Ian A Grable1. 1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. igrable@caregroup.harvard.edu
Abstract
OBJECTIVE: Our purpose was to design a decision analytic model to evaluate the optimal length of time for expectant management after preterm premature rupture of the membranes between 32 and 36 weeks' gestation. STUDY DESIGN: Five models were created for 32 to 36 weeks' gestation. Probabilities for outcomes were obtained from medical center databases. Cost data were collected from the Health Care Microsystem database and were based on 1996 dollars. RESULTS: The optimal time of delivery to minimize major morbidity was 34 to 36 weeks' gestation, depending on the time of rupture. When only major morbidity was considered, the most cost-effective approach between 32 to 34 weeks was to deliver 1 week after rupture. At 35 to 36 weeks, the most cost-effective approach was to deliver at presentation. CONCLUSION: The current method of treating all patients with ruptured membranes similarly and delivery at 34 weeks' gestation is not risk minimizing or cost-effective. By delivery 1 week after rupture at 32 to 34 weeks and immediately at 35 to 36 weeks, significant morbidity can be avoided.
OBJECTIVE: Our purpose was to design a decision analytic model to evaluate the optimal length of time for expectant management after preterm premature rupture of the membranes between 32 and 36 weeks' gestation. STUDY DESIGN: Five models were created for 32 to 36 weeks' gestation. Probabilities for outcomes were obtained from medical center databases. Cost data were collected from the Health Care Microsystem database and were based on 1996 dollars. RESULTS: The optimal time of delivery to minimize major morbidity was 34 to 36 weeks' gestation, depending on the time of rupture. When only major morbidity was considered, the most cost-effective approach between 32 to 34 weeks was to deliver 1 week after rupture. At 35 to 36 weeks, the most cost-effective approach was to deliver at presentation. CONCLUSION: The current method of treating all patients with ruptured membranes similarly and delivery at 34 weeks' gestation is not risk minimizing or cost-effective. By delivery 1 week after rupture at 32 to 34 weeks and immediately at 35 to 36 weeks, significant morbidity can be avoided.
Authors: Jonathan M Morris; Christine L Roberts; Caroline A Crowther; Sarah L Buchanan; David J Henderson-Smart; Glenn Salkeld Journal: BMC Pregnancy Childbirth Date: 2006-03-23 Impact factor: 3.007