OBJECTIVE: This study compared outpatient/home follow-up after initial stabilization with inpatient management in singleton pregnancies with preterm prelabor rupture of membranes (PPROM) before 34 + 0 weeks of gestation, focusing on maternal safety, neonatal outcomes, latency, and healthcare utilization. MATERIALS AND METHODS: In this single-center retrospective cohort, singleton PPROM cases managed between January 2020 and December 2024 were evaluated. After stabilization, patients were classified as outpatient/home or inpatient. The primary outcome was neonatal intensive care unit (NICU) admission. Inverse probability of treatment weighting (IPTW) was used to reduce selection bias, and latency was assessed with landmark Kaplan-Meier analyses. RESULTS: A total of 239 cases were analyzed (inpatient, n = 173; outpatient/home, n = 66). NICU admission was lower in the outpatient/home group (unadjusted risk ratio RR 0.56; IPTW RR 0.59, P = 0.007). The outpatient/home group had higher gestational age at delivery (median 36 vs. 31 weeks), shorter NICU stay (IPTW median difference, -4 days), and greater birth weight (IPTW median difference, +980 g). Placental abruption was more frequent in the outpatient/home group (IPTW RR 2.48). Landmark analyses showed markedly longer additional latency in the outpatient/home group (after 48 h: 43 vs. 3 days; after 7 days: 38 vs. 5 days; log-rank P < 0.001). CONCLUSION: In carefully selected, initially stable PPROM cases before 34 weeks, outpatient/home management was associated with longer latency and lower NICU utilization. However, these findings should be interpreted cautiously because more stable patients might have been preferentially selected for outpatient follow-up. With careful selection and close surveillance, outpatient/home management might be a reasonable alternative to reduce inpatient resource use.
Ay et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: