Prise en charge à domicile des ruptures prématurées des membranes avant 37 semaines d’aménorrhée

Abstract

ObjectiveTo compare maternal and perinatal outcome according to gestational age at delivery and length of latency period in a group of patients with preterm premature rupture of membranes. To propose and evaluate an antenatal protocol of home care in a selected group of them. Patients and methodsInclusion criteria was a delivery in our maternity related to a rupture of membranes prior to 37 week's gestation. Expectant management was applied. Home care management was proposed for patients hospitalised at least 5 days and meeting strict criteria. Maternal-fetal clinical monitoring was performed daily and biological and ultrasound monitoring weekly until 37 or 38 week's gestation. ResultsWe included 222 patients. There was a significant increase in perinatal complications for neonates before 36 week's gestation. Maternal and perinatal outcomes were not influenced by the latency period. In the overall patients, 44 were hospitalised at least 5 days and 9 could return at home. It seems that there was no difference concerning maternal and fetal complications between home care and hospitalized patients. Discussion and conclusionIn preterm premature rupture of membranes after 34 week's gestation, monitored expectant management can reduce prematurity complications without increasing infectious complications. After an initial hospitalization, for a small proportion of them, home care seems possible without increasing maternal and fetal morbidity.