PROM & PPROM Flashcards
Rupture of the amniotic sac (chorion & amnion)
Membranes
Before labor begins, regardless of gestational age
Prelabor
Before 37 weeks AOG
Premature
Also known as bag of water or panubigan
Amniotic sac
Spontaneous rupture of membranes before the onset of labor at greater than or equal to 37 weeks of gestation.
PROM (Prelabor Rupture of Membranes)
Spontaneous rupture of membranes before 37 weeks gestation, before labor begins.
PPROM (Preterm Prelabor Rupture of Membranes)
Ideal time for SROM to occur
- during active labor
- just before delivery
Risk Factors of PROM & PPROM
- Maternal infections
- Chrorioamnionitis
- History of PROM / PPROM
- Smoking, illicit drug use
- Polyhydramnios or multiple gestation
- Cervical insuffiency, history of cervical procedures
- maternal nutritional deficiency
- Trauma or invasive procedures
- Fetal malpresentation
Why is cervical insufficiency, or history of a cervical procedure a risk factor of PROM & PPROM
A weak cervix can’t support the weight of the amniotic sac leading to rupture
Signs & Symptoms
- Gush or leakage of fluid from the vagina
- Pool of amniotic fluid in the lower part of the vagina
- Most accurate sign to diagnose PROM
- Amniotic fluid leaking out from external os as per speculum examination.
Pool of amniotic fluid in the lower part of the vagina
If Diagnosis is still uncertain, these tests will help
- Nitrazine test
- Fern Test
- Ultrasound
Vaginal fluid pH test
- If paper turn blue, fluid is alkaline = amniotic sac
- There are other alkaline secretions that may interfere with results: blood, semen, meconium
Nitrazine Test
Microscopic crystallization pattern or a ferning pattern of dried amniotic fluid
Fern Test
Assess AFV 🡪 Oligohydramnios
Ultrasound
Why are routine vaginal exams avoided after PROM?
Risk of infection increases significantly
Maternal Risks
- Infection
- Placental abruption
- Maternal sepsis
Why is Placental abruption a maternal risk?
AF is decreased, cushioning effect is lost 🡪 fetus can put pressure on placenta
Fetal Risks
- Infection
- Preterm birth
- Cord prolabse / Cord compression
- Neonatal sepsis
- Placental abruption
- Fetal demise
Management for Term PROM (≥ 37 weeks)
- Expectant management (watchful waiting)
- Induction of labor - oxytocin admnistration
- Antibiotics
Management for PPROM (<34 weeks)
- Expectant management
- Corticosteroids
- Antibiotics
- Tocolytics is generally not recommended
What are corticosteroids for (ex. betamethasone or dexamethasone)
To enhance fetal lung maturity
Managment for PPROM (34-36 6/7 weeks)
- Delivery is usually recommended
- GBS prophylaxis if indicated
Management for Signs of infection or fetal distress
Immediate delivery of the baby
Nursing Responsibilities
- Monitoring
- Preventing infection
- Promote comfort & emotional support
- Adminster medications as ordered
- Monitor for complications
- Prepare for delivery
What to monitor as part of the nursing responsibilities
- Vital signs
- Fetal Monitoring
- Amniotic fluid assessment (color, odor, amount)
During her shift, Nurse Kelly is assessing a pregnant patient who experienced a minor car accident. She wants to reassure the patient about the integrity of the fetal membranes. Which statement reflects accurate information regarding the likelihood of blunt trauma to the abdomen causing premature rupture of membranes (PROM)?
A. “Blunt trauma never causes PROM unless the membranes were already weak.”
B. “Blunt trauma can sometimes cause PROM, but it’s not guaranteed.”
C. “Blunt trauma always causes premature rupture of membranes.”
D. “PROM is very rare after blunt trauma, so there’s no need to worry.”
B. “Blunt trauma can sometimes cause PROM, but it’s not guaranteed.”
Which condition must be met before it is safe to induce labor?
A. The fetus is positioned with its head down
B. The fetus’ lungs are mature enough for breathing
C. The fetus weighs at least 5 pounds
D. The woman’s pelvis is wide enough for birth
B. The fetus’ lungs are mature enough for breathing
Nurse Megan is discussing the potential complications of prolonged preterm premature rupture of membranes (PROM) with a patient in labor. She clarifies that hypoxia and asphyxia of the woman in labor is a common complication of prolonged PROM. Is this statement:
A. True
B. False
B. False
Nurse Sandra is assessing a pregnant client suspected of having abruptio placentae. Which of the following findings would she most likely observe?
A. A rigid, boardlike abdomen.
B. Prolonged, tetanic uterine contractions.
C. Premature rupture of membranes.
D. Excessive vaginal bleeding.
A. A rigid, boardlike abdomen.
Nurse Lisa is educating a group of expectant mothers about the risks associated with preterm premature rupture of membranes (PROM). She explains that an infection in the uterus can cause PROM and may also be a complication following PROM. Is this statement:
A. True
B. False
A. True
Nurse Clara is discussing the causes of preterm premature rupture of membranes (PROM) with a pregnant patient. She explains that PROM can occur if the uterus is overstretched due to factors such as fetal malpresentation, multiple pregnancies, or an excessive amount of amniotic fluid. Is this statement:
A. False
B. True
B. True
Nurse Clara is reviewing risk factors with a patient concerned about placental abruption. Which of the following would increase the patient’s risk?
A. A history of previous placental abruption.
B. Age under 35 years.
C. Gestational diabetes.
D. Strenuous exercise.
A. A history of previous placental abruption.
Nurse Julia is reviewing the physician’s orders for a patient admitted with preterm premature rupture of membranes (PPROM). Which order should Nurse Julia question?
A. Perform a vaginal exam every shift.
B. Monitor maternal temperature every 4 hours.
C. Ampicillin 1 gm IVPB q 6 hours.
D. Continuous fetal heart rate monitoring.
A. Perform a vaginal exam every shift.
