Chapter 20 Study Guide.docx - Chapter 20 Childbirth at Risk – Prelabor and Intrapartum Complications Care of the Woman with Premature Rupture of

Chapter 20 Study Guide.docx - Chapter 20 Childbirth at Risk...

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Chapter 20: Childbirth at Risk – Prelabor and Intrapartum Complications Care of the Woman with Premature Rupture of Membranes Premature Rupture of Membranes (PROM) is spontaneous rupture of the membranes before the onset of labor. Preterm PROM (PPROM) is the rupture of membranes occurring before 37 weeks. PROM and PPROM are associated with: o Abruptio placentae o Amniocentesis o Bleeding during pregnancy o Cervical Insufficiency o History of laser conization or loop electrosurgical excision procedure o Hydramnios o Infection specifically chorioamnionitis and endometritis. o Low BMI o Low socioeconomic status o Maternal genital tract anomalies o Multiple Pregnancy o Placenta previa o Previous history of PPROM o Tobacco use o Trauma o Urinary tract infection (UTI) Rare complications include retained placenta and hemorrhage, maternal sepsis, and maternal death. Fetal/newborn complications include: o Compression of cord o Fetal sepsis o Increased perinatal morbidity and mortality o Malpresentation o Non-reassuring fetal heart tracings o Premature birth o Prolapse of the umbilical cord o Respiratory distress syndrome The earlier the gestational age, the greater the likelihood of newborn complications. Clinical Therapy A sterile speculum examination is done to detect the presence of amniotic fluid in the vagina. Nitrazine test, a microscopic examination should be used as a confirmation of rupture bc it is considered a definitive test. On admission, a CBC, C-reactive protein, and urinalysis are obtained. Regular NST or biophysical profiles are used to monitor fetal well-being. Maternal and fetal vitals q 4hrs.
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Women with PROM/PPROM should receive intrapartum GBS prophylaxis when intrapartum indications exist, regardless of any past treatment. Upon admission into the nursery the newborn is assessed for sepsis and placed on antibiotics. Maternal corticosteroids administration promotes fetal lung maturity, prevents RDS, intraventricular hemorrhage, necrotizing enterocolitis, perinatal death, and long-term neurologic morbidity. A single course is recommended. Nursing Management Determining the duration of the rupture of the membranes is a significant component of the intrapartum assessment. Ask when her membranes ruptured and when labor began. Uterine activity and fetal response to the labor are evaluated, but vaginal exams are not done unless necessary due to increased risk for infection. The couple needs to know that although the membranes are ruptured, amniotic fluid continues to be produced. Care of the Woman at Risk Because of Preterm Labor Labor that occurs b/w 20 and 36 weeks of pregnancy is called preterm labor (PTL). Maternal implications of PTL include psychologic stress related to the baby’s condition and physiologic stress related to medical treatment for preterm labor.
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