Premature Rupture of Membranes (PROM) Nursing Care Plan & Management

 Description

• PROM is rupture of the chorion and amnion 1 hour or more before the onset of labor. The gestational age of the fetus and estimates of viability affect management.

Etiology

• The precise cause and specific predisposing factors are unknown.

Pathophysiology

1. PROM is associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and, possibly, incompetent cervix.
2. Basic and effective defense against the fetus contracting an infection is lost and the risk of ascending intrauterine infection, known as chorioamnionitis, is increased.
3. The leading cause of death associated with PROM is infection.
4. When the latent period (time between rupture of membranes and onset of labor) is less than 24 hours, the risk of infection is low.

Assessment Findings

1. Clinical manifestations

• PROM is marked by amniotic fluid gushing from the vagina. The fluid may merely trickle or leak from the vagina in the absence of contractions.
• Pooling of amniotic fluid in the vagina will be visualized during a speculum examination.
• Maternal fever, fetal tachycardia, and malodorous discharge may indicate infection.

2. Laboratory and diagnostic study findings. Rupture of membranes is confirmed by the following.

• Ferning is evident.
• Nitrazine test tape turns a blue-green color.

Nursing Management

1. Prevent infection and other potential complications.

• Make an early and accurate evaluation of membrane status, using sterile speculum examination and determination of ferning. Thereafter, keep vaginal examinations to a minimum to prevent infection.
• Obtain smear specimens from vagina and rectum as prescribed to test for betahemolytic streptococci, an organism that increases the risk to the fetus.
• Determine maternal and fetal status, including estimated gestational age. Continually assess for signs of infection.
• Maintain the client on bed rest if the fetal head is not engaged. This method may prevent cord prolapse if additional rupture and loss of fluid occur. Once the fetal head is engaged, ambulation can be encouraged.

2. Provide client and family education.

• Inform the client, if the fetus is at term, that the chances of spontaneous labor beginning are excellent; encourage the client and partner to prepare themselves for labor and birth.
• If labor does not begin or the fetus is judged to be preterm or at risk for infection, explain treatments that are likely to be needed.

Exam

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Nursing Care Plan

Nursing Diagnosis

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 Intervention	Rationale
Perform initial vaginal examination, when the contraction pattern repeat, or maternal behavior indicates progress.	Repeated vaginal examinations play a role in the incidence of ascending tract infections.
Monitor temperature, pulse, respiration, and white blood cells as indicated.	Within 4 hours after membrane rupture, chorioamnionitis incidence increased progressively in accordance with the time indicated by vital signs.
Give prophylactic antibiotics when indicated.	Antibiotic may protect against the development of chorioamnionitis in women at risk.