Premature Rupture of Membranes/Preterm Premature Rupture of Membranes

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Author:
dsherman
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119664
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Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
Updated:
2011-11-30 14:34:08
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Premature Rupture Membranes Preterm
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Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
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  1. Overview of Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • *Spontaneous repture of the amniotic membranes 1 hr or more proior to the onset of true labor
    • *for most women, PROM signifies the onset of true labor if gestationl duration is at term
    • *preterm premature rupture of membranes (PPROM) is the premature spontaneous rupture of membranes after 20 weeks of gestation and proir to 37 weeks of gestation
  2. Risk factors Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • Risk factors:
    • *infection is the major rosk of PROM/PPROM
    • for both the patient and the fetus once the amniotic membranes have ruptured, *microorganisms can ascend from the vagina into the amniotic sac PPROM is often preceded by infection

    *Chorioamnionitis is the infection of the amniotic membranes

    • There is an increased risk of infection if there is a lag period over the 24-hour period from when the membranes rupture to delivery
  3. Assessments (Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • Subjective data:
    • the patient reports a gush or leakage of clear fluid from the vagina

    • Objective data: signs of infection
    • maternal temperature
    • increased maternal or FHR
    • foul-smelling fluid or vaginal discharge
    • abdominal tenderness

    • assess the patient for
    • prolapsed umbilical cord
    • abrupt FHR variable or prolonged declerations
    • visible or palpable cord at the introitus

    • Laboratory test
    • a positive Nitrazine paper test (blue, pH 6.5 to 7.5) or positive ferning test is conducted on amniotic fluid to verify rupture of membranes
  4. Collaborative care for Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • *prepare for birth if indicated
    • *depends on gestational duration, if there is evidence of infection, or an indication of fetal compromise
    • *provide reassurance to reduce maternal anxiety
    • *assess cervical dilation, effacement, and station
    • *assess vital signs every 4 hrs.
    • *notify the physician of the temperature greater than 38o C (100oF)
    • assess FHR and uterine contractions
    • advise the patient to adhear to bed rest with bathrooom privileges
    • avoid vaginal exams
    • encourage hydration
    • obtain vaginal cultures for streptococcus B-hemolytic, Group B, Chlamydia, and neisseria gonorrhoae
    • collect a CBC
    • instruct the patient to perform daily fetal kick counts
    • notify the nurse of uterine contractions
  5. Ampicillin (Omnipen) use in Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • antibiotic
    • used to treat infection
    • obtain vaginal, urine, and blood cultures prior to administration fo antibiotic
  6. Betamethasone (Celestone) use in Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • glucocorticoid
    • administered IM
    • requires a 24-hr period to be effective
    • enhance fetal lung maturity and surfactant production
    • administer the betamethasone deep into the patients gluteal muscle 24-48 hrs priot to birth of a preterm neonate
    • monitor the mother and neonate for pulmonary edema by assessing lung sounds
    • monitor for maternal and neonate hyperglycemia
    • monitor the neonate for heart rate changes

    • Patient education:
    • signs of pulmonary edema (chest pain, shortness of breath and crackles)
  7. Patient education regarding Premature Rupture of Membranes/Preterm Premature Rupture of Membranes
    • *conduct a self-assessment for uterine contractions
    • *record daily kick counts for fetal movement
    • *monitor for foul-smelling vaginal discharge
    • refrain from inserting anything into the vagins
    • abstain from intercourse
    • avoid tub baths
    • wipe perineal area from front to back aftervoiding and fecal elimination
    • take her temperature every 4 hrs wehn awake and report a temperature that is greater than 38oC (100oF)

    • Discharge instructions;
    • expect patient to be discharged home if dilation is less than 3cm, no signs of infection, no contractions, and malpresentation
    • advise the patient to adheare to bed rest with bathroom privileges
    • encourage hydration

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