Chapter 11: Premature Rupture of Membranes

Question 1

Premature rupture of the membranes (PROM)

Answer 1

rupture of the membranes before the onset of labor at any gestational age
>can lead to premature labor

Question 2

Preterm rupture of membranes

Answer 2

rupture of membranes before 37 completed weeks of gestation

Question 3

Preterm premature rupture of membranes (PPROM)

Answer 3

a combination of both terms, rupture occurs before the 37th completed week of gestation and in the absence of labor

Question 4

Pathophysiology

Answer 4

multifactorial

• choriodecidual infection or inflammation plays an important role
• other: decreased amniotic membrane collagen, lower socioeconomic status, smoking, STIs, prior preterm delivery, prior PTL
• during current pregnancy: uterine distention (e.g. multiple gestation and hydramnios), cervical cerclage, amniocentesis, and vaginal bleeding

Question 5

Diagnosis

Answer 5

-reports gush or leakage of fluid from the vagina
(any increase in vaginal discharge should be evaluated)
-diagnosis based on history of leaking vaginal fluid and the finding of a pooling fluid on sterile speculum examination
-Nitrazine, AmniSure, or fern test
-ultrasound examination of amniotic fluid volume may be useful in documenting oligohydramnios (decreased amniotic fluid) but is not considered diagnostic
-when clinical history or physical exam is unclear, membrane rupture can be diagnosed with ultrasound-guided transabdominal instillation of indigo carmine (a blue dye) followed by observation for passage of blue fluid from the vagina

Question 6

What confirms the diagnosis of PROM

Answer 6

-Nitrazine, AmniSure, or fern test

Question 7

General Management

Answer 7

• gestational age should be established based on clinical history and prior ultrasound assessment when available
• ultrasound should be performed to assess fetal growth, position, and residual amniotic fluid
• the woman should be assessed for evidence of advanced labor, chorioamnionitis (intrauterine infection), abruptio placentae, and fetal distress
• patients with advanced labor, intrauterine infection, significant vaginal bleeding, or non-reassuring fetal testing are best delivered promptly, regardless of gestational age

Question 8

Conservative Management

Answer 8

• impatient observation unless the membranes reseal and the leakage of fluid stops; this approach consists of prolonged continuous fetal and maternal monitoring combined with modified bedrest to promote amniotic fluid reaccumulation and spontaneous membrane sealing
• delivery of the fetus should be accomplished if signs of infection are present: maternal temperature of 100.4 or greater, foul-smelling vaginal discharge, elevated WBC count, uterine tenderness, and maternal and/or fetal tachycardia

Question 9

Nurses Role In caring for the patient with PROM

Answer 9

• explaining to the patient that she will be on full or modified bedrest
• vital signs be checked at least every 4 hours to detect early signs of a developing infection
• if the patient does not exhibit signs of labor, intermittent fetal monitoring
• frequent ultrasound examinations to assess amniotic fluid levels
• provide emotional support to the patient who is understandably worried about the outcome for her baby
• encourage the woman and her family to ask questions and express fears and concerns; when the nurse does not have enough information to respond adequately, another health team member who can appropriately answer the patients questions and address her concerns should be contacted