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

Werner Rath; Holger Maul; Ioannis Kyvernitakis; Patrick Stelzl

doi:10.1055/a-1515-2801

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

Geburtshilfe Frauenheilkd. 2021 Sep 29;82(4):410-419. doi: 10.1055/a-1515-2801. eCollection 2022 Apr.

Authors

Werner Rath¹, Holger Maul², Ioannis Kyvernitakis², Patrick Stelzl³

Affiliations

¹ Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany.
² Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, c/o. Asklepios Klinik Barmbek, Hamburg, Germany.
³ Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria.

Abstract

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.

Keywords: inpatient versus outpatient management; latency period; maternal complications; perinatal/neonatal morbidity; preterm premature rupture of membranes.

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