Premature Rupture of Membranes during Labor Name Institution Case Presentation An African American 20 years old female, at 36 6/7-weeks, G3P2T1P1A0L1, is admitted with premature rupture of membranes. She has no known allergies. Her GA presents to LRC with C/O LOF from 1330pm…
However, her pulse is at 80bpm, 37.7oC temperature, and blood pressure at 111/58, and normal respiration at 16. Fetal heart rate is at 140. The patient is under the monitor of IUPC for frequency, intensity, and duration of contractions. The fetus is monitored by the external electronic fetal. Cervical dilation is 4cm, station 3, and 70% effaced. Fetus is in cephalic presentation. At 1000 assessment, cervical dilation is still 4cm, station -3, and 80% effaced, and the patient is in pain and distress, with a pain of eight in a 1 to 10 scale. Pain medication administered and support person taught lower back massage to alleviate back pain. Fetal heart rates are at 138, with 3 to 5 minutes contractions ranging between 30 seconds to one minute long. At 1200, epidural block administered after patients complain of pain, and advised not to lie on her back. Nursing Diagnosis and Pathophysiology Managing labor at term with spontaneously ruptured membranes can be confusing. Concerns arise about the appropriate management for pre-labor rupture of membranes and the spontaneous rapture of membranes after the labor begins. The nursing diagnosis priority is the examination of the premature rapture of membrane through a thorough physical, history examination, as well as selected laboratory studies. The primary caregiver should carry out a speculum examination to determine the presence of any cervical dilation or effacement. On suspicion of membranes premature rapture, it is integral to halt digital cervical examinations, as they tend to increase mortality and morbidity. Moreover, the digital cervical examinations result to a decrease of about nine days in the latent period (Medina and Hill, 2006). Evidence of pooling fluid in the vagina, or leakage from the cervical on application of fundal pressure or when the patient coughs, assist the care provider in determining membranes raptures. Diagnostic methods such as the use of nitrazine paper and ferning determination have sensitivities of about 90%. Nitrazine paper turns blue in the presence of amniotic fluid with a pH above 6.0. However, other contaminations such as presence of semen, blood, and bacterial vaginosis may give similar outcomes. The care providers should reserve a swab for determining the presence of ferning, which if positive indicates premature membranes rapture (Medina and Hill, 2006). Management of Pre-labor Membranes Ruptures at Term Previous studies on the management of pre-labor membranes ruptures focus essentially on the comparison of the incidence of infection in immediate induction patients versus the expected management on risk of infection after different durations of rupture. In their examinations, researchers compared outcomes from an induction and expected management with premature rupture of membrane at term. According to their reports, there were no differences in infection rate between the two examination groups, as well as a higher rate of caesarian section cases in the induced groups. A more recent research by Hannah and colleagues called TERMPROM study, a large, randomized multicentre trial, which compared immediate induction to expectant management running up to four days after the diagnosis of premature rupture of membrane at term. Results of the study show that maternal infection occurred at higher rates in women managed expectantly (Marowitz and Hunter, 2004). The rates of caesarian sections and neonatal infections were the same. Care Plan The following is the care plan for ...
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