PRETERM

RUPTURE OF
MEMBRANES
BY: OCHONDRA, JOY-RENA SABINAY
BSN 2A
PRETERM LABOR
Is labor that occurs before the end of week 37 of gestation.

 It occurs in approximately 9% to 11% of all pregnancies.

It is responsible for almost two-thirds of all infant deaths in the

neonatal period (Cootauco & Althaus, 2007). Any woman having
persistent uterine contraction (four every 20 minutes) should be
considered to be in labor.
PRETERM RUPTURE OF
MEMBRANES

 is rupture of fetal membranes with loss of amniotic fluid during pregnancy before
37 weeks (Mercer et al., 2007). The cause of preterm rupture is unknown, but it is
associated with infection of the membranes (chorioamnionitis).

It occurs in 5% to 10% of pregnancies. If rupture occurs early in pregnancy, it

poses a major threat to the fetus as, after rupture, the seal to the fetus is lost and
uterine and fetal infection may occur.
PRETERM RUPTURE OF
MEMBRANES

second complication that can result from preterm membrane rupture is increased
pressure on the umbilical cord from the loss of amniotic fluid, inhibiting the
fetal nutrient supply, or cord prolapse (extension of the cord out of the uterine
cavity into the vagina), a condition that could also interfere with fetal circulation.

the development of a Potter-like syndrome or distorted facial features and

pulmonary hypoplasia from pressure
 ASSESSMENT
Rupture of the membranes is suggested by the history. A woman
usually describes a sudden gush of clear fluid from her vagina, with
continued minimal leakage. Occasionally, a woman mistakes urinary
incontinence caused by exertion for rupture of membranes.

Amniotic fluid cannot be differentiated from urine by appearance, so a

sterile vaginal speculum examination is done to observe for vaginal
pooling of fluid.
 ASSESSMENT
Nitrazine paper, amniotic fluid causes an alkaline reaction on the
paper (appears blue) and urine causes an acidic reaction (remains
yellow).
The fluid can also be tested for ferning, or the typical appearance of a
high-estrogen fluid on microscopic examination (amniotic fluid shows
this; urine does not).
The presence of a high level of alpha-fetoprotein (AFP) in the vagina
is also diagnostic (Shahin & Raslan, 2007).
Ultrasound
 ASSESSMENT
If a fetus is estimated to be mature enough to survive in an
extrauterine environment at the time of rupture and labor does
not begin within 24 hours, labor contractions are usually
induced by intravenous administration of oxytocin so the infant
is born before infection can occur.
 THERAPEUTIC MANAGEMENT
If labor does not begin and the fetus is not at a point of viability, a woman is
placed on bed rest either in the hospital or at home and administered a
corticosteroid to hasten fetal lung maturity.

Prophylactic administration of broad-spectrum antibiotics during this period may

both delay the onset of labor and reduce the risk of infection in the newborn
sufficiently to allow the corticosteroid to have its effect.
 THERAPEUTIC MANAGEMENT
Women positive for Streptococcus B need intravenous administration
of penicillin or ampicillin to reduce the possibility of this infection in
the newborn.

A woman with no signs of infection may be administered a tocolytic

agent if labor contractions begin (Mercer, 2007).

Following endoscopic intrauterine procedures, membranes can be

resealed by use of a fibrin-based commercial sealant so they are again
intact.
NURSING DIAGNOSIS
Risk for infection related to preterm rupture of
membranes without accompanying labor.
 OUTCOME EVALUATION
:Maternal white blood cell count remains below 20,000/mm3.Maternal
temperature is less than 100.4° F (38.0° C) while awaiting fetal maturity.
If at home, a woman is asked to take her temperature twice a day and to report a
fever, uterine tenderness, or odorous vaginal discharge.

She should refrain from tub bathing, douching, and coitus because of the danger
of introducing infection.

The white cell count will need to be assessed frequently, perhaps as often as daily.
A count of more than 18,000 to 20,000/mm3 suggests infection.
 OUTCOME EVALUATION
Before a woman is discharged to home care, be certain she knows how
to read a thermometer, she has specific instructions regarding what
degree of temperature she should report, and she understands what
degree of bed rest is expected of her.
Many misconceptions about the difficulty of labor after preterm rupture
of the membranes (dry labor) exist.

*You can assure her that because amniotic fluid is always being
formed, there is no such thing as a “dry labor.”
THANK YOU FOR
LISTENING!!!
“ LIFE DOESN’T REQUIRE THAT WE BE THE
BEST, ONLY THAT WE TRY OUR BEST.”

H. JACKSON BROWN JR.