Outpatient Expectant Management of Term Prelabor Rupture of Membranes: A Retrospective Cohort Study.

OBJECTIVE: To examine outcomes among women with prelabor rupture of membranes (PROM) who declined induction and chose outpatient expectant management compared with those admitted for induction. STUDY DESIGN: This is a retrospective cohort study of term women with singleton, vertex-presenting fetuses who presented with PROM between July 2016 and June 2017 and were eligible for outpatient expectant management (n = 166). The primary outcomes were time from PROM to delivery and time from admission to delivery. Maternal and neonatal outcomes were also compared between groups. Multivariable linear regressions were used to assess time differences between groups, adjusting for known maternal and pregnancy characteristics. RESULTS: Compared with admitted patients, women managed expectantly at home had significantly longer PROM to delivery intervals (median 29.2 vs. 17 hours, p < 0.001), but were more likely to deliver within 24 hours of admission (95.1 vs. 82.9%, p = 0.004). In the adjusted analysis, PROM to delivery was 7 hours longer (95% confidence interval [CI]: 3.9-10.0) and admission to delivery was 5.3 hours shorter (95% CI: 2.8-7.7) in the outpatient expectant management cohort. There were no differences in secondary outcomes. CONCLUSION: Outpatient management of term PROM is associated with longer PROM to delivery intervals, but shorter admission to delivery intervals.

Acceptability of virtual prenatal care: thinking beyond the pandemic.

OBJECTIVE: Obstetrical providers have had to rapidly rethink how to provide comprehensive prenatal care during the SARS-CoV-2 pandemic. At our institution, we implemented a risk-stratified approach to incorporating telemedicine into our prenatal care. The objective of this study was to determine acceptability of virtual prenatal care and preferences for future pregnancies among our patient population. STUDY DESIGN: We sought feedback from a convenience sample of patients regarding the acceptability of virtual prenatal care and desires for future pregnancies. RESULTS: We found that virtual prenatal care is acceptable to patients, and the majority would like to incorporate it into future post-pandemic pregnancy care, although preferences differ by race. CONCLUSION: Virtual prenatal care should continue to be employed in post-pandemic obstetric practice. Obstetrical providers must determine how to incorporate this practice in a risk-stratified and equitable fashion.

Administering Labor Analgesia Under General Anesthesia in an Intellectually Disabled Patient.

Maternal intellectual disability presents anesthetic challenges.1 A 19-year-old primigravida with significant intellectual disability presented with preterm premature rupture of membranes at 31 4/7 weeks of gestation and underwent induction of labor for chorioamnionitis. She was unable to tolerate bedside epidural placement. Intrapartum general anesthesia allowed for epidural catheter placement that provided adequate labor analgesia for a vaginal delivery. This report describes a unique approach to providing labor analgesia in the intellectually disabled patient.