[Prelabour Rupture of Membranes at Term: In- or Outpatient Management? A Survey in Birth Institutions in the...

Approximately 8-10% of pregnant women experience prelabour rupture of membranes at term (tPROM). The ideal timing to induce labour as a means to shorten the time interval to birth and thus to reduce maternal and neonatal risk of infection is a controversial topic. A distinction is made between an active and an expectant approach. There is little evidence comparing in- and outpatient management in the expectant approach. The goal of this investigation was to determine the current management approach in birth institutions in the German-speaking part of Switzerland. In this cross-sectional study, a self-designed online questionnaire was distributed to obstetricians and midwives in leading positions at all obstetric institutions in Switzerland. Outcome measures were: the currently offered approach at tPROM, experience with outpatient expectant management and the willingness to introduce outpatient management as an option for pregnant women. From a total of n=85 Swiss German birth institutions, n=47 (55%) responded to the questionnaire. 53% (n=25) provide outpatient expectant management. The women's satisfaction was seen as a decisive advantage. The respondents furthermore ascribed advantages for maternal outcome but no advantage for fetal outcome. 73% (n=16) of respondents working in institutions that hospitalize exclusively stated their willingness to introduce outpatient management provided that there was evidence of maternal and fetal outcome and that expectant mothers were satisfied. The number of birth institutions offering outpatient management is surprisingly high. In future studies examining general management at tPROM, the question of outpatient management should be included. Even though this survey seems to justify outpatient management under strict quality control conditions, prospective studies to assess safety issues are urgently needed.