Premature rupture of membranes before 37 weeks’ gestation (and where there is at least an hour between membrane rupture and the onset of contractions and labour) can have consequences for both the mother and the baby. It is estimated that after premature rupture of the membranes one-half of women go into labour within a week, and three-quarters within a fortnight. This means that the baby may be born prematurely and both mother and baby are at risk of infection. Where available, the majority of clinicians advise hospital care for the women to allow monitoring and early detection of any problems. It is however possible for some women to go home after a period of observation in hospital. The safety, cost and women's views about home management have not been established.
We included two randomised controlled studies with 116 women in the review. These studies compared planned home versus hospital management for women with preterm, prelabour rupture of the membranes (PPROM). In both studies there were strict criteria for deciding whether women could be included; for example, women had to live within a certain distance of emergency facilities, and there had to be no signs that mothers and babies had infection or other problems. There was a period of monitoring in hospital for women in both groups.
Results suggested that there were few differences in mothers' and babies' health for women cared for at home or in hospital including infant death, serious illness, or admission to intensive care baby units.
There was some evidence that women managed in hospital were more likely to be delivered by caesarean section. Women cared for at home were likely to spend less time in hospital (spending approximately 10 fewer days as inpatients) and were more satisfied with their care. In addition, home care was associated with reduced costs. Overall, the number of women included in the two studies was too small to allow adequate assessment of outcomes.