BACKGROUND AND PURPOSE:

• At-home management of premature prelabor rupture of membranes (PPROM) under the right clinical circumstances has been shown to be safe, but data regarding factors impacting the latency period remain limited
• Point et al. (Acta Obstetrica et Gynecologica Scandinavica, 2021) identified the risk factors associated with a shortened latency to delivery in women with PPROM managed as outpatients

METHODS:

• Retrospective cohort study
• Participants
  • All patients in home care after PPROM at 24 to 36 weeks from 2009 to 2018
• Study design
  • Latency ratio: Calculated as the ratio of the real latency period to the expected latency period, expressed as a percentage
  • Expected latency: Number of days between the PPROM date and the target term
  • Real latency: Number of days between the PPROM date and delivery
• Primary outcomes measures
  • Latency ratio for each patient
  • Risk factors associated with the latency ratio

RESULTS:

• 234 patients with PPROM managed at home
• Patient characteristics
  • Mean maternal age: 28.8 years
  • Nulliparous: 45% 
  • History of PPROM: 5%
  • History of prematurity: 10%
• Latency
  • Mean theoretical latency after PPROM: 45.2 ± 21.3 days
  • Mean observed latency after PPROM: 35.5 ± 20.7 days
  • Latency ratio: 80%
• Percentage of patients with length of homecare >7 days: 83.8%
• A lower latency ratio was significantly associated with
  • Oligohydramnios (p<0.001)
  • Gestational age at PPROM (p=0.006)
  • Leukocyte count at PPROM >12 × 109/L (p=0.025)
  • C-reactive protein concentration >5 mg/L at 7 days after PPROM (p=0.046)
• Median latency ratio for oligohydramnios
  • <32 weeks: ~40%
  • >32 weeks: 100%
• Cervical length was not associated with a lower latency ratio | However, data missing in 114/234 patients

CONCLUSION:

• Most patients with PPROM managed at home achieve a latency period greater than 7 days
• The biggest risk factor for a shortened latency period is oligohydramnios
• The authors state

Previous studies have shown that home-care management of PPROM lengthens the latency period. It seems important to identify the risk factors that can influence this latency

However, this ratio was lower in patients with oligohydramnios or inflammatory syndrome 

Learn More – Primary Sources:

Risk factors associated with shortened latency before delivery in outpatients managed for preterm prelabor rupture of membranes

Related ObG Topics:

What is the Best Course of Action Following PPROM Between 24 and 37 Weeks?

Can Azithromycin be Used as an Alternative to Erythromycin for PPROM?

Does Use of Progestogen Prolong Labor in PPROM Pregnancies?

Does a Weekly Dose of 17-OHPC Improve Outcomes in the Setting of Preterm Ruptured Membranes?