Impact of extending criteria for home care management in Preterm Prelabor Rupture of Membranes.

Abstract

Preterm prelabor rupture of membranes (PPROM) is a frequent obstetrical condition with risks of maternal and neonatal morbidity and mortality. Home hospitalization (HH) management is an alternative to conventional hospitalization (CH) which remains controversial, and there has been little study of eligibility criteria. To study obstetrical and perinatal outcomes of PPROM between 24 and 34 gestational weeks in patients discharged to homecare after 4 days, based on a policy of expanded discharge criteria. Retrospective before-and-after study over 10 years in a single French level III perinatal center. In period A (2009-2013), discharge criteria were restrictive and in period B (2015-2019), more extended discharge criteria were adopted. The primary outcome was the incidence of confirmed early-onset neonatal sepsis (EOS). The proportion of patients discharged to home hospitalization increased from 28/170 (16.5) in period A to 39/114 (34.2) in period B (p < 0.01). Regarding the primary outcome, no statistically significant difference in EOS rates was observed between periods (11/153 (7.1) vs 5/110 (4.5), p=0.37). The incidence of a composite outcome combining severe perinatal complications (intrauterine fetal demise, placental abruption and cord prolapse) did not significantly increase during period B (7/170 (4.1) vs 4/114 (2.7), p=0.37). There was no significant difference between the periods for chorioamniotitis (9.41% in period A and 11.4% in period B, p=0.58). Severe maternal or neonatal complications rates did not increase when criteria for home hospitalization were expanded. Larger, prospective studies are needed to confirm the results of such a strategy.