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PROM

Premature rupture of membranes (PROM) occurs when the amniotic sac breaks before labor begins. Risk factors include infection, low socioeconomic status, smoking, and a previous preterm birth. Complications of PROM include infection, umbilical cord compression, preterm birth, and respiratory distress in the baby. Diagnosis involves testing the fluid for pH and microscopically. Treatment may include antibiotics, corticosteroids, tocolytics, and monitoring for infection and fetal distress. Nursing management focuses on infection assessment, monitoring, education, and preparing for possible early delivery.

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Cathlen Garan
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108 views

PROM

Premature rupture of membranes (PROM) occurs when the amniotic sac breaks before labor begins. Risk factors include infection, low socioeconomic status, smoking, and a previous preterm birth. Complications of PROM include infection, umbilical cord compression, preterm birth, and respiratory distress in the baby. Diagnosis involves testing the fluid for pH and microscopically. Treatment may include antibiotics, corticosteroids, tocolytics, and monitoring for infection and fetal distress. Nursing management focuses on infection assessment, monitoring, education, and preparing for possible early delivery.

Uploaded by

Cathlen Garan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Cathlen Garan BSN-II

PREMATURE RUPTURE OF MEMBRANE

DEFINITION

Premature rupture of membranes (PROM) is a rupture (breaking open) of the


membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of
pregnancy, it is called preterm premature rupture of membranes (PPROM).

ETIOLOGY

Rupture of the membranes near the end of pregnancy (term) may be caused by a
natural weakening of the membranes or from the force of contractions. Before term,
PPROM is often due to an infection in the uterus. Other factors that may be linked to
PROM include the following:

o Low socioeconomic conditions (as women in lower socioeconomic conditions are


less likely to receive proper prenatal care)
o Sexually transmitted infections, such as chlamydia and gonorrhea
o Previous preterm birth
o Vaginal bleeding
o Cigarette smoking during pregnancy

RISK FACTORS

There is no specific cause, but there are many factors that may increase the risk of
PROM. Maternal or intra-amniotic infection and chronic disease, such as systemic
lupus erythematosus, direct abdominal trauma, nutritional deficiencies, smoking
and placenta abruption all increase the risk of PROM. Multiple pregnancy (twins or
more) and a history of previous PROM also indicate an increased risk.

CLINICAL MANIFESTATION

The following are the most common symptoms of PROM. Symptoms may include
leaking or a gush of watery fluid from the vagina and a constant wetness in
underwear.

If you notice any symptoms of PROM, be sure to call your doctor as soon as
possible.

COMPLICATIONS

PROM is a complicating factor in as many as one third of premature births.


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1. The baby is very likely to be born within a few days of the membrane rupture;
2. Development of a serious infection of the placental tissues called
chorioamnionitis, which can be very dangerous for mother and baby;
3. Other complications that may occur with PROM include placental abruption
(early detachment of the placenta from the uterus), compression of the
umbilical cord, cesarean birth, and postpartum (after delivery) infection.

DIAGNOSTIC EVALUATION

Premature rupture of membrane may be diagnosed in several ways, including the


following:

 An examination of the cervix (may show fluid leaking from the cervical
opening)
 Testing of the pH (acid or alkaline) of the fluid
 Looking at the dried fluid under a microscope (may show a characteristic
fern-like pattern)
 Ultrasound. A diagnostic imaging technique that uses high-frequency sound
waves and a computer to create images of blood vessels, tissues, and organs.
Ultrasounds are used to view internal organs as they function, and to assess how
much fluid is around the baby.

MEDICAL/SURGICAL MANAGEMENT

Treatment for premature rupture of membranes may include:

 Hospitalization
 Expectant management
 Monitoring for signs of infection, such as fever, pain, increased fetal heart rate, and/or laboratory
tests.
 Giving the mother medications called corticosteroids that may help mature the lungs of the fetus
(lung immaturity is a major problem of premature babies). However, corticosteroids may mask an
infection in the uterus.
 Antibiotics (to prevent or treat infections)
 Tocolytics. Medications used to stop preterm labor.
 Women with PPROM usually deliver at 34 weeks if stable. If there are signs of abruption,
chorioamnionitis, or fetal compromise, then early delivery would be necessary.)

NURSING MANAGEMENT

1. Assess for signs of infection.


Rationale: Maternal and fetal infection may prompt PROM and must be treated quickly to avoid
fetal compromise.
2. Perform single digital or sterile speculum vaginal exam
Rationale: Vaginal exam may be required to confirm diagnosis, but avoid multiple digital vaginal
exams to reduce the risk of infection. Reserve these exams for when delivery is imminent.
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3. Obtain history from patient regarding complications and status of pregnancy.


Rationale: Treatment depends on gestational age and existing complications
Patient may need to remain on bed rest to continue pregnancy if preterm, or labor may be
induced.
4. Initiate fetal monitoring
Rationale: PROM may be an indicator of fetal distress. Monitor for signs of fetal compromise to
include changes in fetal heart rate.
5. Administer medications and IV fluids as appropriate
Rationale:
a. PPROM may indicate a need for corticosteroids to speed up the fetal lung maturity
b. Antibiotics are given prophylactically to prevent infection
c. Tocolytics may be given to stop preterm labor
d. Magnesium sulfate may be given if prior to 32 wks gestation to prevent fetal
neurological dysfunction
6. Prepare patient for induction of labor and delivery

Rationale: If indicated, labor will likely be induced if it does not spontaneously

begin within 12-24 hours. Explain process to patient to reduce fears.

7. Provide patient education if preterm: Pelvic rest, Avoid tampons and intercourse and Av oid tub
baths (showers ok)
Rationale: If delivery is not indicated(<34 wks gestation), patient will likely remain

in the hospital until delivery is an option.

Regardless of location, patient will be required to remain on bed rest and

antibiotics will continue prophylactically until delivery.

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