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Prematurity

Poster Session 3

(833) Outpatient Versus Inpatient Management of Premature Prelabour Rupture of Membranes: A Systematic Review and Meta-Analysis

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Monica L. Williamson, BSc, MD (she/her/hers)

Obstetrics and Gynecology Resident
University of Toronto
Toronto, ON, Canada

Coauthor(s)

ZD

Zi Yang (Susan) Dong, BSc, MD

University of Toronto
Toronto, ON, Canada
Rohan D'Souza, MD

Maternal-Fetal Medicine Physician, Associate Professor of Obstetrics & Gynaecology
Center for fetal care and high-risk pregnancy, University Hospital of Chieti
Chieti, Emilia-Romagna, Italy
RB

Romina Brignardello-Petersen, MSc, PhD

McMaster University
Hamilton, ON, Canada
SR

Stefania Ronzoni, MD, PhD

Sunnybrook Health Sciences Centre
Toronto, ON, Canada

Objective: We aimed to compare the neonatal, obstetric, and maternal outcomes associated with outpatient management of pregnancies complicated by premature prelabour rupture of membranes (PPROM) against inpatient management.

Study Design: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies. We searched MEDLINE, EMBASE, Cochrane Database and Central Register, and PubMed from 1990 until July 2023 with no language restrictions for eligible studies. Random effects model was used for meta-analysis. The GRADE approach was used to assess quality of evidence.

Results: Of 2,825 records identified, 14 publications (two RCTs, twelve cohort studies) were included, representing 6,010 patients. Management protocols were varied, generally including brief initial hospitalization, strict outpatient eligibility criteria, and surveillance with lab and ultrasound investigations. The RCTs were judged to have very low certainty of evidence due to small sample sizes and limited details available regarding their protocols. Based on data from cohort studies, outpatient management may be associated with lower rates of respiratory distress syndrome (RDS) (RR = 0.63 [0.52 to 0.77, very low certainty of evidence]), longer latency (MD 8.78 days, [2.29 to 15.26 days, low certainty of evidence]), higher gestational age (GA) at delivery (MD = 7.70 days [2.02 to 13.38 days, low certainty of evidence]), and lower rates of histologic chorioamnionitis (RR 0.74 [0.62 to 0.89, low certainty of evidence]) without meaningfully increased risks of other adverse neonatal, obstetric, or maternal outcomes.

Conclusion: Outpatient management may be a viable option for select patients affected by PPROM. The meta-analyzed data indicated that outpatient care may be at least as safe as inpatient management, with no demonstrated difference in risk of severe maternal, obstetric, or neonatal outcomes, and with potential benefits in reduced rates of RDS, longer latency, higher GA at delivery, and lower rates of histologic chorioamnionitis. This opportunity should be explored further in RCTs.