(855) The optimal timing for membranes rupture during twin labor

Rupture of membranes (ROM), can shorten the delivery length in singleton pregnancies without increasing the cesarean section (CS) rate. Since studies about the preferable timing for ROM in twins are limited, we aimed to study this issue.

Study Design:

We performed a retrospective cohort study at a single tertiary hospital, between 2010 – 2020. All twin pregnancies attempting vaginal delivery were included in our study cohort except for twin pregnancies with intrauterine fetal death and previous CS. The cohort was divided into two groups based on the time of ROM: group 1= early ROM during the latent phase ( < 6 cm of cervical dilatation), and group 2 = late ROM during the active phase (> 6 cm). The primary outcome was delivery mode and the secondary outcome included additional maternal and neonatal complications.

Results:

521 pregnancies were included in our study, 418 in group 1 and 103 in group 2. Demographics and clinical outcomes are described in Table 1. As shown in Table 2, the rate of artificial ROM was significantly higher in group 1 compared with group 2 (63.1% vs 50%, P=0.02). CS rate was lower in group 2 compared with group 1(14.6% vs 25.1%, P=0.025). Although women in group 2 had a higher order of parity (1.89±1.15 vs. 2.26±1.62, P=0.007), the duration of the active phase was not statistically different comparing between the groups. Rates of chorioamnionitis and placental abruption were similar comparing the groups and additional maternal and neonatal complications.

Conclusion:

Late ROM is associated with lower rates of CS. Higher rates of artificial ROM among the late ROM group indicate its safety profile in twin gestation augmentation. Our results can aid in the management of twin deliveries.