ABSTRACT: Preterm prelabor rupture of membranes (pPROM) often occurs without any known risk factors, and 50% to 75% of women with pPROM will go into labor within 7 to 14 days. Some women receive expectant management as outpatients after pPROM, with advantages of greater convenience, potentially reduced risk of thromboembolic disease, and reduced costs. This prospective cohort study was undertaken to determine the outcomes of women admitted following pPROM and not delivered within the first 72 hours and to determine the effect of subsequent in-hospital or outpatient care on outcomes.
Of 478 women with pPROM (<34 weeks’ gestation), 151 were undelivered after 72 hours; the final cohort included 144 parturients. Preterm prelabor rupture of membranes was diagnosed and treated by standard methods, including administration of betamethasone, nifedipine, and erythromycin. Outpatient care included twice-weekly review of symptoms, abdominal palpation, vital observations, fetal heart rate, assessment of amniotic fluid, and ultrasound scans for fetal growth (every 2 weeks), and maternal full blood and C-reactive protein determinations. Hospital care comprised daily review of similar parameters. The primary outcomes were composites of maternal morbidity factors and perinatalmorbidity/mortality. The neonatal composite included stillbirth, neonatal death, respiratory distress syndrome, neonatal infection, chronic neonatal lung disease, intraventricular hemorrhage, periventricular leukomalacia, and necrotizing enterocolitis.
Ninety-one and 53 women were managed in hospital and as outpatients, respectively. The groups did not differ in demographic characteristics. Gestational ages at pPROM for the in-hospital and outpatient groups were 28.5 and 28.0 weeks, respectively. However, the respective latency periods from membrane rupture to birth were 12.4 and 32.6 days; birth weights were 1602 and 2121 g, respectively (P G 0.001 for all 3 comparisons). For 105 babies admitted to the NICU, the stays were 32.8 and 20.2 days, respectively (P G 0.014.). The groups did not differ in perinatal mortality or incidences of neonatal infection, respiratory distress syndrome, chronic neonatal lung disease, periventricular leukomalacia, periventricular hemorrhage, or necrotizing enterocolitis. The groups also did not differ in the likelihood of Apgar score of less than 7 at 5 minutes (17.1% vs 8.0%; P = 0.108), need for intubation during resuscitation (22.0% vs 20.8%; P = 0.863), or NICU admission (86.8% vs 81.1%; P = 0.361). When adjusted for confounders, in-hospital and outpatient care did not differ in the composite outcome of perinatal morbidity/mortality (adjusted odds ratio, 1.37; 95%confidence interval, 0.55–3.47). Maternal outcomes were similar; when adjusted for confounders, the groups did not differ in the composite outcome of maternal morbidity (adjusted odds ratio, 1.62; 95% confidence interval, 0.67–3.89).
These results suggest the incidence of adverse maternal/perinatal outcomes is similar for women receiving in-hospital or outpatient care.
Department of Obstetrics and Gynaecology, Mater Health Services (M.B.), Mater Medical Research Institute (M.B., G.G.), and Centre for Maternal Fetal Medicine, Mater Health Services (G.G.), Raymond Terrace, South Brisbane, Queensland, Australia