(142) Outpatient mangement protocol for preterm premature rupture of membranes before 34 weeks

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

BARROIS Mathilde, MD

Port Royal Maternity Unit Cochin Hospital
Paris, Ile-de-France, France

Coauthor(s)

SA

Seyral Antonin

Port Royal Maternity Unit Cochin Hospital
Paris, Ile-de-France, France
Aude Girault, MD, PhD (she/her/hers)

FHU PREMA, Paris, France. FHU PREMA, Paris, France; Université Paris Cité, Inserm, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.
Paris, Ile-de-France, France
FG

Francois Goffinet, MD, PhD

Professor
Université Paris Cité, Inserm, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)
Paris, Ile-de-France, France
Camille Le Ray, MD, PhD (she/her/hers)

Professor
INSERM 1153, APHP, Port Royal maternity unit, Université de Paris
Paris, Ile-de-France, France

Objective: In cases of preterm premature rupture of membranes (PPROM), expectant management is preferred to reduce neonatal morbidity when no infection is present. While monitoring has traditionally been done through hospitalization, outpatient management (OM) is now an option, though selection criteria remain unclear. This study aims to compare obstetric and neonatal outcomes before and after the implementation and modification of a OM protocol for PPROM patients introduced in April 2013.

Study Design:

We included all patients with PPROM before 34 weeks, admitted from January 1, 2011, to December 31, 2021. Patients were divided into two groups: Period A, where all were hospitalized until delivery, and Period B, where eligible patients were monitored at home (OM). Periods B1 to B3 reflect successive modifications of the OM protocol (Figure 1).
The primary outcome was the latency period, defined as the duration in days between PPROM and delivery. Secondary outcomes included obstetric and neonatal outcomes. Obstetric and neonatal outcomes were compared between periods A and B, and further analyzed among OM patients across periods B1 to B3

Results: During Period A, 145 patients were included, and 394 in Period B, of whom 126 (32%) received OM. Gestational age at PPROM was comparable between the periods (28.9 weeks ±3.1 vs. 28.9 weeks ±3.32, p=0.94), as were the latency period (13.9 ±19.9 days vs. 14.5 ± 16.8, p=0.77) and gestational age at delivery (30.8 ±3.26 weeks vs. 30.9 ±3.77, p=0.62). Early neonatal bacterial infections were significantly lower in Period B (42% vs. 31%; p = 0.018), as was the rate of intraventricular hemorrhage (24% vs. 6.2%; p < 0.01). OM use increased from B1 to B3 due to relaxed eligibility criteria, with no significant change in the latency period (Table).

Conclusion: After the OM protocol was implemented, one-third of patients benefited from home monitoring, with usage increasing over time. In PPROM cases, HCM, even with broad eligibility criteria, does not appear to extend the latency period but may reduce neonatal morbidity.