A Reading on

Premature Rupture of Membranes

In Partial fulfillment of the

Requirements in NCM 209 RLE

OBSTETRIC NURSING

Submitted to:
Portia Ituhat , RN,MN
Clinical Instructor

Submitted by:
Adrienne Nicole U. Alforte, St.N
BSN-2G; Group 2

March 23, 2020

Title: Premature Rupture of Membranes (at Term)
Bibliography: Jazayeri, A. (2018), Premature Rupture of Membranes:
https://emedicine.medscape.com/article/261137-overview#a2; Retrieved March 21,
2020

Summary:
Premature rupture of membranes (PROM) is a condition that is related with
spontaneous rupture of the amniotic membranes before any signs of the active labor or
beyond 37 weeks of gestation. It increases the risk of complications on maternal and
fetal health. It occurs in 10 percent of pregnancies and is the cause of one third of
preterm deliveries. Patients with PROM is associated with leakage of fluid, vaginal
discharge, vaginal bleeding, pelvic pressure and with no active contractions. Blood
pollution of the Nitrazine paper and ferning of cervical bodily fluid may deliver wrong
positive outcomes. Pooling of liquid in the vagina or spillage of liquid from the cervix,
ferning of the dried liquid under minute assessment, and alkalinity of the liquid as
controlled by Nitrazine paper affirm the finding. On the off chance that every single
liquid has spilled out as in early PROM, a ultrasonographic assessment may then show
nonappearance of or extremely low measures of amniotic liquid in the uterine pit. New
proof proposes that the utilization of biochemical markers to analyze ROM in dubious
cases might be fitting and financially beneficial. PROM can lead to significant perinatal
morbidity, including pulmonary hypoplasia, neonatal sepsis, umbilical cord prolapse,
placental abruption, fetal distress, fetal restriction deformities and fetal death.

Reaction:

With this article, I have learned that the premature rupture of membranes definitely
increases the complications and the probability of the chances that the risk factors of
delivery would likely happen. Nurses should apply an appropriate nursing theories in
developing the nursing care plan to be able to have a good nursing management to
prevent various complications that would arise due to PROM. This article provides
information that can contribute to clinical nursing guidelines for the mother diagnosed
with PROM who should be managed expectantly. As a student nurse and a future
registered nurse, caring for pregnant patients should be versed in the management of
PROM so that rapid diagnosis and appropriate management can be possible. This
article discussing the preterm rupture of membrane signifies the appropriate evaluation
and management of health care workers that are very important for improving maternal
and neonatal outcomes in the delivery.

Reference: https://emedicine.medscape.com/article/261137-overview#a2;
Premature Rupture of Membranes (at Term)

Premature rupture of membranes (PROM) at term is rupture of membranes prior to the

onset of labor at or beyond 37 weeks' gestation. PROM occurs in approximately 10% of
pregnancies. Patients with PROM present with leakage of fluid, vaginal discharge,
vaginal bleeding, and pelvic pressure, but they are not having contractions.

ROM is diagnosed by speculum vaginal examination of the cervix and vaginal cavity.
Pooling of fluid in the vagina or leakage of fluid from the cervix, ferning of the dried fluid
under microscopic examination, and alkalinity of the fluid as determined by Nitrazine
paper confirm the diagnosis.

Blood contamination of the Nitrazine paper and ferning of cervical mucus may produce
false-positive results. Pooling of fluid is by far the most accurate for diagnosis of ROM. If
all fluid has leaked out as in early PROM, an ultrasonographic examination may then
show absence of or very low amounts of amniotic fluid in the uterine cavity.

New evidence suggests that the use of biochemical markers to diagnose ROM in
uncertain cases may be appropriate and cost effective. Echebiri et al reported cost
effectiveness compared to standard methods of diagnoses between 34 and 37 weeks.
[5]

Ng et al reported placental alpha-microglobulin-1 levels have a 95.7% sensitivity, 100%

specificity, 100% positive predictive value, and 75% negative predictive value. [6] In
select cases when the diagnoses or ROM is not clear, placental alpha-microglobulin-1
should be used to provide additional information for appropriate management.

Given the importance of making the correct diagnoses, the associated morbidity with
hospitalization and delivery prior to term in PROM reaching 34 weeks and beyond, and
the potential neonatal morbidity resulting from prematurity in cases of incorrect
diagnoses of PROM, it is mandatory to confirm the diagnosis of PROM with pooling of
amniotic fluid with some evidence of decreased or absence of amniotic fluid in all cases
of suspected PROM.

Most patients (90%) enter spontaneous labor within 24 hours when they experience
ROM at term. The major question regarding management of these patients is whether
to allow them to enter labor spontaneously or to induce labor. In large part, the
management of these patients depends on their desires; however, the major maternal
risk at this gestational age is intrauterine infection. The risk of intrauterine infection
increases with the duration of ROM. Evidence supports the idea that induction of labor,
as opposed to expectant management, decreases the risk of chorioamnionitis without
increasing the cesarean delivery rate. [7, 8, 9]

Hannah et al studied 5041 women with PROM who were randomly assigned to
induction of labor with intravenous oxytocin or vaginal prostaglandin E2 gel versus
expectant management for as many as 4 days with induction of labor for complications.
[10] They concluded that, in women with PROM, induction of labor and expectant
management resulted in similar rates of cesarean delivery and neonatal infection.
However, induction with oxytocin resulted in a lower risk of maternal infection
(endometritis) when compared with expectant management. Additionally, the women in
the study viewed induction of labor more favorably than expectant management.

Other smaller studies have shown results with higher cesarean and/or operative
delivery rates when the cervix was unfavorable.

At term, infection remains the most serious complication associated with PROM for the
mother and the neonate. The risk of chorioamnionitis with term PROM has been
reported to be less than 10% and to increase to 40% after 24 hours of PROM. [11] This
points out the importance of appropriate management strategies for PROM at term.

Since risk of infection at term with ROM is small during the first 24 hours, expectant
management and waiting for spontaneous labor may be considered in selected patients
for the first 12-24 hours if a patient desires expectant management. The use of
expectant management after the first 24 hours is questionable.

Digital vaginal examinations should be avoided until labor is initiated; however, fetal
presentation should be documented to avoid discovering malpresentation of the fetus
long after admission for ROM. All patients with ROM should be asked to come to the
hospital to ensure fetal well being.

The neonatal risks of expectant management of PROM include infection, placental

abruption, fetal distress, fetal restriction deformities and pulmonary hypoplasia, and
fetal/neonatal death. Fetal death does occur in approximately 1% of patients with
PROM after viability who have been expectantly managed [1] and in about 1:1000 term
PROM. [12]

The primary determinant of neonatal morbidity and mortality is gestational age at

delivery, again stressing the importance of conservative management when possible.
(See the Gestational Age from Estimated Date of Delivery calculator.)

In general, prognosis is good after 32 weeks' gestation as long as no other complicating

factor, such as congenital malformation or pulmonary hypoplasia, exists.