/
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)

Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)

Watch More! Unlock the full videos with a FREE trial
START FREE TRIAL
Master
To Master a topic you must score > 80% on the lesson quiz.
Take Quiz

Included In This Lesson

Study Tools
Outline
Nursing Diagnosis
Transcript
Additional Lessons

Study Tools For Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)

Chorion and Amniotic Sac (Image)
Example Care Plan_Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM) (Cheatsheet)
Blank Nursing Care Plan_CS (Cheatsheet)

Outline

Lesson Objectives for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM):

  • Define PROM and PPROM:
    • Clearly differentiate between PROM (Premature Rupture of Membranes) and PPROM (Preterm Premature Rupture of Membranes).
    • Understand the gestational age criteria that classify PPROM.
  • Recognize Clinical Signs and Symptoms:
    • Identify the clinical signs and symptoms associated with PROM and PPROM, including the sudden gush or leakage of amniotic fluid.
    • Understand the importance of differentiating amniotic fluid leakage from other causes.
  • Comprehend Risk Factors:
    • Explore and understand the risk factors that predispose individuals to PROM and PPROM, such as bacterial infections, multiple pregnancies, and a history of preterm birth.
  • Appreciate the Complications and Implications:
    • Recognize the potential complications and implications of PROM and PPROM for both the pregnant individual and the fetus, including the risk of infection and preterm birth.
    • Understand Nursing Interventions and Management:
    • Familiarize oneself with nursing interventions and management strategies for individuals experiencing PROM and PPROM, emphasizing the importance of monitoring, infection prevention, and support.

Pathophysiology of Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM):

  • Weakening of Fetal Membranes:
    • Structural changes in the fetal membranes (amnion and chorion) may occur, leading to weakening and increased susceptibility to rupture.
  • Inflammatory Processes:
    • Inflammation within the gestational tissues, often triggered by infection or other factors, can contribute to the breakdown of collagen and weakening of the fetal membranes.
  • Decidual Bleeding:
    • Decidual bleeding, a phenomenon where blood vessels in the decidua (lining of the uterus) rupture, can cause localized separation of the fetal membranes, leading to rupture.
  • Uterine Stretching:
    • Overdistension of the uterus, as seen in multiple pregnancies or polyhydramnios, can exert mechanical stress on the fetal membranes, increasing the risk of rupture.
  • Amniotic Fluid Volume:
    • Changes in amniotic fluid volume, either excessive or insufficient, may impact the integrity of the fetal membranes, predisposing them to premature rupture.
    • Etiology of Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM):
  • Infection:
    • Bacterial infections, particularly those ascending from the lower reproductive tract, can lead to inflammation and weaken the fetal membranes, increasing the risk of rupture.
  • Genital Tract Procedures:
    • Invasive procedures such as amniocentesis or cervical cerclage may inadvertently cause trauma to the fetal membranes, leading to PROM or PPROM.
  • Cervical Insufficiency:
    • Incompetent cervix, characterized by the inability of the cervix to remain closed during pregnancy, may result in premature dilation and rupture of the membranes.
  • Multiparity:
    • Women who have had multiple pregnancies may experience increased stretching of the uterine tissues, which can contribute to the weakening of the fetal membranes.
  • Polyhydramnios:
    • Excessive amniotic fluid surrounding the fetus may lead to increased pressure on the fetal membranes, contributing to their weakening and potential rupture.

Desired Outcome in the Management of Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM):

 

  • Infection Prevention:
    • Prevent maternal and fetal infection by promptly identifying and treating any signs of infection.
    • Minimize the risk of ascending infection through careful monitoring and interventions.
  • Prolongation of Pregnancy:
    • Aim to prolong the gestation period to enhance fetal maturation and reduce the risks associated with preterm birth.
    • Monitor for signs of preterm labor and implement interventions as needed.
  • Fetal Well-being:
    • Ensure continuous fetal monitoring to assess for any signs of distress or compromise.
    • Implement interventions to support fetal lung maturation, if indicated.
  • Stable Maternal Vital Signs:
    • Maintain stable maternal vital signs, including temperature, heart rate, and respiratory rate.
    • Monitor for any signs of maternal infection or complications.
  • Psychosocial Support:
    • Provide emotional support and education to address anxiety and concerns related to PROM or PPROM.
    • Foster open communication and involve the individual in decision-making.

