Midwifery 4 Preterm Management - Ruptured membranes and Birth 7 March 2025

Preterm Labour and Rupture of Membranes

• Learning Outcomes: Important to align with discussed material, particularly regarding risks and management of preterm labour and rupture of membranes.

Preterm Labour Risks

• Pre-term Rupture of Membranes: A significant risk factor for preterm labour.

  • Leads to possible infection of amniotic fluid, affecting the developing baby.

• Cervical Changes: Shortened cervix indicates a high likelihood of rupture and subsequent preterm labour.

Second and Third Trimester Bleeding

• APIs (Abnormal Placental Implantations): Stimulate labour onset.

  • Websites may see rapid labour progression in cases of significant bleeding.

• Underweight Risks: Low body mass can signal poor environmental conditions for fetus, prompting early delivery.

• Placental Size: Small placentas correlate with early deliveries (35-37 weeks).

• Socioeconomic Factors and Substance Abuse: Both pose additional risks for preterm complications.

Management of Pre-labour Rupture of Membranes

• 50% Rule: 50% of pre-term ruptures result in birth within one week, regardless of interventions.

• Antibiotic Therapy: Essential for preventing sepsis after rupture.

  • Erythromycin: Preferred due to low risk for the baby and good patient compliance.

  • Augmentin Caution: Strongly discouraged as it may cause necrotizing enterocolitis in newborns.

• Monitoring: Essential to assess signs of infection; patients may go home with antibiotics.

Assessment and Diagnostic Techniques

• Clear Evidence of Fluid: Diagnose using speculum examination rather than digital to avoid introducing infection.

• Pooling of Fluid: Confirmed through lying down for examination.

• New Diagnostic Tests: New techniques emerging but not universally available.

First 48 Hours Management

• Initial Antibiotics: Start IV ampicillin and maintain a course of oral erythromycin.

• Infection Prevention: Focused to avoid complications.

• Home Management: Patients can be discharged if stable; hourly monitoring encouraged (temperature checks, signs of infection).

Gestational Age Considerations

• Corticosteroids Administration: Ideally administered between 32+6 and 34+6 weeks to aid fetal development.

• Decision-Making: Treatment plans are contingent on fetal positioning and mother's stable health.

Psychological Support and Environment Preparation

• Support Structures: Ensure healthcare teams are ready to support preterm birth scenarios adequately.

• Neonatal Care Planning: Specialists ready to assist with immediate infant care, focusing on temperature maintenance and attachment.

• Communication: Continuity in care must include discussions post-delivery about what occurred and the next steps.

Postpartum and Continuity of Care

• Closure Opportunities: Provide space for conversations regarding outcomes and potential future pregnancies.

• Importance of Follow-Up: Ensure patients feel supported through postpartum care by maintaining communication with obstetric teams.

• Debriefing Sessions: Should be offered at the family's discretion, either immediately or after they have processed the event further.

Preterm Prelabour Rupture of Membranes (PPROM)

Major Risk Factors

• Previous preterm prelabour rupture of membranes: This history significantly increases the risk of PPROM in subsequent pregnancies.

Diagnosis by Midwives

• Midwives play a key role in diagnosing PPROM through patient assessment, identifying signs and symptoms.

Management of Women with PPROM

• Initial Assessment: Confirm rupture using appropriate methods (speculum examination recommended to avoid infection).

• Monitoring and Support: Regular monitoring for signs of infection and fetal distress is essential. Education about observed symptoms is critical.

• Antibiotic Therapy: Initiate antibiotic treatment to prevent infection; erythromycin is commonly preferred.

Basic Plan of Care When Woman Calls with Signs and Symptoms of Preterm Labour (PTL)

1. Obtain detailed history: Ask about the symptoms, including fluid leakage, contractions, bleeding, and any previous obstetric history.

2. Educational Support: Provide information on the signs of preterm labour and when to seek immediate care.

3. Encourage Monitoring: Advise patients to monitor their symptoms closely, including temperature and fetal movement.

4. Follow-Up Plan: Arrange a follow-up assessment either in person or via telehealth to ensure ongoing evaluation of the condition.