Hospital versus outpatient care for preterm pre-labour rupture of membranes.

BACKGROUND To report the outcomes of women admitted following preterm pre-labour rupture of membranes (pPROM) and to determine whether the location of care (hospital vs outpatient) influences maternal and perinatal outcomes. METHODS A retrospective cohort study was performed using routinely collected de-identified data of 144 women (between June 2007 and June 2011) who presented to the Mater Mother's Hospital, Brisbane, Australia, with pPROM (prior to 34 weeks 0 days gestation) and who remained undelivered after 72 h from the time of ruptured membranes. Outcomes were compared for women who were subsequently managed as an outpatient (n = 53) versus those who were managed in hospital (n = 91). The two primary outcome measures were composite outcomes of (i) maternal morbidity and (ii) perinatal morbidity/mortality. The composite outcome of maternal morbidity comprised one or more of antepartum haemorrhage, clinical chorioamnionitis and/or endometritis, cord prolapse, blood transfusion, wound infection/haematoma/dehiscence/seroma. The composite outcome of perinatal morbidity/mortality comprised one or more of stillbirth, neonatal death, respiratory distress syndrome, neonatal infection, chronic neonatal lung disease, intraventricular haemorrhage, periventricular leukomalacia and necrotising enterocolitis. RESULTS When adjusted for confounders, there was no difference between hospital care and outpatient care in the composite outcome measure of perinatal morbidity/mortality (aOR 1.37; 95%CI 0.55-3.47) or the composite outcome measure of maternal morbidity (aOR 1.62; 95%CI 0.67-3.89). CONCLUSIONS Women with pPROM who remain undelivered after 72 h and are managed out of hospital do not appear to have significant differences in major adverse maternal or perinatal outcomes compared with those managed as inpatients.