Outcomes of Selective Reduction of DCDA Twins Complicated by PV-PROM Compared with Expectant Management: A Case Series and Review of the Literature

Objective: To report the outcomes of selective reduction (SR) in dichorionic twins complicated by pre-viable, premature rupture of membranes (PV-PROM).

Methods: Retrospective case series. Ultrasound database was searched for cases of dichorionic twin pregnancy with PV-PROM, either managed conservatively or with SR. Chart reviews were done for these cases. Simple descriptive statistics were used where appropriate.

Results: Twenty-two cases of expectantly managed dichorionic twins complicated by PV-PROM with delivery information were available for analysis. Mean GA at PV-PROM was 20.6 weeks, mean GA of delivery was 27.6 weeks, and the mean latency was 39.6 days. There were five cases of SR following PV-PROM in dichorionic twin pregnancies. Mean GA of PV-PROM was 17.0 weeks. Average time from PV-PROM to procedure was 2.5 weeks. Mean GA of delivery of the surviving fetus was 32.6 weeks (P = 0.20) with mean latency of 108 days (P = 0.06). Twelve additional cases have been published and are summarized along with our five cases.

Conclusion: There was a trend towards an increase in latency interval between cases of PV-PROM managed by SR and expectant management in our institution. When combined with the existing literature data, there may be an improvement in latency.