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Chapter: Obstetric and Gynecological Nursing : Abnormal Labour

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Premature Rupture of the Membrane (PROM)

Premature rupture of the membranes (PROM) is defined as the rupture of the chorion and amnion one hour or more before the onset of labour. With PROM amniotic fluid leaks form the vagina in the absence of contractions.

Premature Rupture of the Membrane (PROM)

 

Premature rupture of the membranes (PROM) is defined as the rupture of the chorion and amnion one hour or more before the onset of labour. With PROM amniotic fluid leaks form the vagina in the absence of contractions. If prolonged, presents risks for both mother and fetus.

 

Etiologic and predisposing factors

 

The precise cause of PROM is unknown, and specific predisposing factors have not been identified. However it is known to be associated with

 

·        Malpresentations

 

·        Weak areas in the amnion and chorion

 

·        Vaginal infection

 

·        Incompetent cervix

 

Treatment

 

The obstetric management of PROM is based on the assessment of the risks to mothers and fetus.

-                  Active management of PROM involves induction of labour or caesarean delivery if labour doesn’t begin with in 24 hours. 

-                  Expectant or conservative management involves careful observation with out intervention unless signs of amnionitis or fetal distress is seen.

-                  When the risk of morbidity associated with PROM is greater than that associated with pregnancy termination, active management is indicated.

-                  When risk associated with terminating the pregnancy is considerable, as is the case premature, conservative management is indicated.

-                  In management of PROM with signs of advanced infection, delivery of the infant is the first priority. In such cases the mother will be given antibiotics and labour induction will be attempted.

-                  Prophylactic administration of antibiotics has been tried in order to prevent maternal infection when PROM has occurred

-                  Vaginal examinations should be kept to a minimum

-                  The patient’s temperature, pulse, and respiration rate should be assessed on admission and hourly

-                  The color, amount, and odor of fluid from the vagina should be noted.

 

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