PREMATURE RUPTURE OF MEMBRANES (PROM)

• Premature rupture of membranes

  • refers to the rupture of membranes earlier than the end of the 37th week of gestation with or without contractions before the onset of labor
  • associated with preterm labor and preterm birth
• Can premature rupture of membranes resort to the prolapse of the cord?

  YES
• Assessment findings/diagnosis

  • Maternal report of passage of fluid on the vagina
• How do we know if leak is positive?

  • Nitrazine test - involves putting a drop of fluid obtained from the vagina onto paper strips containing Nitrazine dye. The strips change color depending on the pH of the fluid
  • Blue = pH is greater than 6.0 = leak
  • Yellow = no leak or no ruptures fluid
• Complications

  1. Prolapse of the cord - when the cord drops through the open cervix into the vagina before the fetus moves into the birth canal = hemorrhage = death of the mother = fetal death
  2. Maternal infection and fetal infection / chorioamnionitis - most common
  3. Premature labor
  4. Fetal distress
• Conditions associated with PROM / Risks

  • Natural weakening of the membranes results to force of contractions
  • Infections of the vagina and cervix - due to the dilation of the cervix
  • Incompetent cervix
  • Fetal abnormalities and malpresentation
  • Hydramnios - above the normal level of amniotic fluid
• Conditions associated with PROM / Risks (2)

  • AMniotic sac with a weak structure
  • Recent procedures such as amniocentesis or cerclage
  • Recent sexual intercourse
  • Nutritional deficiencies - weakens the mother's immune system = affects the growth of the fetus and environmental structure intrauterine
• Conditions associated with PROM / Risks (3)


  • Previous preterm birth related to PROM
  • Positive fetal fibronectin results
  • Positive Nitrazine test
• Fibronectin


  a protein that helps keep the amniotic sac attached to the lining of the uterus. Acts as an adhesive that helps stick to the uterus wall
• Two risks of PROM

  1. Prolapse of the cord = severe bleeding
  2. Intrauterine infection - ask the mother how long was the leak, and if more than 14 hours start giving antibiotics to combat against invading infection
• Nursing interventions

  • Maintain bed rest. Do not allow ambulation to prevent prolapse of the cord. Bedrets without bathroom privileges
  • Calculate the age of gestation = premature labor and delivery - if the fetus has chances of survival in extrauterine life
  • Monitor maternal vital signs and fetal well-being
  • Observe and record the character, amount, color, and odor of amniotic fluid
  • Be alert for early signs of infection: fever, chills, body malaise
  • Signs of labor onset = premature labor contractions
• Nursing interventions (2)

  • Provide psychological support

  -explain the procedure and findings

  -support the client and family

  -open lines of communication to the family to inform progress of condition

  -prepare the client and family for early interruption of pregnancy as indicated

  • Maintain hydration = start IFV
• Best position for the patient to prevent cord prolapse during PROM

  • Trendelenburg
  • Knee chest - the best
  • Sim's position
• Nursing alert

  • Mother is administered corticosteroids = lung maturity of the fetus incase born prematurely
  • Mothers are administered antibiotics to prevent further infection
  • Newborn is given antibiotics right after birth for preventive measures = prophylaxis against or to combat infection that may set in. To prevent neonatal sepsis