Preterm/Prelabor Rupture of Membranes

Risk factors

• Low socioeconomic status

• Low pre-pregnancy BMI

• Tobacco use

• History of PPROM

• Infection

• Short cervical length

• Vaginal bleeding

Comorbidities

• Gestational DM

• Hypertensive disorders

• Cardiac disease

• Polycystic kidney disease

• Sickle cell disease

Assess fetal well-being, presentation and gestation, signs of infection

• Presentation: 

  • Feel for head, back, butt, shoulder

• How to monitor their well being:

  • Fetal monitor

• Gestational age:

  • Ultrasound 

• Fluid leakage:

  • With speculum exam 

• Infection signs:

  • Herpes?

Diagnostics

• Visual – color, odor, amount, time

• Fern test

• Nitrazine test

• Amniotic protein tests

• Ultrasound

Treatments

• Near to term

  • Expectant management, induction

• Additional treatment determined by gestational age

• Tocolytics, antibiotics, activity limitations, corticosteroids or magnesium sulfate

• Psychosocial support

• Health promotion – modifiable risk factors

Complications

• Maternal sepsis

• Cesarean birth

• Fetal sepsis

• Fetal respiratory problems

Assessment

• Time of rupture → Number #1 (24 hours)

• Color, consistency, odor

• Maternal VS, history

• FHTs and contractions

• Avoid vaginal exam

Interventions: Physical comfort

• Frequent pad changes

• Hydration

• Nutrition

• Education