This is the management given to the pregnant woman by the midwife when membranes have ruptured or leaking before the onset of labour. It can occur either when the foetus is immature (preterm or before 37 weeks) or when pregnancy has reached term.
Aims
· Prevent infection
· Make early diagnosis for management
· Prevent complications such as Chorioamnionitis and Pulmonary Embolism
· Help foetal lungs to mature in preterm or before 37 weeks
· Prevent neonatal complications such as Respiratory Distress Syndrome and Intraventricular haemorrhage
Requirements
a. Vital signs tray
b. Speculum examination tray
c. Foetal monitor
d. IV fluids
e. IV Cannula
f. Cotton wool swabs
g. Sterile gloves
h. Perineal pad
i. Delivery Set
j. Prescribed Antibiotics
k. Prescribed Tocolytics
l. Prescribed Corticosteroids
m. Resuscitaire
n. Foetal kick count chart
o. Maternal and Child Health Record Book (Manual/Electronic)
Steps
1. Establish rapport (refer steps)
2. Explain procedure to client (refer steps)
3. Take history suggestive of PROM (onset, nature and amount)
4. Perform hand hygiene and don examination gloves
5. Perform general assessment from head to toe
6. Check vital signs 4 hourly
7. Monitor foetal heart sounds quarter hourly
8. Teach and encourage client to do foetal kick count and to report no foetal movement as soon as possible
9. Examine the perineal pad for the nature, amount, colour, odour of liquor
10. Perform hand hygiene and do speculum examination to confirm PROM
11. Perform an ultrasound scan to ascertain condition of foetus and amount of liquor
12. Assess the gestational age and manage as such
13. Administer oxygen to avoid maternal and foetal compromise
14. Set up IV fluids (normal saline or Ringer’s Lactate) to run slowly
15. Inform the Obstetrician and prepare for induction if the gestation is 37 weeks and above
16. Administer prescribed combination of antibiotics if membranes have ruptured more than 18 hours
17. Arrange for transporting the client to a higher facility for further management if at the Primary Health Care level
18. Administer prescribed corticosteroids to the mother if pregnancy is less than 37 weeks and no signs of infection to improve foetal lungs maturity
19. Communicate foetal condition to client and family
20. Emphasize the need for client to adhere to information given
21. Express appreciation of client for her cooperation
22. Record and report all information in the Maternal and Child Health Book (Manual or Electronic)
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