NURSING CARE FOR MOTHER WITH

PRETERM PREMATURE RUPTURE

OF MEMBRANES

CREATED BY:
VITA ADRIANI
04.435

NURSING ACADEMY
OF CENTRAL JAVA PROVINCE
2007

PREFACE REPORT
NURSING CARE FOR MOTHER WITH
PRETERM PREMATURE RUPTURE
OF MEMBRANES
A.

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).
PROM occurs in about 10 percent of all pregnancies. PPROM (before 37
weeks) occurs in about 2 percent of all pregnancies.
Definitions and abbreviations
PROM

Premature rupture of the membranes before labour contractions

begin, whatever the age of the pregnancy.

pPROM

Pre-term premature rupture of the membranes, meaning rupture

of the membranes before labour contractions begin in a preterm pregnancy.

Latent

Time from rupture of the membranes up to delivery.

period
Latent

Time from rupture of the membranes to the beginning of the

interval

active phase of labour.

AFI

Amniotic fluid index

AGA

Adequate for gestational age

AL

Amniotic liquid

BPP

Biophysical profile

CST

Contraction stress test

FBM

Fetal breathing movement

FM

Fetal movement

FRH

Fetal heart rate

GA

Gestational age

IAI

Intra-amniotic infection

IUGR

Intra-uterine growth retardation

IVH

Intra-ventricular haemorrhage

MP

Multifetal pregnancy

NST

Non-stress test

RDS

Respiratory distress syndrome

SGA

Small for gestational age

B.

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:

Low

socioeconomic

conditions

(as

women

in

lower

socioeconomic conditions are less likely to receive proper prenatal care)

Sexually transmitted infections such as chlamydia and

gonorrhea

Previous preterm birth

Vaginal bleeding

Cigarette smoking during pregnancy

Unknown causes

C.

CLINICAL MANIFESTATION
The following are the most common symptoms of PROM. However, each
woman may experience symptoms differently. Symptoms may include:

Leaking or a gush of watery fluid from the vagina

Constant wetness in panties

If you notice any symptoms of PROM, be sure to call your physician as

soon as possible. The symptoms of PROM may resemble other medical

conditions. Consult your physician for a diagnosis.
D.

PHATOFISIOLOGY

E.

PATHWAYS

F.

DIAGNOSTIC TEST
In addition to a complete medical history and physical examination,
PROM 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 which uses highfrequency 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 blood flow through various vessels.

Taking Vital Signs: These include temperature, blood pressure,

pulse (counting heartbeats), and respirations (counting breaths). A
stethoscope is used to listen to the heart and lungs. Blood pressure is taken
by wrapping a cuff around the arm.

Pelvic Exam: This is also called an "internal" exam. Physician

will gently put a warmed speculum (SPEK-u-lum) into vagina. This tool
opens vagina to let doctor see cervix (the bottom part of your uterus).
Nurses will take a sample of the fluid in vagina and have it tested to
determine whether bag of waters has broken.

Fetal Heart Monitoring: A loose fitting belt with a small metal

disc may be placed around abdomen to monitor the baby. The disc sends
signals to a TV-like screen that shows a tracing of the baby's heartbeat.

Abdominal Ultrasound: This painless test uses sound waves to

view the inside of abdomen. Pictures of the area show up on a TV-like
screen.

Activity: Might be suggested to stay in bed. The doctor will tell

when it's OK to get up.

Blood Tests: It can be drawn from a vein in the hand or from

the bend in elbow. Several samples may be needed.

IV: A tube placed in the vein for giving medicine or liquids. It

will be capped or have tubing connected to it.

G.

TREATMENT
Specific treatment for PROM will be determined by your physician based on:

Your pregnancy, overall health, and medical history

Extent of the condition

Your tolerance for specific medications, procedures, or

therapies

Expectations for the course of the condition

Treatment for premature rupture of membranes may include:

Hospitalization

Expectant management (in some cases of PPROM, the

membranes may seal over and the fluid may stop leaking without
treatment)

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.

Delivery (if PROM endangers the well-being of the mother or

fetus, then an early delivery may be necessary to prevent further
complications)

H.

MANAGEMENT
Many studies advise decision making according to the gestational age:

20-24 weeks of pregnancy: the survival rate is very low (less

than 20-25%), with a very accurate expectant management of the
pregnancy. Infection risk is very high and the long-term complications are
very common and need an expensive follow-up. Therefore, termination of
pregnancy is more often offered to the parents (60).

24-26 weeks of pregnancy: most of the studies suggest active

management, checking for infection or fetal distress. In case of clinically
apparent symptoms and positive laboratory results for chorio-amnionitis, it
is advisable to interrupt the pregnancy by induction of labour (64).
Caesarean section should be avoided if possible, being associated with a
high rate of puerperal infection (39).

26-30 weeks of pregnancy: observation and follow-up are

advisable. Antibiotic prophylaxis and steroids are considered to be of
benefit. The risk of prematurity is higher than the risk of fetal/neonatal
infection. This age-group has the highest benefits from the steroids
treatment. Tocolysis is indicated if transfer to another health care unit is
needed (58).

30-36 weeks of pregnancy: survival rate is high in this agegroup (95%) (6). Lung maturation is achieved in more than 50% of cases,
thus one has to check if steroids are needed. Antibiotics are advisable if
the latent period is rather long. Interruption of pregnancy, once the
diagnosis of IAI is confirmed, has no better outcome than using a
antibiotics before induction is commenced. In this age-group induction

failure rate is low and the need of C/S and its puerperal complications are
rare (53; 55).

I.

FOCUS ASSESSMENT

J.

INTERVENTION