Obstetric management and neonatal outcomes of single fetal previable preterm premature rupture of membranes (PV-PPROM) in dichorionic twin pregnancy: A case series.

Objective: This study aimed to assess the maternal and neonatal outcomes associated with various obstetric management strategies in dichorionic twin pregnancies following fetal previable preterm premature rupture of membranes (PV-PPROM), in instances where the pregnancy is continued. Methods: In this case series, seven pregnancies involving dichorionic twins admitted with PV-PPROM before 23+6 weeks of gestational age were included, totaling 14 fetuses. The assessed parameters included demographic details, PPROM onset time, delivery time, duration of the latent period, cervical length upon hospitalization post-PPROM, cervical dilatation, white blood cell (WBC) count (103 /µL), C-reactive protein (CRP) levels (mg/L), obstetric examination findings, chosen obstetric management, outpatient follow-up, mode of delivery, neonatal mortality, APGAR score, cord pH, birth weight, and neonatal intensive care requirements. Results: The study encompassed seven pregnant individuals and 14 fetuses. The average maternal age was 31.2 years (range 24–43 years), with 57% of pregnancies being dichorionic twins resulting from in vitro fertilization. The mean gestational week at the time of PPROM was 16.8 weeks (ranging from 13 to 19+3). Among the cases studied, expectant management was employed in three cases, selective fetal reduction in two cases, and delayed-interval delivery in two cases. Neonatal outcomes revealed a 35% rate of live births and a 21% neonatal survival rate without significant morbidity. Conclusion: Managing obstetric care poses challenges following single fetal PV-PPROM in dichorionic pregnancies. Obstetric management should be personalised by evaluating the intrauterine localization of the fetus with PPROM, considering cervical examination findings, and taking into account chorioamnionitis findings. It is essential to engage in discussions with parents about potential risks and complications. [ABSTRACT FROM AUTHOR]