Subjective Data:

  • Sudden gush or steady trickle of clear fluid from vagina

Objective Data:

  • Blue nitrazine paper test- turns dark blue if positive for amniotic fluid 
  • Visual pooling of amniotic fluid in vagina

Nursing Assessment for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM):

 

  • Fluid Assessment:
    • Assess amniotic fluid characteristics, including color, odor, and amount.
    • Differentiate between amniotic fluid leakage and other causes, such as urinary incontinence.
  • Vital Signs Monitoring:
    • Monitor maternal vital signs, including temperature, heart rate, and blood pressure.
    • Assess for signs of maternal infection, such as fever or chills.
  • Fetal Monitoring:
    • Implement continuous electronic fetal monitoring to assess fetal heart rate patterns.
    • Evaluate for signs of fetal distress and intervene as necessary.
  • Assessment of Uterine Activity:
    • Monitor uterine contractions and assess for signs of preterm labor.
    • Use tocodynamometry or palpation to measure uterine activity.
  • Laboratory Tests:
    • Perform laboratory tests as ordered, including complete blood count (CBC) and C-reactive protein (CRP), to assess for signs of infection.
    • Monitor white blood cell count and other inflammatory markers.
  • Cervical Examination:
    • Conduct cervical examinations to assess for cervical dilation and effacement.
    • Evaluate the presence of any prolapsed umbilical cord or other complications.
  • Nutritional Status:
    • Assess maternal nutritional intake to ensure proper nutrition for both the mother and the fetus.
    • Consider nutritional supplements as needed.
  • Psychosocial Assessment:
    • Evaluate the emotional well-being of the individual and their support system.
    • Assess for signs of anxiety, stress, or depression related to PROM or PPROM.

Continuous and thorough nursing assessment, coupled with prompt intervention and support, is essential for optimizing outcomes in individuals experiencing PROM or PPROM. This approach allows for early detection of complications, timely interventions, and collaborative decision-making between the healthcare team and the individual.

 

Implementation for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM):

 

  • Infection Prevention:
    • Administer prophylactic antibiotics promptly as prescribed to reduce the risk of maternal and fetal infection.
    • Monitor maternal vital signs for signs of infection, such as fever or increased heart rate.
  • Fetal Monitoring and Assessment:
    • Implement continuous electronic fetal monitoring to assess fetal well-being.
    • Evaluate fetal heart rate patterns and variability for signs of distress.
  • Medication Administration:
    • Administer corticosteroids as prescribed to enhance fetal lung maturity if preterm birth is anticipated.
    • Implement tocolytic therapy to suppress uterine contractions if preterm labor is detected.
  • Fluid Management:
    • Monitor amniotic fluid volume regularly to assess for any signs of oligohydramnios.
    • Encourage oral hydration to maintain amniotic fluid levels and maternal well-being.
  • Psychosocial Support:
    • Provide emotional support and education to the individual and their support system.
    • Encourage open communication, address concerns, and involve the individual in decision-making.

Nursing Interventions and Rationales

 

Nursing Intervention (ADPIE) Rationale
Assess for signs of infection Maternal and fetal infection may prompt PROM and must be treated quickly to avoid fetal compromise.
Perform single digital or sterile speculum vaginal exam Vaginal exam may be required to confirm diagnosis but avoid multiple digital vaginal exams to reduce the risk of infection. Reserve these exams for when delivery is imminent.
Obtain history from patient regarding complications and status of pregnancy. Treatment depends on gestational age and existing complications

Patient may need to remain on bed rest to continue pregnancy if preterm, or labor may be induced.
Initiate fetal monitoring PROM may be an indicator of fetal distress. Monitor for signs of fetal compromise to include changes in fetal heart rate.
Administer medications and IV fluids as appropriate:

Prophylactic antibiotics

Corticosteroids

Tocolytics

Magnesium sulfate

 PPROM may indicate a need for corticosteroids to speed up the fetal lung maturity

Antibiotics are given prophylactically to prevent infection

Tocolytics may be given to stop preterm labor

Magnesium sulfate may be given if prior to 32 wks gestation to prevent fetal neurological dysfunction
Prepare patient for induction of labor and delivery If indicated, labor will likely be induced if it does not spontaneously begin within 12-24 hours. Explain process to patient to reduce fears.
Provide patient education if preterm:

Pelvic rest

Avoid tampons and intercourse

Avoid tub baths (showers ok)

 If delivery is not indicated (<34 wks gestation), patient will likely remain in the hospital until delivery is an option.

Regardless of location, patient will be required to remain on bed rest and antibiotics will continue prophylactically until delivery.

Evaluation

 

  • Infection Prevention:
    • Monitor for signs of infection, such as maternal fever, elevated white blood cell count, or foul-smelling amniotic fluid.
    • Evaluate the effectiveness of antibiotic prophylaxis.
  • Prolongation of Pregnancy:
    • Assess the gestational age at delivery and evaluate the success in prolonging the pregnancy.
    • Monitor for signs of preterm labor or other complications.
  • Fetal Well-being:
    • Evaluate fetal outcomes, including Apgar scores and neonatal complications.
    • Assess for any signs of fetal distress during labor and delivery.
  • Maternal Vital Signs:
    • Monitor maternal vital signs, ensuring stability and absence of signs of infection.
    • Evaluate the effectiveness of interventions in maintaining maternal well-being.
  • Psychosocial Well-being:
    • Assess the individual’s emotional well-being and coping mechanisms.
    • Evaluate the impact of psychosocial support on reducing anxiety and stress related to PROM or PPROM.

