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To compare severe maternal morbidity (SMM) and mortality after pre- or periviable prelabor rupture of membranes (pPPROM) in multiple gestation pregnancies among individuals choosing expectant management (EM) or termination of pregnancy (TOP).
Study DesignA retrospective cohort study of multiple gestations with pPPROM between 140/7 and 236/7 at five hospitals within a large health system from 2011 to 2024. The primary outcome was SMM by the Centers for Disease Control (CDCs), 21 indicators compared between the two cohorts. Continuous outcomes were compared with Mann–Whitney U tests. Chi-square/Fisher's exact tests were used for categorical outcomes. Data was analyzed using R.
ResultsForty-five twin and 1 triplet gestations were included (n = 37 EM, n = 9 TOP). There were no differences in gestational age at PPROM, age, race, and history of PPROM. There were no maternal deaths and no differences in chorioamnionitis, sepsis, ICU admission, blood loss, or hospital readmission. Seventy point three percent of patients undergoing EM experienced some form of maternal morbidity, and 27.0% experienced at least one CDC SMM indicator, but this was not different between groups.
ConclusionOne in four individuals with multiple gestations undergoing EM of pPPROM experienced at least one adverse maternal outcome by CDC criteria. There were no significant differences identified between EM and TOP, likely due to the study's limited size.
Key PointsMore than 70% of multiples with pPPROM electing EM experienced an adverse maternal outcome.
There was no difference in maternal morbidity detected between EM and termination.
One in four multiples with pPPROM electing EM had a severe adverse maternal outcome.
Given disparities in access to termination, understanding maternal risks of pPPROM is critical.
Keywords maternal morbidity - maternal complications - adverse outcomes - preterm prelabor rupture of membranes - multiple gestation Publication HistoryReceived: 26 April 2025
Accepted: 11 June 2025
Accepted Manuscript online:
27 June 2025
Article published online:
09 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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