Preterm Rupture of Membranes - Nursing Case Study

by - June 24, 2020

DESCRIPTION:
Preterm rupture of membranes is a rupture of fetal membranes with loss of amniotic fluid before 37 weeks of pregnancy. The cause is unknown but it is strongly associated with infection of the membranes like chorioamnionitis. If the rupture occurs early in pregnancy, it will be major threat to the fetus because the seal to the fetus is lost and uterine and fetal infections may occur. It can brought an increased pressure on the umbilical cord from the loss of amniotic fluid or cord prolapse that can interfere with fetal circulation. Another risk to the fetus is the development of Potter – like syndrome or distorted facial features and pulmonary hypoplasia from uterine pressure.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
If the client is experiencing a preterm rupture of membranes, there will be a sudden gush of clear fluid from her vagina with continued minimal leakage.  

DIAGNOSTIC AND LABORATORY TEST:
A sterile vaginal speculum examination is done to observe for vaginal pooling of fluid. If the fluid is tested with Nitrazine paper, amniotic fluid causes an alkaline reaction and will appears blue on the paper, and in contrast, urine causes an acidic reaction and the paper will remain yellow. The fluid can also be tested for ferning or the typical appearance of a high – estrogen fluid on microscopic examination. And if there is still in doubt, ultrasound can be used to assess the amniotic fluid index. Since it is related to vaginal infection, the cultures for Neisseria gonorrhoeae, group B streptococcus, and chlamydia are usually obtained. The blood will be drawn for white blood cell count and C – reactive protein. Doing a routine vaginal examination is avoided since it will rise the risk for infections.

RISK FACTORS:
The risks factors that are associated with preterm rupture of membranes are chorioamnionitis, cigarette smoking, previous preterm birth, sexually transmitted infections, polyhydramnios, multiple pregnancy, trauma, poor maternal nutrition, and genetics

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Anxiety related to threat to the fetus
Risk for deficient fluid volume related to fluid discharge of vagina secondary to PROM
Risk for infection related to preterm rupture of membranes without accompanying labor
Impaired gas exchange to fetus related to premature rupture of membranes
Risk for fetal injury related to PROM

NURSING CARE PLAN:
Anxiety related to threat to the fetus
Risk for deficient fluid volume related to fluid discharge of vagina secondary to PROM
Risk for infection related to preterm rupture of membranes without accompanying labor
NURSING MANAGEMENT / INTERVENTION:
The nurse need to monitor the maternal and fetal vital signs, provide comfort to the mother, administer medications as prescribed by the healthcare provider, provide perineal care, health education and assist in procedures to be done to the client.

MEDICAL / SURGICAL MANAGEMENT:
If labor is not starting yet within the 24 hours and the fetus is matured enough to survive in an extrauterine environment, the labor contractions may be induced by intravenous administration of oxytocin so the infant can be born before the infection occurs. However, if the infant is not viable enough, the women will be offered to end the pregnancy but if she declines, she will be placed in a bed rest. The woman will be given some medications like corticosteroids, prophylactic administration of broad – spectrum antibiotics effective against B streptococcus, tocolytic agents, and also amnioinfusion in order to reduce the pressure in the fetus or cord and to allow a safer term birth.

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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