Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

Maternal and fetal outcomes in term premature rupture of membrane

BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia.METHODS: A retrospective cross sectional study was conducted using data available at MizanAman General Hospital during a period of 3 years(January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically signifi cant.RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours(AOR=5.6, 95%CI 1.3–24.1) latency >24 hours(AOR=2.8, 95%CI 1.7–11.8), residing in rural areas(AOR=4.2, 95%CI 3.96–29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes.CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.

THE RELATIONSHIP BETWEEN INTERLEUKIN-6,INTERLEUKIN-8 CONCENTRATIONS AND INTRAAMNIO INFECTION AND APGAR SCORES

we d.termlned amniotic fluid and blood IL-6, 8 concentrations or so pregnancy womenwith premature rupture of membrane,(PROM) by ELISA - e^led the fetal membranes by.pathology. The results showed that there were 36 petients with intraamnio infection (IAI) and theirIL-6.IL-8 concentrations were significantly higher than those of the patients without IAI. In 20 ofthe 36 patients their neonates Apgar scores≤7 and their fluid- blood IL-6.IL-8 cooreuthed.were significently higher htat those. of other 16 patients whose Apgar scores≥8.These results ndicated that the bkood and amnioiotic fluid IL-6. IL-8 concentrations of pregnancy wom-en with PROM would help to predict and esimate fetus prognosis