SYSTEMS PLUS COLLEGE FOUNDATION

College of N ursing

CASE STUDY:

Premature Rupture of
Membranes (PROM)

A Case Study presented to the

Faculty of the College of Nursing of Systems
Plus College Foundation

In Partial Fulfillment of the Requirements

For the Degree of
Bachelor of Science in Nursing

Submitted By:

Villarino, Khalil Jane

NUR03C

Submitted To:

Prof. Junefaith Elese C. Neo RM, RN, MSN

October 2022

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College of N ursing

I. INTRODUCTION
a. Brief description of the disease/statistical incidence.

The rupture of the gestational membranes before the start of labor is known
as Premature Rupture of the Membranes (PROM). According to Dayal, there are
variety of factors that result to the disease. One reason is due to the physiological
occurrence of weaking of the membranes induced by the force of uterine
contractions. Preterm PROM refers to membrane rupture that happens before labor
and before 37 weeks of pregnancy (PPROM).

Specifically, Increased collagenase and protease activity, imbalanced

interactions between matrix metalloproteinases and tissue inhibitors of matrix
metalloproteinases, localized cytokine production, and other factors that can raise
intrauterine pressure are the primary culprits to the disease.

b. Latest statistics or incidence of the disorder.

According to the National Library of Medication, the National Center for

Biotechnology Information. there are about 8% of pregnancies recorded that have
shown complications due to PROM as of 2022. About 1% of deliveries are
exacerbated by preterm PROM, which is common in African Americans.

Children’s Hospital of Philadelphia claimed that the Premature Rupture of

Membranes (PROM) occurs 8-10% of all cases of pregnancies specifically those
who do not receive proper care and prenatal check-ups, smoking while being
pregnant, vaginal bleeding, and with present condition of STI’s specifically
chlamydia and gonorrhea.

c. Current Trends (New approach/method of treatment)

Premature Rupture of Labor (PROM) is diagnosed by determining the Age

of Gestation (AOG). Patients who are in early term, actual in term, and late term
are moved to the delivery room and then administered with Streptococcus
prophylaxis. For pre-term, expectant management, antibiotics for latency, single
course of corticosteroids, and GBS prophylaxis as needed. For patients with less
than 24 weeks of gestational age, induction of labor, patient counselling,
consideration of antibiotics are done.
The use of tocolytics is still in debate to administer due to the effects of
prolonged latency period withing 48 hours. To add, there are still no significant
records of any neonatal benefits from using tocolytics and is linked to the increased
risk of developing chorioamnionitis.

d. Significance of these figures on your part as nursing student

The significance of the disease to the knowledge of a nursing student is to
keep in mind all the intervention during inevitable situations in the Labor
Room/Delivery Room. When handling patients who could be possibly
encountering PROM, the knowledge is being utilized by the student nurse and is
honed to learn the skills needed to be done during actual situations. With realistic
means of the knowledge, the student nurse provides education to the client with
the hopes of cooperation and collaboration with the interventions.

II. THE DISEASE PROCESS

 Definition of the disease
The word "premature rupture of membranes" (PROM) pertains to the fetal
membranes rupturing before to the beginning of labor. The majority of the time,

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this happens close to term, however preterm PROM is the name for when it
happens before 37 weeks of pregnancy. The majority of the time, this happens
close to term, whereas preterm PROM is the name for when it happens before 37
weeks of pregnancy. About 3 percent of pregnancies are exacerbated by preterm
PROM, which causes one-third of pretermbirths.1 Preterm PROM also increases
the likelihood of prematurity and causes a number of perinatal and neonatal
complications, including a 1 to 2 percent risk of fetal death.2 Doctors who treat
pregnant patients should be knowledgeable about preterm PROM management
because prompt diagnosis and appropriate treatment can improve outcomes.

 Risk factors
The risk factors that worsen the premature ruptures of membranes are the
following:

 Ethnicity: Black patients are reported to have more cases of

premature rupture of membranes (PROM) than white patients.
 Lifestyle and Economic Status: Patients who do not receive any
prenatal care and check-ups, have existing sexually transmitted
infections (chlamydia and gonorrhea), smoking vices have higher
risks of developing premature rupture of membranes (PROM)
when pregnant.
 History of Pregnancy: Patients who had vaginal bleeding, uterine
distension due to multifetal pregnancies, and pre-term pregnancies
also have higher risks of developing PROM.

Reduced collagen in the membranes are linked with being susceptible to

premature rupture of membranes (PROM).

c. Sign and Symptoms

The signs and symptoms that are common in premature rupture of
membranes (PROM) are the following:

 sudden gush of leaked liquid that may be transparent or pale yellow.

 fetal heart rate is increased
 uterine contractions
 tenderness and pain in the uterus
 foul smelling vaginal discharge
 Increased WBC count

III.ANATOMY AND PHYSIOLOGY

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The Amniotic Sac contains the growing and developing fetus to serve as the cushion for
protection supported by amniotic fluid and membranes. The two main membranes of the
amniotic sac are the Chorion and Amnion. These parts take part in feeding and supporting
the fetus needed for thermoregulation and protection. Up to roughly 36 weeks of pregnancy,
the volume of amniotic fluid rises.

The placenta is a vascular structure that wraps around the uterine wall and permits the
mother and fetus to exchange metabolic materials. The placenta plays numerous vital roles
for the development of the fetus, like supplying nutrition. The placenta plays numerous vital
roles for the development of the fetus, like supplying nutrition.

