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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2022; 82(04): 410-419
DOI: 10.1055/a-1515-2801
GebFra Science
Review/Übersicht

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

Article in several languages: English | deutsch
Werner Rath
1   Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Holger Maul
2   Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, c/o. Asklepios Klinik Barmbek, Hamburg, Germany
,
Ioannis Kyvernitakis
2   Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, c/o. Asklepios Klinik Barmbek, Hamburg, Germany
,
Patrick Stelzl
3   Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
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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.

Key words

preterm premature rupture of membranes - inpatient versus outpatient management - latency period - maternal complications - perinatal/neonatal morbidity


Publication History

Received: 17 February 2021

Accepted after revision: 19 May 2021

Article published online:
29 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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