OP16.07: Outcomes of twin pregnancies complicated by prelabour rupture of membranes before 26 weeks of gestation: systematic review and meta‐analysis

To investigate the rate of obstetric and perinatal outcomes of premature rupture of membranes (PROM) occurring before 26 weeks in twin pregnancies. Medline, Embase, Cinahl and Web of Science databases were searched electronically up to January 2024. We included both randomised controlled trials as well as observational studies. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. We used meta-analyses of proportions to combine data and assess the pooled proportions. We used a random-effect model to perform the pooled data analyses. The study was registered with the PROSPERO database (CRD 42022368057). Eight studies including 227 twin pregnancies were included in the analysis. The pooled proportion of termination of pregnancy (TOP) was 4.6%, while the rate of selective TOP (sTOP) was 24.5%. After the exclusion of cases of TOP, the overall rate of spontaneous miscarriage or fetal demise was 20.9%, whereas the live birth rate of at least one twin was 71.6% of the ongoing pregnancies. The mean gestational age at delivery was 26.5 weeks and the mean latency between PROM and delivery was 5.4 weeks in all cases including those with fetal deaths. Neonatal outcomes showed that the overall neonatal mortality was 26.4%. When focusing only on pregnancies undergoing sTOP, the observed livebirth rate was 87.7%. The gestational age at rupture of membranes in these cases was 16.8 weeks and the latency between PROM and delivery was significantly longer (19.9 weeks) than that observed in unterminated pregnancies, with a mean gestational age at delivery nearly in the range of term (36.9 weeks). PROM in twins before 26 weeks is associated with overall high rates of adverse obstetric and neonatal outcomes, and it represents a clinical challenge for both counselling and management. Larger prospective studies unified objective protocols in terms of antenatal surveillance and management are needed.