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
