Pre-Viable Spontaneous Rupture of Membrane in an IVF Achieved Twin Gestation: A Case Report

Abstract

Pre-viability is the limit of viability or the earliest stage of fetal maturity when a fetus has a reasonable chance for extra-uterine survival. Pre-viable preterm premature rupture of membranes has a higher risk for early preterm delivery which is associated with high perinatal and neonatal morbidity and mortality. Survivors may even develop long-term neurologic manifestations. To improve chances of survival conservative treatment is done, but on the other hand, it increases maternal infectious morbidity. We present a 36-year-old primigravida with an in-vitro fertilization (IVF) achieved twin gestation at 25 weeks who had spontaneous rupture of membranes. She was managed conservatively with close feto-maternal surveillance, steroid (dexamethasone), and antibiotics (erythromycin) for a 6-week latency period. She developed features suggestive of chorioamnionitis and genuine preterm labour. Loading dose of magnesium sulphate was given. She subsequently had an emergency caesarean section and was delivered ofss a set of viable twins.  Twin 1 is a live male neonate, with a birth weight of 1.6kg and an Apgar score of 4 in 1 minute, 5 in 5 minutes, and 6 in 10 minutes.   Twin 2 is a live female neonate, birth weight 1.8 kg with an Apgar score of 8 in 1 minute, and 10 in 5 minutes. They were managed at the neonatal intensive care unit and were both discharged with no sequelae. This shows the success of conservative management for pre-viable preterm premature rupture of membrane resulting in a positive maternal and fetal outcome.