Prelabor rupture of the membranes at term: expectant management at home or in hospital? The TermPROM Study Group.
OBJECTIVE
To determine whether adverse effects of expectant management for premature rupture of membranes (PROM) at term and patient satisfaction were greater if women were managed at home rather than in a hospital.


METHODS
We undertook a secondary analysis of data from the International TermPROM Study for women managed expectantly at home or in a hospital. Using multiple logistic regression analyses, we determined the effect of home and hospital management and controlled for differences in baseline characteristics, in measures of maternal and neonatal infections and rates of cesarean.


RESULTS
Six hundred fifty-three women (39.1%) were managed at home, and 1017 (60.9%) in a hospital. Management at home, compared with in a hospital, increased risk of nulliparas needing antibiotics before delivery (odds ratio [OR] 1.52 95% confidence interval [CI] 1.04, 2.24, P =.03), those not colonized with group B streptococcus having cesareans (OR 1.48 95% CI 1.03, 2. 14, P =.04), and neonatal infections (OR 1.97 95% CI 1.00, 3.90, P =. 05). More multiparas managed at home said they would participate in the study again (OR 1.80 95% CI 1.27, 2.54, P <.001).


CONCLUSIONS
Expectant management at home, rather than in a hospital, might increase the likelihood of some adverse outcomes.
Hannah
M E
ME
Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. mary.hannah@utoronto.ca
Hodnett
E D
ED
Willan
A
A
Foster
G A
GA
Di Cecco
R
R
Helewa
M
M
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders; D013292:Streptococcus agalactiae / Q000302:isolation & purification
D000900:Anti-Bacterial Agents