Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared outside of the session

CME Credit Offered

Abstract Award

Recording available 2/16-5/2

AIUM Credit

Foundation Awardee

Poster Icons

Abstract Award

Foundation Awardee

Poster Session 3

Category: Clinical Obstetrics

Poster Session 3

(742) Risk Factors for Unplanned Cesarean Delivery after Prelabor Rupture in Term Twin Pregnancies

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Avishag Abecassis, MD, MSc

MFM Fellow
Department of Obstetrics and Gynecology, Sheba Medical Center
Ramat Gan, HaMerkaz, Israel

Coauthor(s)

Keren Zloto, MD

sheba medical center
Tel Hashomer, Tel Aviv, Israel
HW

Hadeel Wattad, MD

Sheba Medical center, Israel
Ramat Gan, HaMerkaz, Israel
Noa Gonen, MD

MFM Fellow
Wolfson Medical Center
Holon, HaMerkaz, Israel
SM

Shali Mazaki-Tovi, MD

Vice Chairman
Department of Obstetrics and Gynecology, Sheba Medical Center
Ramat Gan, Tel Aviv, Israel
MF

Michal Fishel Bartal, MD

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Objective:
Current literature offers limited data regarding the association between prelabor rupture of membranes (PROM) likelihood of unplanned cesarean delivery (CD) in twin pregnancies. Our study aims to determine risk factors associated with unplanned CD in individuals with twin pregnancies presenting with PROM.

Study Design:
A retrospective cohort study conducted at a single tertiary medical center including all twin pregnancies with planned vaginal deliveries and PROM ≥ 36 weeks between 2011and 2025. Maternal and neonatal outcomes were compared between individuals who delivered vaginally and those who underwent unplanned CD.

Results:
During study period 421 twins pregnancies presented with PROM > 36 weeks of them 258 (61.2%) met inclusion criteria. The rate of unplanned CD was 28.3%. Patients in the unplanned CD group had a higher median maternal age (33.7 VS. 32.4 years, p=0.04), higher BMI (29 vs. 27.1, p=0.02), higher rate of nulliparity (60.3% vs. 38.9%, p < 0.01), cervical dilation < 2cm on admission (67.1% vs.36.8%, p < 0.01) and PROM duration >24 hours (32.9% vs. 14.6%, p < 0.01). Prior vaginal delivery was less common in the unplanned CD group (58.9% vs. 19.2%, p < 0.01). Intrapartum fever and oxytocin use were not associated with increased CD rates (Table 1). Postpartum hemorrhage occurred more frequently following vaginal delivery (9.7% vs. 1.4%, p < 0.01), whereas adverse neonatal outcomes including 1-minute Apgar < 7 and NICU admission were more common after CD (6.8% vs. 3%, p=0.04 and 8.2% vs. 2.4%, p < 0.01, respectively). (Table 2).

Conclusion:
In term twin pregnancies with PROM, a trial of labor is associated with a high rate of vaginal delivery. Nulliparity, limited cervical dilation, and prolonged latency were associated with unplanned cesarean delivery. These factors may aid clinicians and patients alike in decision-making during labor induction in this population.