07.01 PROM

Overview

  1. Premature rupture of membranes (rupture of amniotic sac) before onset of labor

Nursing Points

General

  1. Normal progression is for the sac to rupture AFTER labor starts
  2. Absence of the buffer of the amniotic fluid in uterus should stimulate uterine contractions
  3. If membranes rupture before term labor, biggest concern is infection

Assessment

  1. Assess and note color, amount and odor of fluid
  2. Can be anywhere from 50-300 ml at once, or a slow leak
  3. Frequently described as “water breaking,” but if it’s a slow leak, mother may confuse it with urination

Therapeutic Management

  1. Perform amnisure test
    1. Vaginal swab gives a yes or no result
    2. Detects a placental protein that is found in the amniotic fluid
  2. Perform Nitrazine test to determine if it is urine vs. amniotic fluid
    1. Amniotic fluid is alkaline and will turn the nitrazine paper blue
  3. Monitor temp, increased temp can indicate infection
  4. Fetal monitoring will be indicated; watch FHR for tachycardia (infection indicator)
  5. Avoid vaginal exams to decrease risk of infection
  6. Antibiotics may be indicated
  7. If 24-33 weeks, may require tocolytics to prevent labor and will be hospitalized for close monitoring (Premature PROM)
    1. “Expectant management” – will watch and wait for labor to begin while making sure baby is safe in utero and mom is safe

Nursing Concepts

  1. Reproduction
  2. Infection Control

Patient Education

  1. Notify your provider when your membranes rupture (when your water breaks).  
  2. Notify if there is any leaking of fluids
  3. If this occurs before 37 weeks a possible induction of labor could be necessary and FHR monitoring

Reference Links

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Video Transcript

In this lesson I will explain premature rupture of membranes and your role in providing care to the patient.

So what is PROM? PROM stands for premature rupture of membranes. So why is it premature? Premature means it occurs before the onset of labor. So the patient ruptures and labor never starts. It is like her body doesn’t realize the rupture has started and doesn’t kick into actian. The normal scenario is a patient is in labor and then the sac ruptures or it could be that the sac ruptures and it causes labor to start. This is because the absence of the buffer or barrier of the amniotic fluid is supposed to stimulate contractions. For a PROM patient the rupture happens but no contractions start. Our big risk here for this patient If membranes rupture prematurely then our biggest concern is infection.

Let’s now look at our assessment for this patient. So her water has broken and we need to note color, amount and odor of fluid. It should be clear and odorless. The amount could be a full rupture of 300 ml or it could be a small leak. Sometimes women think they have ruptures their membranes but have actually urinated on themselves. so this will be assessed to ensure an actual rupture has occurred. This will be checked by nitrazine or an amnisure and I’ll explain that next.

Our management is going to include seeing if the patient is ruptured or did she pee on herself? This is so common. We have patients all the time come thinking they have ruptured and turns out they aren’t. They are mortified but it really happens all the time! They have a big baby dancing on their bladder so it is hard not to pee on yourself! So to see if the rupture has occurred we can perform an amnisure test. A vaginal swab is collected and gives a yes or no result by detecting a placental protein that is found in the amniotic fluid. Another option is to perform a Nitrazine test. A vaginal swab is taken and the amniotic fluid is alkaline so this will turn the nitrazine paper blue if the sac has ruptured. We need to monitor the patient for infection so frequent temperatures should be taken. We also want to limit vaginal exams so we don’t increase the risk of infection. Fetal monitoring will be necessary and if tachycardia is seen this is a sign that the fetus is getting infected. Tocolytics might be given to prevent labor if the patient is premature and keep the patient hospitalized to keep monitoring and make sure everyone is safe.

The patient needs to be educated that if she has any leaking or rupture of membranes then she needs to notify the doctor. An induction might be necessary because remember PROM means premature rupture. The bag ruptures and the patient isn’t in labor so if this occurs and the patient is term an induction of labor might be necessary to get contractions started. This is the worst. I always feel so bad for patients that rupture and aren’t in labor. They come in and walk, walk, walk and contractions never start. So we have to induce and it just takes longer sometimes for their bodies to kick in and start contracting regularly.

Reproduction and infection control are our concepts for a patient with premature rupture of membranes. Infection is a huge risk for these patients. Remember the barrier is gone!
Let’s review! Ok so PROM is premature rupture of membranes and is when the membranes rupture prior to labor starting. Infection is the biggest risk because remember that barrier is gone! So we need to check and see if she really ruptured. So an amnisure or nitrazine test and then we need to monitor. So monitor for our signs of infections. Increased temperature, tachycardia for fetus or mom are signs we watch for.

Make sure you check out the resources attached to this lesson and review the infection symptoms you would see. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A nurse enters a pregnant client’s room just as her membranes rupture with a gush of fluid. What is the priority assessment at this time?

  • Question 2 of 5

A nurse is caring for a laboring client who experienced PROM over 24 hours ago. Which findings would indicate the mother is experiencing complications of this?

  • Question 3 of 5

A pregnant client arrives to the emergency room stating “my water broke”. Which diagnostic test finding would be consistent with this?

  • Question 4 of 5

A 28-week pregnant client experiences rupture of membranes, but is not in active labor. She is admitted to the unit for monitoring. What management should the nurse anticipate? Select all that apply.

  • Question 5 of 5

A student nurse is caring for a pregnant client who has experienced rupture of membranes. Which of the following statements by the student demonstrates best understanding of the needs for this patient?

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