Expanded Clinician Offering of Expectant Management of PPROM 34 Weeks 0 Days–36 Weeks 6 Days After Introduction of Shared Decision-Making Aid [ID: 1364841

Abstract

INTRODUCTION: In March 2020, the American College of Obstetricians and Gynecologists updated recommendations for prelabor preterm rupture of membranes (PPROM) at 34 weeks 0 days–36 weeks 6 days to include shared decision-making (SDM) for expectant management (EM) versus immediate delivery (ID). We sought to compare the patient populations offered EM before and after a SDM aid. METHODS: This is a retrospective cohort study from March 2020 to February 2022 of patients presenting with PPROM 34 weeks 0 days–36 weeks 6 days. On October 25, 2022, a SDM aid was introduced to help clinicians discuss the benefits and risks to EM versus ID of PPROM. Patients offered EM were compared before and after the SDM aid using Fisher exact, χ2, and t tests. RESULTS: Eighty-six patients presented with PPROM during the study period, 26 before the SDM aid and 60 afterwards. Populations were similar, with the exception of more publicly insured patients post-SDM aid. Significantly more patients were offered EM of PPROM post-SDM aid than pre-SDM aid (48% versus 11%, P=.001). The proportion of Caucasian and privately insured patients offered EM significantly increased after the SDM aid; more African American and publicly insured patients were offered EM as well, but this was not statistically significant. No patients accepted EM prior to the SDM aid compared to 41% who chose EM after the SDM aid. CONCLUSION: A SDM aid significantly increased the number of patients offered EM of PPROM. Still, while more patients elected for EM after the SDM aid, the majority elected for ID. A standardized approach to SDM may improve provider awareness of management options and provide patients with necessary information to make informed decisions.