الفهرس 
Complications of PPROMOnly 14 pages are availabe for public view
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Abstract
Complications of pregnancy come with feelings such as fear and frustration, especially while being admitted to the hospital. As antenatal anxiety and depressive symptoms are common among obstetric inpatients, they increase the risk of postpartum depression and adversely affect infant and child development
The hospital admission group in our study reported a growing sense of boredom and anxiety during their admission, which is in line with earlier work on hospitalization during pregnancy: women report concerns for the health of their future baby, feeling of helplessness and loneliness while being separated from home, family and friends.
Lack of privacy, when admitted, affected our patients’ contact with health care providers, partner, kids (if present) and other family and friends. In contrast, the experiences at home in our domiciliary group were more positive: although they still felt like a patient at times, the domiciliary group responded that the comfort of their own home and bed was very pleasant. In this group, only a minority of participants reported being anxious at times at home, while not having a physician or nurse nearby. Findings from our and previous studies reveal that domiciliary care could provide important psychological benefits during pregnancy.
When women’s perception of low-risk pregnancy and quality of care experience improve with domiciliary care, this may contribute to an increase in quality of life and reduction of antenatal anxiety and its consequences for mother and child.
The results of our study are assumed to have profound cost-saving effects in favor of domiciliary care, an important aspect regarding the ever-increasing health care costs and workloads.
In addition, domiciliary care has an economic benefit. Our study was prospective with variation of costs and we were not able to evaluate cost effectiveness of homecare, but Carlan et al. 1993 have shown that hospital care following PPROM was likely to be associated with higher cost to the health-care system.
Conclusion
This study adds to the current knowledge on women’s perspectives on antenatal monitoring from home during low-risk pregnancy as social changes are demanding a shift to home-based patient-centered care, and remote monitoring provides flexibility to both physicians and patients.
As regard maternal outcomes, we found that latency period was significantly longer in the domiciliary group with less frequent cesarean rate with less risk of intra-amniotic infection and shorter antenatal and postnatal hospital stay.
And concerning fetal and neonatal outcomes, we found that neonatal birth weight was significantly higher in the domiciliary group with less NICU admission and less neonatal complications including RDS.
By the end of this study, we found that there was a higher rate of take-home babies in the domiciliary group with less perinatal mortality ensuring the success of the outpatient care as a substitute for the standard hospital care.
Recommendations
We recommend integrating the principles of domiciliary care as a standard protocol for management of low-risk pregnancy in limited-resource hospitals according to strict selection criteria.
Health-care authorities should advocate & offer domiciliary care for the women presented with PPROM as a substitute for hospital care, also they should support women if they prefer domiciliary care and invest in the remote monitoring of these patients.
Regarding safety, it is recommended to work using strict protocols including equipment, manuals for the care-providers and patients and a limit for transfer time to the hospital.