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Conservative management leading to delivery of a twin pregnancy complicated by previable preterm premature rupture of membranes: a case report

Year: 2026

Type: article

Abstract: Background: The threshold of neonatal viability is established at a gestational age of 22-23 weeks. Previable preterm premature rupture of membranes (pPPROM) occurring prior to this period is frequently associated with recommendations for pregnancy termination due to exceedingly high rates of neonatal mortality and maternal infectious morbidity. The objective of this study is to provide a therapeutic reference for patients who experience premature rupture of membranes before 22 weeks of gestation and opt to continue their pregnancy. Case Description: fertilization and embryo transfer (IVF-ET) secondary to tubal factor infertility. At 18 weeks and 6 days of gestation, protrusion of the amniotic sac to the vaginal introitus occurred, resulting in pPPROM. A multidisciplinary team conducted a comprehensive assessment. After detailed counseling, an active conservative management strategy was implemented. This encompassed targeted antibiotic therapy, emergent cervical cerclage, planned administration of fetal lung maturation agents, and intensive maternal-fetal surveillance. The pregnancy was successfully prolonged for nearly 10 weeks, during which infection was controlled and normal fetal growth was maintained. At 28 weeks and 3 days of gestation, preterm labor necessitated cesarean delivery. Two live neonates were delivered; notably, Fetus B was delivered using the en caul cesarean delivery technique. Conclusions: This case illustrates that, with meticulous patient selection and individualized intervention, management of pPPROM occurring before the established limit of viability can yield favorable perinatal outcomes. These findings challenge the conventional paradigm of relying solely on gestational age criteria for decision-making.

Source: AME Case Reports

DOI: 10.21037/acr-2026-0092

Authors: Wen-Zhen Wang, Xiao-Guohui Zhang, Jing-Zhen Zhou, Xiao-Yan Lv, Li-Li Meng

Institution: Jinan University

Language: English

Topic: Preterm Birth and Chorioamnionitis

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: Jinan University