结局。评估了预测围产期死亡率或达到可存活期（从23 + 0周起定义）的因素。在纳入的45例患者中，7例（15.6%）在诊断后的前24小时内自然分娩。2例患者（5.3%）要求选择性终止受影响的胎儿。在选择期待治疗的36例持续妊娠中，总体存活率为35/72（48.6%）。25/36（69.4%）例患者在妊娠23 + 0周后分娩。当达到可存活期时，新生儿存活率提高到35/44（79.5%）。分娩时的孕周是围产期死亡率的唯一独立危险因素。双胎妊娠合并未足月PPROM的总体存活率较低，但与单胎妊娠相似。除了达到可存活期外，未发现其他预后因素可作为围产期死亡率的个体预测指标。
