Management of very early preterm premature rupture of membranes (PPROM) in twin pregnancies by selective feticide

Abstract

Abstract Aim: To assess the efficacy of selective termination in improving pregnancy outcome in very early preterm premature rupture of membranes (PPROM) in twin pregnancies. Methods: A total of six dichorionic twin intracytoplasmic sperm injection (ICSI) pregnancies complicated with very early PPROM between 17+5 and 19+3 gestational weeks were admitted to our hospital and were managed by selective termination of the member with ruptured membranes and followed up. Two cases were twins reduced from triplets at our unit (33%). The fetuses with ruptured membranes were subjected to feticide by intra-cardiac injection of potassium chloride after a mean of 3.5 days following PPROM. Results: The overall PPROM-delivery/miscarriage time-interval was 80 days using the proposed management scheme. Two cases ended with total pregnancy loss at 21+ and 23+ weeks, respectively. Four cases progressed successfully beyond 29 weeks, reaching an average of 35+5 days. Conclusions: The handling of these six twin PPROM cases as described produced a healthy baby to take home in four instances, resulting in a success rate of 67%, whereas the implementation of a more conservative approach using antibiotics and steroids is expected to lead to a survival rate of around 15% and a handicap rate up to 50%.