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

Outpatient management of prelabour rupture of membranes (PROM) at term - a re-evaluation and contribution to the current debate

OBJECTIVES

Our study aims to underpin the safety of ambulatory management for 24 h after PROM at term. Patient data from 2021 were compared with data from 2010 to 2013, when ambulatory management was first introduced at the Women's Clinic of the University Hospital of Basel.

METHODS

In this retrospective study with historical control groups, we compared a cohort of women who underwent outpatient management of PROM at term in 2021, n=78 with two previous cohorts with inpatient management in 2010-2012, n=202 and outpatient management in 2013, n=37, respectively.

RESULTS

The maternal and foetal outcomes of our cohort were comparable to those of the previous cohorts. The expected difference in shorter hospital stay was confirmed.

CONCLUSIONS

The study confirms the safety of an outpatient approach in the management of PROM at term. Further studies, especially RCTs, are needed for a definitive evaluation.

Home Cardiotocography in High-Risk Pregnancies: A Retrospective Study on Feasibility and Patient Well-Being

Background

Around 15% of pregnancies develop complications requiring detailed monitoring. With technological advancements, home cardiotocography has emerged as a potential alternative to the conventional approach, aiming to alleviate the stress and logistical challenges associated with in-clinic care. The objective of this study was to evaluate the capability of a portable device to collect data for accurate interpretation of the examination and to evaluate patient satisfaction, along with physical and emotional comfort during the monitoring process.

Methods

This retrospective study included 32 women with high-risk pregnancies, who independently performed 581 examinations utilizing the portable cardiotocography device Pregnabit Pro (Nestmedic, Poland). Moreover, participants were asked to provide feedback on their experiences through a comprehensive survey.

Results

In total, 95.7% of examinations successfully captured all necessary diagnostic data. Patients reported a high satisfaction rate, recognizing the potential of the home-based approach to improve their overall pregnancy experience. A preference for home-based testing over in-clinic visits was consistently noted among patients.

Discussion

This study shows evidence that home cardiotocography is a feasible and patient-preferred method for monitoring high-risk pregnancies. Our findings underline the importance of technological integration in prenatal care, advocating for a shift toward more patient-centered, accessible, and potentially cost-effective health care solutions.

Statement of the Obstetrics and Prenatal Medicine Working Group (AGG - Preterm Birth Section) on "Outpatient Management for Pregnant Women with Preterm Premature Rupture of Membranes (PPROM)"

Preterm premature rupture of membranes (PPROM) is one of the leading causes of perinatal morbidity and mortality. After a PPROM, more than 50% of pregnant women are delivered within 7 days. Fetal and maternal risks are primarily due to infection and inflammation, placental abruption, umbilical cord complications and preterm birth. Standard care usually consists of an expectant approach. Management includes the administration of antenatal steroids and antibiotic therapy. Patients with PPROM require close monitoring. The management of pregnant women with PPROM (inpatient vs. outpatient) is still the subject of controversial debate. The international guidelines also do not offer a clear stance. The statement presented here discusses the current state of knowledge.