Abstract:

Very early preterm prelabor rupture of membrane (PPROM) refers to PPROM occurring before 24 weeks of gestation, when the fetus is not yet viable, often leading to extreme prematurity and high perinatal mortality. The occurrence of very early PPROM in twin pregnancies is relatively rare and is typically associated with a poor prognosis. Reaccumulation of amniotic fluid is uncommon in PPROM but is associated with improved perinatal outcomes. This report describes a case of dichorionic diamniotic twin pregnancy where PPROM occurred at 14⁺⁵ weeks of gestation. Ultrasound indicated that the amniotic fluid depth for fetus A was only 0.7 cm. After 8 days of expectant management, the leakage of amniotic fluid ceased, and by 17⁺⁴ weeks of gestation, the amniotic fluid depth for fetus A had gradually recovered to 2.1 cm. The pregnancy was successfully prolonged to 29⁺³ weeks of gestation, at which point a cesarean section was performed due to antepartum hemorrhage, resulting in the delivery of two live-born infants. Fetus A was hospitalized for 121 days and fetus B for 62 days. Follow-up assessment at 3 months and 8 months of age showed favorable growth and development. This case suggests that, in the absence of infection, active and individualized expectant management may create conditions for spontaneous healing of the membranes, and that reaccumulation of amniotic fluid is a key factor in improving maternal and neonatal outcomes.

Key words: Fetal membranes, premature rupture, Obstetric labor, premature, Oligohydramnios, Amniotic fluid reaccumulation, Pregnancy, twin, Expectant management