A retrospective cohort study of hospital versus home care for pregnant women with preterm prelabor rupture of membranes

Palmer, Lynne; Grabowska, Kirsten; Burrows, Jason; Rowe, Hilary; Billing, Erin; Metcalfe, Amy

doi:10.1002/ijgo.12122

Cited by 18 publications

(32 citation statements)

References 11 publications

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“…In fact, most of the papers analyzed reported higher rates: 23.9% (18), 34.7% (9), 35% (46), 47% (8), 53% (47), and 67.1% (7). However, there were also studies with comparatively lower rates: 20.2% (49); 17.4% (21); 16.5% (37), 14.6% (10); 12% (19); 9% (20); and 2.4% (11). However, in the latter case (11), only 29.7% of the sample had PPROM, and the great majority were >37 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological profile of patients with preterm premature rupture of membranes at a tertiary hospital in São Paulo, Brazil

Galletta

Bittar

Agra

et al. 2019

Clinics

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OBJECTIVE:To perform a descriptive analysis of preterm premature rupture of membranes (PPROM) cases attended in a tertiary hospital.METHOD:Retrospective analysis of medical records and laboratory tests of patients admitted to a Brazilian tertiary hospital between 2006 and 2011, with a confirmed diagnosis of PPROM and gestational age (GA) at delivery <37 weeks.RESULTS:A total of 299 pregnant women were included in the study. Nine patients evolved to abortion, and 290 pregnant women remained for the final analysis. There was initial diagnostic doubt in 17.6% of the cases. The oligohydramnios rate [amniotic fluid index (AFI) <5] was 27.9% on admission. Chorioamnionitis was initially diagnosed in 10.8% of the patients and was retrospectively confirmed in 22.9% of the samples. The latency period had a mean of 9.1 days. The main reasons for interruption were premature labor (55.2%), GA ≥36 weeks (27.2%), and fetal distress (6.9%). The delivery method was cesarean section in 55% of cases. The mean birth weight was 2,124 grams, and 67% of the neonates had a low birth weight (<2500 g). The GA at delivery averaged 33.5 weeks. The stillbirth rate was 5.3%, and the early neonatal mortality rate was 5.6%. There were complications at delivery in 18% of mothers.CONCLUSION:In one of the few Brazilian reports on the epidemiological profile of PPROM, with GA until 37 weeks and intercurrences generally excluded from assessments (such as twinning and fetal malformations), there is a favorable evolution, with an acceptable rate of complications.

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Section: Discussionmentioning

confidence: 99%

Epidemiological profile of patients with preterm premature rupture of membranes at a tertiary hospital in São Paulo, Brazil

Galletta

Bittar

Agra

et al. 2019

Clinics

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“…Three retrospective studies have shown that maternal outcomes (chorioamnionitis, mode of delivery) and neonatal outcomes (hospitalization in intensive care units, respiratory distress syndrome, intraventricular hemorrhage) were comparable between outpatients and inpatients, but these studies suffer from selection bias 14,27–29 . Indeed, most of the women in outpatient care were different from inpatients because of specific eligibility criteria with better prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Outpatient versus inpatient care for preterm premature rupture of membranes before 34 weeks of gestation

Bouchghoul

Kayem

Schmitz

et al. 2019

Sci Rep

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Preterm premature rupture of membranes (PPROM) is associated with an increased risk of serious maternal, fetal, and neonatal morbidities. We compared neonatal outcomes of women with PPROM before 34+0 weeks of gestation according to inpatient or outpatient management policy. 587 women with PPROM >48 hours, 246 (41.9%) in the group with an inpatient care policy (ICP) and 341 (58.1%) in the group with an outpatient care policy (OCP), were identified in France, from 2009 to 2012. Neonatal outcomes were compared between the two groups using logistic regression. A second analysis was performed to compare inpatient care and effective outpatient care (discharge from hospital) through propensity score matching. The outcome was a neonatal composite variable including one or more of the neonatal morbidity complications. The perinatal composite outcome was 14.6% with the ICP and 15.5% with the OCP (p = 0.76). After using the 1:1 ratio propensity score matching, effective outpatient care was not associated with a significantly higher risk of the perinatal composite outcome (OR 0.88, CI 0.35 to 2.25; p = 0.80) compared with inpatient care. Outpatient care is not associated with an increased rate of obstetric or neonatal complications and can be an alternative to hospital care for women with uncomplicated PPROM.

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“…Overall, comparative studies found no significant differences in the rate of major complications, including chorioamnionitis, between the study groups 33 , 34 , 37 , 38 , 40 , 41 .…”

Section: Discussionmentioning

confidence: 80%

“…The clear benefit of outpatient management compared to inpatient care is the significantly shorter hospital stay 30 , 34 , 38 , 40 , 50 , which in combination with a significantly shorter length of stay of preterm infants on the neonatal intensive care unit results in considerable savings in treatment (hospital) costs 29 , 30 , 51 .…”

Section: Discussionmentioning

confidence: 99%

“…In another retrospective ICD-based data analysis from Canada 38 , 87 pregnant women with PPROM at 23 + 0 to 34 + 0 weeksʼ gestation were managed at home and 89 as inpatients (see Table 1 for inclusion criteria). After hospital admission, all pregnant women received antibiotics and betamethasone for foetal lung maturation induction for 3 days and then were assigned to either of the two study groups.…”

Section: Outcomes From Retrospective Studiesmentioning

confidence: 99%

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Preterm Premature Rupture of Membranes – Inpatient Versus Outpatient Management: an Evidence-Based Review

Rath

Maul

Kyvernitakis

et al. 2021

Geburtshilfe Frauenheilkd

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According to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the increasing burden on obstetric departments and the growing importance of satisfaction and right to self-determination in pregnant women, outpatient management in PPROM is a possible alternative to inpatient monitoring. The most important criterion for this approach is to ensure the safety of both the mother and the child. Due to the small number of cases (n = 116), two randomised controlled trials (RCTs) comparing inpatient and outpatient management were unable to draw any conclusions. By 2020, eight retrospective comparative studies (cohort/observational studies) yielded the following outcomes: no significant differences in the rate of maternal complications (e.g., chorioamnionitis, premature placental abruption, umbilical cord prolapse) and in neonatal morbidity, significantly prolonged latency period with higher gestational age at birth, higher birth weight of neonates, and significantly shorter length of stay of preterm infants in neonatal intensive care, shorter hospital stay of pregnant women, and lower treatment costs with outpatient management. Concerns regarding this approach are mainly related to unpredictable complications with the need for rapid obstetric interventions, which cannot be performed in time in an outpatient setting. Prerequisites for outpatient management are the compliance of the expectant mother, the adherence to strict selection criteria and the assurance of adequate monitoring at home. Future research should aim at more accurate risk assessment of obstetric complications through studies with higher case numbers and standardisation of outpatient management under evidence-based criteria.

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A retrospective cohort study of hospital versus home care for pregnant women with preterm prelabor rupture of membranes

Abstract: Maternal and newborn outcomes were similar between women who received PCAH and those who were managed in hospital. The reduced resource use in PCAH might lead to cost savings without compromising outcomes.

Cited by 18 publications

References 11 publications

Epidemiological profile of patients with preterm premature rupture of membranes at a tertiary hospital in São Paulo, Brazil

Epidemiological profile of patients with preterm premature rupture of membranes at a tertiary hospital in São Paulo, Brazil

Outpatient versus inpatient care for preterm premature rupture of membranes before 34 weeks of gestation

Preterm Premature Rupture of Membranes – Inpatient Versus Outpatient Management: an Evidence-Based Review

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