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The Association Between Early Membrane Rupture, Latency, Clinical Chorioamnionitis, Neonatal Infection, and Adverse Perinatal Outcomes in Twin Pregnancies Complicated by Preterm Prelabour Rupture of Membranes

Published online by Cambridge University Press:  21 February 2012

Peter von Dadelszen ,
Sari Kives ,
Marie-France Delisle ,
R. Douglas Wilson ,
Ruth Joy ,
Laurie Ainsworth ,
Lamya Al Kharusi ,
Marilynne Oskamp ,
Jon F.R. Barrett  and
Greg Ryan
...Show all authors
Peter von Dadelszen*
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia,Vancouver. pvd@cw.bc.ca
Sari Kives
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia,Vancouver.
Marie-France Delisle
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia,Vancouver.
R. Douglas Wilson
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia,Vancouver.
Ruth Joy
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
Laurie Ainsworth
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
Lamya Al Kharusi
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
Marilynne Oskamp
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
Jon F.R. Barrett
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
Greg Ryan
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
Dan Farine
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
P. Gareth R. Seaward
Affiliation:
Clinical Research Support Unit, British Columbia Research Institute for Children's and Women's Health,Vancouver and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Canada.
*
*Address for correspondence: Dr Peter von Dadelszen, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Children's and Women's Health Centre of British Columbia, Suite 2H30, 4500 Oak Street, Vancouver, British Columbia, Canada V6H 3N1.

Abstract

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The objective of this study was to evaluate associations between adverse outcomes in twin pregnancies and preterm prelabour rupture of membranes (PPROM). A chart review of 246 consecutive twin pregnancies with confirmed PPROM was conducted. Regression analysis (β [natural log of the odds ratio] and odds ratio [OR]) was performed to identify independent predictors. Two hundred and forty-six twin pregnancies, 492 liveborns, and 20 neonatal deaths. Mean (SD) PPROM gestational age (GA): 31.3 (3.8) wk; delivery GA: 32.0 (3.3) wk. PPROM < 30wk was associated with increased parity (OR: 2.66), and log (admission leukocyte count) (OR: 9.99). Shortened latency was associated with PPROM GA (β = −0.17) and chorioamnionitis (β = 0.95). Neonatal sepsis was predicted by lower delivery GA (OR: 2.04). Adverse perinatal outcomes were protected against by older GA at PPROM (OR 0.53) and shortened latency (OR 0.73). It was concluded that increased leukocytosis and parity implies an infectious aetiology in earlier PPROM. Increased risk for neonatal sepsis at earlier delivery GA is consistent with gestation-dependent fetal immunocompetence. Early PPROM and long latencies were associated with increased adverse perinatal outcomes.

Type
Articles
Information
Twin Research and Human Genetics , Volume 6 , Issue 4 , 01 August 2003 , pp. 257 - 262
Copyright
Copyright © Cambridge University Press 2003