title: A retrospective cohort study of hospital versus home care for pregnant women with preterm prelabor rupture of membranes.
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes between in-hospital management and prepartum care at home (PCAH) among women with preterm prelabor rupture of membranes (PPROM) before 34 weeks of pregnancy.
  
  
  METHODS
  In a retrospective study, data were analyzed from women who experienced PPROM between 23 and 34 weeks of pregnancy, and received care from two hospitals in British Columbia, Canada, between April 2007 and March 2012. Women were included if they had been stable in hospital for at least 72 hours and met eligibility criteria for PCAH. Management of PPROM differs at the centers: at one, women are monitored in hospital, whereas PCAH is used at the other. Outcomes were compared between management strategies. Logistic regression was used to assess severe maternal morbidity and neonatal morbidity/mortality after adjustment for pregnancy length at PPROM.
  
  
  RESULTS
  Among 176 included women, 87 received PCAH and 89 were managed in hospital. There was no difference in severe maternal morbidity (adjusted odds ratio [aOR] 0.64, 95% confidence interval [CI] 0.35-1.17) or neonatal morbidity/mortality (aOR 0.63, 95% CI 0.31-1.30). Latency increased and length of stay decreased with PCAH (P<0.001 for both).
  
  
  CONCLUSIONS
  Maternal and newborn outcomes were similar between women who received PCAH and those who were managed in hospital. The reduced resource use in PCAH might lead to cost savings without compromising outcomes.
authors.affiliation: Maternal Infant Child Youth Program, Fraser Health Authority, Surrey, BC, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Palmer
authors.affiliation: Department of Obstetrics and Gynecology, Fraser Health Authority, Surrey, BC, Canada.|Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Grabowska
authors.affiliation: Department of Obstetrics and Gynecology, Fraser Health Authority, Surrey, BC, Canada.|Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Burrows
authors.affiliation: Neonatal and Pediatric Pharmacy, Fraser Health Authority, Lower Mainland Pharmacy Services, Surrey, BC, Canada.
authors.forename: Hilary
authors.initials: H
authors.lastname: Rowe
authors.affiliation: Maternal Infant Child Youth Program, Fraser Health Authority, Surrey, BC, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Billing
authors.affiliation: Departments of Obstetrics and Gynecology and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Metcalfe
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality* / Q000628:therapy; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D000068101:Maternal-Child Health Services; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care; D012189:Retrospective Studies; D055815:Young Adult
keywords: Maternal outcomes; Neonatal outcomes; Prepartum care at home; Preterm prelabor rupture of membranes