294 Outcomes in twins versus singletons subsequent to preterm premature rupture of membranes

Abstract

To compare maternal and neonatal outcomes subsequent to preterm premature rupture of membranes (PPROM) in people with twin versus singleton gestations. We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their neonates who were born in 25 hospitals nationwide (2008 to 2011). Those with PPROM between 23 0/7 and 33 6/7 weeks of gestation were included in this analysis, while those with triplet pregnancy, or major fetal anomalies were excluded. The co-primary outcomes were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, or stillbirth subsequent to admission). For the twin cohort, one randomly selected twin from each gestation was used to identify the presence of morbidity for that gestation. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aORs) with 95% CIs for twin vs. singleton gestations. 1531 (1.3%) individuals met eligibility criteria for this analysis, with 218 (14.2%) having twin gestations. The median gestational age at PPROM was similar between patients with twins and singletons (31.2 weeks [IQR 27.4-32.9] vs 30.6 weeks [IQR 26.9-32.7], p=0.23), however those with twin gestations had a shorter median latency period (2.0 days [IQR 1.0-5.0] vs 3.0 days [IQR 2.0-8.0], p<0.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, aOR 0.97, 95% CI 0.66-1.42) or composite neonatal morbidity (17.9% vs 17.9%, aOR 1.01, 95% CI 0.69-1.48) did not differ between groups (Table). In a large, diverse cohort, the odds of composite maternal or neonatal morbidity per fetus following PPROM was similar between twin and singleton gestations.