F Arias1. 1. Department of Obstetrics and Gynecology, St. John's Mercy Medical Center, St. Louis, MO 63141.
Abstract
OBJECTIVE: Premature rupture of membranes in multifetal gestations during the second trimester has an ominous prognosis and the majority of the fetuses die after preterm delivery. STUDY DESIGN: We used cervical cerclage, tocolysis, and antibiotic therapy after vaginal delivery of the fetus with ruptured membranes in eight patients with multifetal pregnancies to extend the intrauterine life and improve the outcome of the remaining fetuses. RESULTS: Survival of six fetuses was achieved in five of the eight pregnancies (four originally twins and one originally triplets). The mean +/- SD gestational age of the fetuses first delivered was 19.6 +/- 2.6 weeks, and it was 26.7 +/- 6.8 weeks in the fetuses with delayed delivery (exact two-tailed p = 0.01). The mean +/- SD birth weight of the fetuses delivered first was 306 +/- 149 gm and it was 1029 +/- 947 gm for the fetuses who had delayed delivery (exact two-tailed p = 0.05). The mean +/- SD prolongation of pregnancy was 48.8 +/- 42.06 days (range 8 to 114 days). CONCLUSIONS: Intervention with tocolysis, antibiotics, and cervical cerclage after delivery of the first fetus is a reasonable option for some patients with multifetal pregnancies and premature rupture membranes in the second trimester.
OBJECTIVE: Premature rupture of membranes in multifetal gestations during the second trimester has an ominous prognosis and the majority of the fetuses die after preterm delivery. STUDY DESIGN: We used cervical cerclage, tocolysis, and antibiotic therapy after vaginal delivery of the fetus with ruptured membranes in eight patients with multifetal pregnancies to extend the intrauterine life and improve the outcome of the remaining fetuses. RESULTS: Survival of six fetuses was achieved in five of the eight pregnancies (four originally twins and one originally triplets). The mean +/- SD gestational age of the fetuses first delivered was 19.6 +/- 2.6 weeks, and it was 26.7 +/- 6.8 weeks in the fetuses with delayed delivery (exact two-tailed p = 0.01). The mean +/- SD birth weight of the fetuses delivered first was 306 +/- 149 gm and it was 1029 +/- 947 gm for the fetuses who had delayed delivery (exact two-tailed p = 0.05). The mean +/- SD prolongation of pregnancy was 48.8 +/- 42.06 days (range 8 to 114 days). CONCLUSIONS: Intervention with tocolysis, antibiotics, and cervical cerclage after delivery of the first fetus is a reasonable option for some patients with multifetal pregnancies and premature rupture membranes in the second trimester.
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