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 8 to 10 percent of all pregnancies. PPROM (before 37 weeks) accounts for one fourth to one third of all preterm births.
The management of PPROM is among the most controversial issues in perinatal medicine. Points of contention include:
- Expectant management versus intervention
- Use of tocolytics
- Duration of administration of antibiotic prophylaxis
- Timing of administration of antenatal corticosteroids
- Methods of testing for maternal/fetal infection
- Timing of delivery.
Risk Factors and Causes:
Certain types of infections appear to be able to cause preterm PROM, and in rare cases procedures such as amniocentesis can cause PROM, but researchers do not believe there is a single cause of the condition. The following are some known risk factors:
- Lower socioeconomic status
- history of PPROM
- bleeding during pregnancy
- Smoking
- Prior preterm birth
- Sexually transmitted diseases
- Multiple pregnancy
- Polyhydramnios
- Leaking or a gush of watery fluid from the vagina
- Constant wetness in underwear
Nursing Diagnosis for Premature Rupture of Membranes : Risk for Infection related to invasive procedures, recurrent vaginal examination, and amniotic membrane rupture.
Goal: maternal infection does not occur
Expected outcomes: Mother states / shows are free of any signs of infection.
Nursing Interventions for Premature Rupture of Membranes:
1. Perform initial vaginal examination, when the contraction pattern repeat, or maternal behavior indicates progress.
R /: Repeated vaginal examinations play a role in the incidence of ascending tract infections.
2. Monitor temperature, pulse, respiration, and white blood cells as indicated.
R /: Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs.
3. Give prophylactic antibiotics when indicated.
R /: Antibiotic may protect against the development of chorioamnionitis in women at risk.
Source : http://nandahealth.blogspot.com/2013/09/risk-for-infection-related-to-premature.html