PTL/PROM

Question 1

PPROM

Answer 1

Pre-term premature rupture of membranes
- No contractions, water breaks

Question 1

PTL Assessments

Answer 1

• S/S of contractions (back labor/cramping)
• Increased vaginal discharge or bloody show (cervix dilating)
• S/S of UTI/infection - elevated temp & FHR tachycardia
• Pelvic pressure
• GI upset (N/V, diarrhea)
• Cervical changes (dilation, effacement, station)

Question 2

PTL diagnostics

Answer 2

• CBC w WBC (18,000+ = infection)
• UA (WBC/RBC/bacteria = UTI)
• Amniotic fluid for 34wks+ for lung maturity
• Evaluate for ROM (Fluid pooling in cervix, nitrazine test, ferning)
• Cervical cultures (Group B strep, STDs)
• Fetal Fibronectin (Enzyme that shows up when in labor)
• Ultrasound

Question 3

PTL nursing interventions

Answer 3

• Palpate contractions to assess for strength
• Continuous external fetal monitoring
• Hydrate PO/IV (LR or 0.9% NS)
• Modified bed rest lying on left side
• Pain management
• Administer tocolytic agents

Question 4

Tocolytic Drugs

Answer 4

Cause smooth muscle relaxation in the uterus to stop contractions

Question 5

PROM

Answer 5

• Premature Rupture of Membranes before 36wks
• No contractions, water breaks
• At term they deliver the baby within 48 hours

Question 6

Risks associated with prolonged PROM

Answer 6

• Maternal infections (Chorioamnitis, Endometritis, sepsis)
• Neonatal infections (Meningitis, pneumonia)

Question 7

Chorioamnitis

Answer 7

Infection of the amnion/chorion

Question 8

Endometritis

Answer 8

Infection of the uterine muscle

Question 9

PROM Nursing interventions

Answer 9

• Note uterine activity (Contractions/irritability)
• Uterine palpation - tenderness, (chorioamnitis - localized pain)
• NO vaginal exams (increases infection)
• Administer antibiotics
• Turn on left lateral (decrease perfusion cord compression (variable decels) due to decrease amniotic fluid)
• Modified bedrest with FHR monitoring
• Evaluate fetal position by palpation or ultrasound (HR low = vertex, HR high = breech)