Wesleyan University Philippines Mabini Extension, Cabanatuan City College of Nursing

PREMATURE RUPTURE OF
MEMBRANES

Prepared by: June Albert P. Perez BSN IV Block 1, Group 6

Submitted to: Rosita C. Batangan, RN, MAN Clinical Instructor

Premature rupture of membranes (PROM) is defined as a spontaneous leakage of amniotic fluid from the amniotic sac where the baby swims; the fluid escapes through ruptured fetal membranes, occurring after 28 weeks of gestation and at least one hour before the onset of true labour. PROM can occur before or after 40 weeks gestation, so the word premature does not mean that the gestational age of the fetus is preterm. PROM is of concern because rupture of fetal membranes before the onset of labour is not normal and is associated with many complications. In a normal labour, the fetal membranes usually rupture after the labour has progressed for some time, when the fetal head is deeply engaged and the cervix is near to full dilatation, with no complications in most labouring women. PROM increases the risks of certain pregnancy complications, including:

Preterm deliverybaby is born prematurely and is not fully developed Placental abruptionplacenta separates from the uterus before the baby is delivered Prolapsed umbilical cordumbilical cord is squeezed between the baby and the pelvis Infection in the uterus or baby Miscarriage CAUSES

The causes of PROM are not clearly understood. Some of the possible causes are:

Early dilation of the cervix (may be due to the weight of baby and placenta, or changes in the cervix itself)

Infections of the vagina, uterus, or membranes surrounding the fetus Premature labor (occurring previously in the same pregnancy)

RISK FACTORS The following factors may increase the chance of PROM:

PROM in earlier pregnancies Infection in the amniotic sac Other infections in mother (chlamydia, bacterial vaginosis) Preterm labor Amniocentesis Bleeding during the second and third trimester

Certain procedures used to treat abnormal conditions of the cervix (such as cervical conization) Lung disease during pregnancy Connective tissue disease Nutritional deficits Low body mass index Low socio-economic status Smoking during pregnancy

SYMPTOMS The main symptom of PROM is fluid leaking from the vagina. You may experience a sudden gush of fluid or a slow, constant trickle. It can be difficult to distinguish between a slow amniotic trickle and urine. Your doctor can do simple tests to determine this. PROM also increases the risk of infection. Symptoms include a fever above 100.4 degrees Fahrenheit (38 degrees Celsius).
Premature rupture of membranes Perez, June Albert P. BSN IV Block 1, Group 6

DIAGNOSIS To diagnose PPROM, the doctor may do the following tests:

Visual exam The doctor may be able to see a trickle of fluid through the cervix, or a pool of fluid collected behind the cervix A nitrazine paper test The doctor puts a small amount of fluid on a piece of paper to see if it is amniotic fluid Look at the fluid under a microscope to see if it is amniotic fluid. Ultrasound Using sound waves, the doctor examines the baby and amniotic sac to see if there is plenty of fluid and the baby is doing well TREATMENT

Treatment of PPROM depends on when it occurs in the pregnancy. 34 weeks or longer of gestation The doctor will:

Try to delay delivery until completion of 33 weeks gestation

Monitor the babys heart rate Induce labor by giving you medicines Possibly give antibiotics

24-31 weeks of gestation The doctor will provide treatment with antibiotics and steroids. The doctor may attempt to delay delivery until completion of 33 weeks gestation. Less than 24 weeks of gestation The doctor may admit to the hospital for bed rest and to monitor the mother and the baby. Twenty-four weeks of gestation is about the youngest a baby can be born. The doctor will discuss the risks and benefits of the treatment options.

32-33 weeks of gestation The doctor may:

Induce labor if your babys lungs have matured enough Give antibiotics Possibly give steroids to help your baby's lungs develop faster

NURSING CONSIDERATIONS

Nursing Diagnosis: Risk for Infection related to invasive procedures, recurrent vaginal examination, and amniotic membrane rupture. Goal: maternal infection does not occur Expected outcomes: Mother states / shows are free of any signs of infection. Nursing Interventions for Premature Rupture of Membranes: Perform initial vaginal examination, when the contraction pattern repeat, or maternal behavior indicates progress. However, repeated vaginal examinations play a role in the incidence of ascending tract infections.
Premature rupture of membranes Perez, June Albert P. BSN IV Block 1, Group 6

Monitor temperature, pulse, respiration, and white blood cells as indicated. Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs. Give prophylactic antibiotics when indicated. As, antibiotic may protect against the development of chorioamnionitis in women at risk.

PREVENTION Researchers are investigating ways to prevent PROM. Taking preventive antibiotics during the second and third trimester may reduce risk. The mother can also take steps for a healthier pregnancy, like quitting smoking.

Premature rupture of membranes Perez, June Albert P. BSN IV Block 1, Group 6