Management of Preterm Premature Rupture of Membranes: A Comparison of Inpatient and Outpatient Care

Abstract

Objectives: We sought to evaluate the safety of outpatient management of pregnancy complicated by preterm premature rupture of membranes (PPROM).

Study design: We performed a retrospective cohort study of women with PPROM and a latency period of at least one week in one provincial health region between January 2007 and December 2012. We evaluated pregnancy outcomes for 133 women whose cases were managed using specialized community care and compared these with outcomes of a similar group of 122 women whose cases were managed entirely in the hospital. The primary outcome measured was the difference in the latency period between the two groups. For categorical variable outcomes, data were analyzed using chi-square tests, and continuous variable outcomes were compared using t tests.

Results: The median latency period for inpatients was 11 days compared with 18 days for patients in the community (P < 0.001). The most common reason for delivery was spontaneous labour (57% of inpatients and 50% of outpatients). Rates of stillbirth and neonatal mortality were similar between the two groups (3% in the inpatient group and 4% in the outpatient group). Precipitous vaginal delivery of a preterm breech infant was associated with mortality. Umbilical cord pH was < 7.10 in 5% of the inpatient group and 3% of the outpatient group. Median Apgar scores were slightly higher among the outpatient group.

Conclusion: The safety of outpatient management of appropriately selected patients with PPROM is comparable with the safety of in-hospital management. Patients with PPROM and a fetus in breech presentation may not be appropriate for outpatient management, especially prior to 28 weeks' gestation. The decision to manage a patient with PPROM on an outpatient basis must be made after careful evaluation, with a thorough discussion of the risks and benefits and with serial reassessment of patient suitability.

Keywords: PPROM (preterm premature rupture of membranes); inpatient management; outpatient management.