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Prelabor Rupture of the Membranes at Term: Expectant Management at Home or in Hospital?

From the Department of Obstetrics and Gynaecology, Sunnybrook and Women’s College Health Sciences Centre, the Faculty of Nursing, Maternal Infant, and Reproductive Health Research Unit at the Centre for Research in Women’s Health, University of Toronto, Toronto, Ontario, Canada; Departments of Obstetrics and Gynaecology, St Joseph’s Health Centre, University of Western Ontario, London, Ontario, Canada; and St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.

Address reprint requests to: Mary Elizabeth Hannah, MDCM University of Toronto Centre for Research in Women’s Health Maternal, Infant, and Reproductive Health Research Unit 790 Bay Street, Suite 751 Toronto, ON M5G 1N8 Canada E-mail: mary.hannah{at}utoronto.ca

Objective: To determine whether adverse effects of expectant management for premature rupture of membranes (PROM) at term and patient satisfaction were greater if women were managed at home rather than in a hospital.

Methods: We undertook a secondary analysis of data from the International TermPROM Study for women managed expectantly at home or in a hospital. Using multiple logistic regression analyses, we determined the effect of home and hospital management and controlled for differences in baseline characteristics, in measures of maternal and neonatal infections and rates of cesarean.

Results: Six hundred fifty-three women (39.1%) were managed at home, and 1017 (60.9%) in a hospital. Management at home, compared with in a hospital, increased risk of nulliparas needing antibiotics before delivery (odds ratio [OR] 1.52 95% confidence interval [CI] 1.04, 2.24, P = .03), those not colonized with group B streptococcus having cesareans (OR 1.48 95% CI 1.03, 2.14, P = .04), and neonatal infections (OR 1.97 95% CI 1.00, 3.90, P = .05). More multiparas managed at home said they would participate in the study again (OR 1.80 95% CI 1.27, 2.54, P < .001).

Conclusion: Expectant management at home, rather than in a hospital, might increase the likelihood of some adverse outcomes.

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