Longest Survival of Expectantly Managed Twin Gestation Complicated by Previable Preterm Premature Rupture of Membranes at 13 Weeks' Gestation

Previable preterm premature rupture of membranes (PV-PPROM) is defined as rupture of membranes prior to 24 weeks and is a rare phenomenon with an estimated prevalence of 0.5% of all pregnancies. Given that this phenomenon is even more rare in patients with dichorionic diamniotic (DCDA) twin pregnancies, there is no clear consensus in the literature on outcomes and management of DCDA PV-PPROM due to the scarcity of reports. We report a case of a rare successful prolongation of first trimester DCDA PV-PPROM pregnancy with rupture of the amniotic sac of one twin with survival of both twins without major complications. A 20-year-old female gravida 1 para 0 at about 13 weeks and three days presented with vaginal watery discharge mixed with vaginal bleeding. Abdominal ultrasound revealed a live twin dichorionic diamniotic (DCDA) spontaneous intrauterine gestation and a significantly low amniotic fluid volume involving fetus A. At 23 weeks gestational age, she experienced increased leaking of clear fluid, and she was admitted to the hospital for continuous monitoring with daily non-stress tests (NST), and ultrasounds every four weeks, and received antibiotics, betamethasone, and magnesium. Preterm labor occurred at 30w1d, and a primary low transverse cesarean section was performed on the 114th day after PPROM. Though, twin A required prolonged hospitalization both twins recovered and progressed well without complications. To the best of our knowledge, this is the longest case of successful expectant management of both twins with PV-PPROM yet reported.