(599) Inpatient versus Outpatient Management of Preterm Prelabor Rupture of Membranes: A Systematic Review and Meta-Analysis

The management of preterm prelabor rupture of membranes (PPROM) varies across healthcare settings with limited data on the safety of outpatient management. The aim of this study was to compare neonatal sepsis and other maternal and perinatal outcomes by outpatient vs inpatient management of PPROM.

Study Design: We performed a systematic review in October 2023 of Cochrane Central, Embase, PubMed and Web of Science databases for studies comparing outpatient and inpatient management of PPROM. We included studies of pregnancies complicated by PPROM < 37 weeks’ gestational age (GA) published in full text English. Primary outcome was neonatal sepsis; secondary outcomes included neonatal intensive care unit (NICU) admission, NICU length of stay (LOS), intrauterine fetal demise (IUFD), neonatal death, pregnancy latency, chorioamnionitis, and maternal LOS. A random-effects model was used to calculate pooled odds ratios (OR) or mean differences (MD) and 95% confidence intervals (CI) for all outcomes.

Results: Out of the 485 studies identified, 10 were included. These studies comprised a total of 2,286 patients, with 1,040 undergoing outpatient and 1,246 inpatient management. Included studies involved pregnancies from 20 to 35 weeks’ GA. Neonatal sepsis was assessed in all studies, and no significant statistical differences were found between the groups (pooled OR 0.92, 95% CI 0.63-1.35, Figure 1). The latency period was longer (pooled MD 7.73; 95% CI 0.56-14.90; Figure 2) and there was less chorioamnionitis (pooled OR 0.54; 95% CI 0.41-0.72) in the outpatient setting. Regarding neonatal outcomes, the outpatient group had lower odds of NICU admission (pooled OR 0.57; 95% CI 0.36-0.90) and a shorter NICU LOS (pooled MD -9.43 days; 95% CI -13.02 to -5.84). There were no significant differences in maternal LOS, IUFD, and neonatal death.

Conclusion:

Outpatient management of PPROM was associated with a longer latency period, lower odds of chorioamnionitis, NICU admission, and shorter NICU length of stay, without an increase in rates of neonatal sepsis.