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Am J Perinatol 2021; 38(07): 714-720
DOI: 10.1055/s-0039-3400997
Original Article

Outpatient Expectant Management of Term Prelabor Rupture of Membranes: A Retrospective Cohort Study

Kelly M. Chacón 
1   Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
2   Harvard Medical School, Harvard University, Boston, Massachusetts
,
Allison S. Bryant Mantha
1   Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
2   Harvard Medical School, Harvard University, Boston, Massachusetts
,
Mark A. Clapp
1   Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
2   Harvard Medical School, Harvard University, Boston, Massachusetts
› Author Affiliations Funding None.
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Abstract

Objective To examine outcomes among women with prelabor rupture of membranes (PROM) who declined induction and chose outpatient expectant management compared with those admitted for induction.

Study Design This is a retrospective cohort study of term women with singleton, vertex-presenting fetuses who presented with PROM between July 2016 and June 2017 and were eligible for outpatient expectant management (n = 166). The primary outcomes were time from PROM to delivery and time from admission to delivery. Maternal and neonatal outcomes were also compared between groups. Multivariable linear regressions were used to assess time differences between groups, adjusting for known maternal and pregnancy characteristics.

Results Compared with admitted patients, women managed expectantly at home had significantly longer PROM to delivery intervals (median 29.2 vs. 17 hours, p < 0.001), but were more likely to deliver within 24 hours of admission (95.1 vs. 82.9%, p = 0.004). In the adjusted analysis, PROM to delivery was 7 hours longer (95% confidence interval [CI]: 3.9–10.0) and admission to delivery was 5.3 hours shorter (95% CI: 2.8–7.7) in the outpatient expectant management cohort. There were no differences in secondary outcomes.

Conclusion Outpatient management of term PROM is associated with longer PROM to delivery intervals, but shorter admission to delivery intervals.

Keywords

prelabor rupture of membranes - induction of labor - outpatient expectant management

Note

This study was presented as a poster at the ACOG Annual Meeting in Nashville, TN, on May 3, 2019.




Publication History

Received: 17 May 2019

Accepted: 28 October 2019

Article published online:
31 December 2019

© 2019. Thieme. All rights reserved.

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  • References

  • 1 Gunn GC, Mishell Jr. DR, Morton DG. Premature rupture of the fetal membranes. A review. Am J Obstet Gynecol 1970; 106 (03) 469-483
    CrossrefPubMedSearch in Google Scholar
  • 2 Cammu H, Verlaenen H, Perde MP. Premature rupture of membranes at term in nulliparous women: a hazard?. Obstet Gynecol 1990; 76 (04) 671-674
    PubMedSearch in Google Scholar
  • 3 Newton ER, Prihoda TJ, Gibbs RS. Logistic regression analysis of risk factors for intra-amniotic infection. Obstet Gynecol 1989; 73 (04) 571-575
    PubMedSearch in Google Scholar
  • 4 Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 188: prelabor rupture of membranes. Obstet Gynecol 2018; 131 (01) e1-e14
    CrossrefPubMedSearch in Google Scholar
  • 5 Hannah ME, Hodnett ED, Willan A, Foster GA, Di Cecco R, Helewa M. Prelabor rupture of the membranes at term: expectant management at home or in hospital? The TermPROM Study Group. Obstet Gynecol 2000; 96 (04) 533-538
    PubMedSearch in Google Scholar
  • 6 Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2017; 1: CD005302
    CrossrefPubMedSearch in Google Scholar
  • 7 Seaward PGR, Hannah ME, Myhr TL. et al. International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes. Am J Obstet Gynecol 1998; 179 (3, Pt 1): 635-639
    CrossrefPubMedSearch in Google Scholar
  • 8 Hannah ME, Ohlsson A, Farine D. et al; TERMPROM Study Group. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl J Med 1996; 334 (16) 1005-1010
    CrossrefPubMedSearch in Google Scholar
  • 9 Gee RE, Corry MP. Patient engagement and shared decision making in maternity care. Obstet Gynecol 2012; 120 (05) 995-997
    CrossrefPubMedSearch in Google Scholar