PHYSIOLOGY OF THE AMNIOTIC SAC

Amniotic Fluid

The amniotic sac will form and fill with fluid a few days after conception. The majority
of the amniotic fluid will be water at the start of fetal development. Starting around week 10
of pregnancy, the fetus will begin passing minute volumes of pee into the fluid as it develops.
The amniotic fluid is a transparent liquid. The amniotic sac will rupture before or during
labor, and the amniotic fluid will either gradually drain into the vagina or abruptly rush
through in a rush. The amniotic sac breaking is what is often called to as when a woman's
"water breaks," and because there is an increased risk of infection following this event,
medical assistance should be sought.

f. Surgical Management
i. Definition of the Operation

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Cesarean Operation or also called as the C-section is a surgical delivery in

which the mother's abdomen and uterus are cut (incisions are made). When
medical professionals feel it's safer for the mother, the child, or both, they
utilize it. When labor is induced after the sustained premature rupture of the
membranes (PROM) at term, women are more likely to require a cesarean
delivery than women whose labor starts naturally within 24 hours of the
PROM.

ii. Procedure (Preoperative, Intra-operative and Postoperative)

1. Postoperative Procedures
 Consent forms are given and signed by the patient
 The procedures will be thoroughly discussed to give heads up of what to expect
after the operation with your obstetrician.
 IV will be utilized to administer the medicines needed before the procedure.
 The patient will be asked for the choice of anesthesia. The most famous type of
anesthesia in labor is the epidural since sensations will be blocked completely
from the chest to the lower extremities.
 Monitoring of vital signs will be done.
 If the patient has hair in the incisional area, they will be shaved.

2. Intra-operative Procedures
 An antiseptic agent will be used to clean the incisional area
 Sterile drapes will be placed in the proper places of specifically in the are of
incision and over the chest area and lower extremeties.
 Sterile curtain are to be held up and hold that should cover the area of incision
 Incision of the abdomen begins. Vertical or transverse incision may be done.
 An incision of the uterine wall will be made for up to 4 inches.
 When the incision is done, abdomen is squeezed open to remove the baby.
 When the baby is held up, the umbilical cord is cut then the placenta is being
removed.
 The procedure ends with stitches as the incisions are closed then staples the
skin to hold them together.

3. Postoperative Procedures
 Vital signs of the patient and the fetus is monitored
 The patient is transferred to the recovery room.
 Pain medications are prescribed to alleviate the pain caused by the sutures.
 Staples are to be removed in a week after procedure. The stitches must
dissolve in the incisional area.

iii. Instruments

Sponge Holding Forceps Used to hold the sponge

as it is used to clean the
area of incisional area.

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Towel Clips To lock and secure the

towels in its proper place.

Blade Holder Used to cut the skin,

uterus and the tissues
inside the abdomen.

Artery Forceps Clinging tissue and

clamping stay sutures,
bleeding vessels are
clamped to ensure
hemostasis.

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College of N ursing

Curved Mayo Scissors Used to Cut tissue, sheat

and muscle.

Straight Mayo Scissors Used to cut the suture

made while closing up.

Allis Forceps Hold tissue and sheat into

their places

Needle Holder Hold the needles in place

while suturing.

Thumb Forceps To grasp the tissue and

hold it properly.

Tissue Forceps Used to Hold the tissue

while closing the suture

Bladder To place and squeeze the bladder

Retractor and abdomen for easier delivery

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of the baby.

Suction Tube Used to suck the blood and any

With amniotic fluid
Nozzle

Umbilical Cord Used for cutting the umbilical

Scissor cord of the fetus.

Umbilical Cord Used to clamp the umbilical cord

Clamp while cutting.

Green Armytage Securely grasp tissue, especially

Forceps the uterine angle, and clamp
bleeders.

Kidney Tray This is where the sterilized

instruments are placed for sterility.

iv. Responsibilities of the Nurse

- Before the procedure

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College of N ursing

 Consent form must be read and signed by the client before all
interventions.
 The client must wear the hospital gown and cap, making sure
that no hair must be untied.
 To ensure that the newborn is fully awake at birth and that
respirations begin spontaneously, just the absolute minimum of
preoperative drugs are administered.
 Urine output must be drained and maintained below the bladder
to prevent backflow.
 Documentation must be made at all costs.

- During the procedure

 The surgical nurse must assist the patient to the operating table
while anesthesia is being administered.
 Advise the patient to remain on her side of the pillow to keep
her body tilted preventing supine hypotension.
 Prepare for emergency cases like administering spinal
anesthesia. Assist the patient to stand up to administer spinal
anesthesia.
 While epidural anesthesia is being administered while the
patient is on her side, monitor for respiratory depression.
 Shave all visible hairs in the incisional area with soap and
water.
 A sterile drape must be must be used to cover the respiratory
tract to the incision site to support the line of incision.
 The incision area must cleaned and scrubbed by an antiseptic.
 Prepare the patient for the invasive procedure and ask her to
stay calm.
 A classic incision is made in the abdominal skin and uterus or
the bikini incision.

- After the procedure

 The patient is then transferred to the post-anesthesia care unit

by a stretcher
 If the patient was given spinal blocks, the patient may not be
able to feel her legs yet.
 During assessment, use the pain scale to ask the patient for the
rate of pain.
 Epidural injections may be given to patient to relieve the pain.
 Analgesics must be supplemented by moving and straightening
the bed.
 Remind the patient to not take Aspirin for it interferes with
surgical healing and blood clotting.
 Encourage football hold for breast feeding.
 Take note the patient’s first bowel movement. If doctor
advised, enema must be administered.
 Encourage fiber intake for diet.
 Advise the patient to not strain during bowel movement.
 Educate the patient that it is normal that she can not have any
bowel movements for 3-4 days after surgery.

IV. Nursing Management

a. Nursing Care Plan
Assessmen Nursing Scientific Planning Nursing Rationale Expected

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College of N ursing

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College of N ursing

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