Outpatient management of women with preterm prelabour rupture of the membranes: A retrospective multicentre cohort study

Preterm prelabour rupture of the membranes poses maternal and perinatal risks including maternal sepsis, placental abruption, preterm labour and its sequelae, perinatal mental health complications, and mortality. Optimum management is not well understood. Most recent UK guidance suggested outpatient management may be appropriate, but guidance was not given on frequency or mode of monitoring, and outcomes following this are not well understood. This study aimed to determine monitoring practices and outcomes of women whose pregnancies complicated by preterm prelabour rupture of the membrane who are cared for in the outpatient setting, and to understand their experience. Retrospective data collection including patient demographics, preexisting risk factors, diagnosis and outpatient monitoring (including maternal observations, biochemistry and ultrasound findings), delivery outcomes and placental histopathology. Counselling of women was assessed at two timepoints: diagnosis and first review by a consultant. All women were invited to participate in a service evaluation. Across six units, 233 women were cared for in outpatient services for PPROM. Median gestation at diagnosis was 32 weeks (IQR 28 + 1 - 34 + 3 weeks). 34% had an equivocal diagnosis. Counselling on outcomes varied across units. Spontaneous preterm birth occurred in 41% of cases with a further 18% being delivered preterm for suspected chorioamnionitis. All units used maternal heart rate, temperature, C-reactive protein and white cell count to monitor for infection although neither absolute values at delivery nor trends in any of these were predictive of histological chorioamnionitis. Most women felt that their outpatient care was acceptable, but highlighted deficiencies in emotional support offered.