Content Reviewed

References

View the FULL Outline

When you start a FREE trial you gain access to the full outline as well as:

  • SIMCLEX (NCLEX Simulator)
  • 6,500+ Practice NCLEX Questions
  • 2,000+ HD Videos
  • 300+ Nursing Cheatsheets
Start Free Trial

Example Nursing Diagnosis For Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)

  1. Risk for Infection: Premature rupture of membranes can increase the risk of infection to both the mother and the fetus. This diagnosis emphasizes infection prevention.
  2. Risk for Preterm Birth: Premature rupture of membranes is a risk factor for preterm labor and birth. This diagnosis highlights the potential for preterm delivery.
  3. Altered Fluid Volume: This diagnosis addresses changes in amniotic fluid volume and the need for monitoring and management.

Transcript

Hi everyone, today, the nursing care plan we’re going to be discussing right now is the premature rupture of the membranes. So, the pathophysiology of this is when the membranes rupture prior to 37 weeks’ gestation, it is considered a premature rupture of the membranes or preterm premature rupture of the membranes, PPROM. Nursing considerations: patients, geological history, vaginal exam, fetal monitoring, assess for signs of infection, IV fluids, or medications, preparing for the delivery, and educating the patient. Some desired outcomes: the patient will be free from infection for maternal and fetal and have a viable birth. 

So, coming into the care plan, we’re going to be going over some subjective data and we’re going to be going over some objective data. So, what are we going to see in the patient? So, there might be a sudden gush or steady trickle of clear fluid from the vagina or some objective, which is going to be super common, is a blue nitrazine paper test. And with this test, if it’s positive for amniotic fluid, it’s going to be turning a dark blue color. And there also might be some visual pooling of amniotic fluid from the vagina. 

Some interventions: we want to make sure that we’re looking for any sort of sign of infection – maternal or fetal infection. It may prompt a premature rupture of the membranes, and it must be treated quickly and able to avoid any sort of fetal compromise. We also want to perform any sort of single digital or sterile speculum vaginal exam. So, any sort of vaginal exam, it may be required to confirm a diagnosis, but you want to avoid multiple digital vaginal exams as that will increase the risk of infection. So, reserve those exams for when delivery is imminent. Another thing you want to make sure that we’re doing is getting a history of the patient. So, this could be the amount of pregnancies the patient has had prior to the current, or any existing complications that the patient may have. They may have to remain on bedrest to be able to continue pregnancy. If preterm labor is induced, we want to initiate fetal monitoring. 

So premature ROM can be an indicator of fetal distress. So, you might want to be monitoring for signs of fetal compromise, to include changes in a fetal heart rate. Some other things that we want to assess are medications and IV fluids. So, some medications that you might be looking at are some corticosteroids or tocolytic or magnesium sulfate and some prophylactic antibiotics, just to make sure we’re preventing any infection from arising. Since it may indicate a need for corticosteroids to speed fetal lung maturity is also very important with steroids, especially if it is a preterm premature, we want to make sure we’re preparing the patient for labor and delivery. 

So, if labor and delivery is imminent and they’re not able to keep the baby from not being born at that moment in time, they will educate the patient and get them to the delivery room. We also want to make sure that we’re doing pelvic rest for the mom. So, you want to avoid any sort of tampons or intercourse during that period, avoiding any tub baths or showers. If delivery is not indicated less than 34 weeks, the patient is likely to remain in a hospital until delivery is an option, but regardless of location, the patient will be required to remain on bedrest and antibiotics will continue prophylactically until delivery. 

So, we’re going to go over some key points here. So, pathology, premature rupture of the membrane time prior to 37 weeks factors include maternal or intra amniotic fluid infection, abdominal trauma, nutritional deficits, smoking, and placental abruption. A steady gush or a steady trickle of clear fluid from the vagina blue nitric paper that turns dark blue will be positive for amniotic fluid and any visual pooling of amniotic fluid in the vagina. So, these are going to be things you’re going to see in the patient. You want to assess, perform fetal monitoring, get a full history from the patient, assess for any sort of signs of infection, and vaginal exams. Using a fetal monitor to monitor the fetus to make sure that there is no fetal compromise. You want to give eye meds, perform education, and initiate any sort of IV fluids and medication as appropriate for the patient. And you want to prepare the patient for delivery if it’s not spontaneously done within 12 to 24 hours. And as always, educate the patient on every treatment plan that you initiate. 

You guys did a wonderful job. We love you guys. Be sure you go out and be your best self today. And, as always, happy nursing.

 

View the FULL Transcript

When you start a FREE trial you gain access to the full outline as well as:

  • SIMCLEX (NCLEX Simulator)
  • 6,500+ Practice NCLEX Questions
  • 2,000+ HD Videos
  • 300+ Nursing Cheatsheets
Start Free Trial