Hospital or Home? Pre-labour Rupture of Membranes

The management of pre-labour rupture of membranes at term remains a debated issue and there is a wide variation in practice, with no clear agreement on what comprises the optimal management of spontaneous rupture of membranes (SROM) at term. I conducted a systematic review to examine the effectiveness of going home versus staying in hospital for women at term who present with pre-labour rupture of membranes on maternal, neonatal, labour and birth outcomes. The results of this review needed to be interpreted with caution as the included studies were of weak methodological rating. Following on from this, an audit was conducted looking at the outcomes of women with low-risk pregnancies who went home after membrane rupture versus those that stayed in hospital. The results were then presented to the labour ward leads, support was obtained and a guideline was developed. This change in practice was audited in the first six months and again in the second six months and there were no adverse outcomes. This guideline has been implemented since December 2016, and women with pre-labour rupture of membranes at term now have the choice to stay in hospital or go home for a specified time period.