title: Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation.
abstract: BACKGROUND
  Preterm prelabour rupture of membranes (PPROM) is associated with increased risk of maternal and neonatal morbidity and mortality. Women with PPROM have been predominantly managed in hospital. It is possible that selected women could be managed at home after a period of observation. The safety, cost and women's views about home management have not been established.
  
  
  OBJECTIVE
  To assess the safety, cost and women's views about planned home versus hospital care for women with PPROM.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013) and the reference lists of all the identified articles.
  
  
  METHODS
  Randomised and quasi-randomised trials comparing planned home versus hospital management for women with PPROM before 37 weeks' gestation.
  
  
  METHODS
  Two review authors independently assessed clinical trials for eligibility for inclusion, risk of bias, and carried out data extraction.
  
  
  RESULTS
  We included two trials (116 women) comparing planned home versus hospital management for PPROM. Overall, the number of included women in each trial was too small to allow adequate assessment of pre-specified outcomes. Investigators used strict inclusion criteria and in both studies relatively few of the women presenting with PPROM were eligible for inclusion. Women were monitored for 48 to 72 hours before randomisation. Perinatal mortality was reported in one trial and there was insufficient evidence to determine whether it differed between the two groups (risk ratio (RR) 1.93, 95% confidence interval (CI) 0.19 to 20.05).  There was no evidence of differences between groups for serious neonatal morbidity, chorioamnionitis, gestational age at delivery, birthweight and admission to neonatal intensive care.There was no information on serious maternal morbidity or mortality. There was some evidence that women managed in hospital were more likely to be delivered by caesarean section (RR (random-effects) 0.28, 95% CI 0.07 to 1.15). However, results should be interpreted cautiously as there is moderate heterogeneity for this outcome (I² = 35%). Mothers randomised to care at home spent approximately 10 fewer days as inpatients (mean difference -9.60, 95% CI -14.59 to -4.61) and were more satisfied with their care. Furthermore, home care was associated with reduced costs.
  
  
  CONCLUSIONS
  The review included two relatively small studies that did not have sufficient statistical power to detect meaningful differences between groups. Future large and adequately powered randomised controlled trials are required to measure differences between groups for relevant pre-specified outcomes. Special attention should be given to the assessment of maternal satisfaction with care and cost analysis as they will have social and economic implications in both developed and developing countries.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen's Medical Centre, Nottingham University Hospital, Derby Road, Nottingham, Nottinghamshire, UK, NG7 2UH.
authors.forename: Ghada
authors.initials: G
authors.lastname: Abou El Senoun
authors.forename: Therese
authors.initials: T
authors.lastname: Dowswell
authors.forename: Hatem A
authors.initials: HA
authors.lastname: Mousa
mesh_terms: D002821:Chorioamnionitis / Q000453:epidemiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality / Q000628:therapy*; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis; D007902:Length of Stay; D010351:Patient Discharge; D017060:Patient Satisfaction; D054238:Perinatal Mortality; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
references.citation: Cochrane Database Syst Rev. 2010 Apr 14;(4):CD008053
references.pmid: 20393965
references.citation: J Obstet Gynaecol. 2007 Jan;27(1):37-40
references.pmid: 17365456
references.citation: Obstet Gynecol. 2007 Apr;109(4):1007-19
references.pmid: 17400872
references.citation: Curr Opin Obstet Gynecol. 1993 Feb;5(1):33-9
references.pmid: 8425033
references.citation: Int J Gynaecol Obstet. 2002 Aug;78(2):153-5
references.pmid: 12175717
references.citation: Aust N Z J Obstet Gynaecol. 2005 Jun;45(3):201-6
references.pmid: 15904444
references.citation: Am J Obstet Gynecol. 2004 Oct;191(4):1497-502
references.pmid: 15507990
references.citation: Cochrane Database Syst Rev. 2000;(2):CD000942
references.pmid: 10796224
references.citation: Cochrane Database Syst Rev. 2011 Oct 05;(10):CD007062
references.pmid: 21975760
references.citation: Cochrane Database Syst Rev. 2010 Aug 04;(8):CD001058
references.pmid: 20687063
references.citation: Am J Obstet Gynecol. 1999 Feb;180(2 Pt 1):349-52
references.pmid: 9988799
references.citation: Lancet. 2008 Jan 5;371(9606):75-84
references.pmid: 18177778
references.citation: Am Fam Physician. 2006 Feb 15;73(4):659-64
references.pmid: 16506709
references.citation: Obstet Gynecol. 1984 Jul;64(1):60-4
references.pmid: 6738948
references.citation: Pediatrics. 2005 Mar;115(3):e262-8
references.pmid: 15687417
references.citation: Obstet Gynecol. 1993 Jan;81(1):61-4
references.pmid: 8416463
references.citation: Cochrane Database Syst Rev. 2010 Mar 17;(3):CD004735
references.pmid: 20238332
references.citation: Clin Obstet Gynecol. 2007 Jun;50(2):487-96
references.pmid: 17513934
references.citation: Semin Perinatol. 1996 Oct;20(5):451-61
references.pmid: 8912999
references.citation: Int J Technol Assess Health Care. 1991;7(4):460-77
references.pmid: 1778693
references.citation: Lancet. 2001 Mar 31;357(9261):979-88
references.pmid: 11293640
references.citation: Am J Obstet Gynecol. 1996 Feb;174(2):525-8
references.pmid: 8623778
references.citation: J Matern Fetal Neonatal Med. 2006 Dec;19(12):783-9
references.pmid: 17190688
references.citation: Am J Perinatol. 2008 Jan;25(1):69-73
references.pmid: 18075965
references.citation: Cochrane Database Syst Rev. 2011 Jun 15;(6):CD003935
references.pmid: 21678343
references.citation: Clin Obstet Gynecol. 1998 Sep;41(3):503-14
references.pmid: 9742348
references.citation: J Perinatol. 2005 Mar;25(3):189-92
references.pmid: 15592427
references.citation: BJOG. 2005 Mar;112 Suppl 1:32-7
references.pmid: 15715592
references.citation: N Engl J Med. 1998 Jul 30;339(5):313-20
references.pmid: 9682045
references.citation: J Perinatol. 2005 Feb;25(2):108-13
references.pmid: 15538398
references.citation: Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004454
references.pmid: 16856047
references.citation: Aust N Z J Obstet Gynaecol. 2004 Oct;44(5):400-3
references.pmid: 15387859
references.citation: BMJ. 2007 Sep 29;335(7621):667-8
references.pmid: 17901518
references.citation: Obstet Gynecol. 2003 Jan;101(1):178-93
references.pmid: 12517665