The relationship between practice setting and management of preterm premature rupture of membranes

Objective. To compare preterm premature rupture of membranes (PPROM) management between maternal-fetal medicine (MFM) providers practicing in an academic university (AU) versus other settings (NAU). Methods. Secondary analysis of a national survey of 1375 MFM providers of whom 504 (37%) responded and answered queries on demographic and practice characteristics and various PPROM management issues. Results. Fifty-three percent of the respondents were in an AU practice setting. Providers in AU and NAU settings reported a similar prevalence of corticosteroid (99% vs. 100%), antibiotic (99% vs. 100%), and tocolytic (74% vs. 76%) use. There was significant variability between NAU and AU providers in issues related to the evaluation and expectant management of PPROM. NAU providers, as compared to AU providers, more commonly reported performing diagnostic amniocentesis in the acute evaluation of PPROM (72% vs. 61%, p = 0.02). There was a higher prevalence of fetal lung maturity assessment among NAU providers (84%) as compared to AU providers (73%, p = 0.005) and significant variability was noted with respect to the fetal lung maturity tests used (p < 0.0001). NAU providers continued expectant management later into gestation than AU providers (p = 0.002). Significant variability was also noted in the use of antepartum surveillance techniques (p = 0.01). Conclusion. MFM practitioners from academic universities and non-academic settings utilize similar management strategies for PPROM in regard to corticosteroid, tocolytic, and antibiotic use. However, differences are evident in issues related to the evaluation and expectant management of patients with PPROM.