A CASE PRESENTATION

OF
PREMATURE RUPTURE
OF MEMBRANE
Prepared by:
Maricris A. Datinguinoo
BSU SN 2018
 Premature rupture of membranes
(PROM) refers to a patient who is beyond 37
weeks' gestation and has presented with
rupture of membranes (ROM) prior to the
onset of labor. Preterm premature rupture of
membranes (PPROM) is ROM prior to 37
weeks' gestation. Spontaneous premature
rupture of the membranes (SPROM) is ROM
after or with the onset of labor. Prolonged
ROM is any ROM that persists for more than
24 hours and prior to the onset of labor.
PATIENT’S HISTORY
 DEMOGRAPHIC PROFILE
Name: Patient R.R.
Birthday: August 18.1988
Age: 29 years old
Address: Balintawak,Lipa,City Batangas
Chief Complain: Rupture of membrane on
January 17. 2018 @ 5am in the morning

Admitting Diagnosis:
Gravida 5 Para 3 (3013) Pregnancy
Uterine 36 1/7 weeks Age Of Gestation, Cephalic
in Preterm Labor (CIPL) Premature Prelabor
Rupture Of Membrane X 5 hours (5:30am)

Source of Information: Patient & Patients Chart

HISTORY OF PRESENT ILLNESS

Patient R.R. was admitted at Delivery Room

last Wednesday (January 17,2018) at 10:44am
accompanied by her husband because the bag of
water have ruptured. According to her the EDC or
the estimated date of delivery is scheduled at the
14th day of february
PAST MEDICAL HISTORY

Client has no known medical

history, she had undergo operation on
the year 2007 because of appendicitis.
FAMILY HISTORY

According to the patient, she is

unmarried to his lived in partner and
her father has a history of stroke and
hypertension , she has 7 siblings and
she is the second to the youngest.
SOCIO-ECONOMIC HISTORY

 According to the patient, she is a house wife and

her husband is a vendor
DEVELOPMENTAL HISTORY

 Patient R.R. is a graduate highschool student

of Hinuslaban, Marawi school of Lipa due to
financial crisis she did not continue in College.
NUTRITIONAL HISTORY

According to the patient she doesn’t have

any vices, he loves to eat salty foods, such as
noodles and canned goods
MATERNAL HISTORY

 Client has 3 children her oldest child is a girl, age

9 years old, her second child is a boy age 7 ,
followed by a girl age 5 years old unfortunately,
her 4th child have been aborted, all of her 3
children (alive) is delivered at home, only her 5th
child is to be delivered at hospital because of
ruptured membrane
HEAD TO TOE ASSESSMENT
ANATOMY AND PHYSIOLOGY
 Amniotic fluid

Is the nourishing and protecting liquid contained by the

amnion of a pregnant woman. The amnion grows and
begins to fill, mainly with water, around two weeks after
fertilization. After a further 10 weeks the liquid contains
proteins, carbohydrates, lipids and phospholipids, urea
and electrolytes, all which aid in the growth of the fetus.
In the late stages of gestation much of the amniotic fluid
consists of fetal urine. The amniotic fluid increases in
volume as the fetus grows. The amount of amniotic fluid
is greatest at about 34 weeks after conception or 34weeks
ga (gestational age). At 34 weeks ga, the amount of
amniotic fluid is about 800 ml. This amount reduces to
about 600 ml at 40 weeks ga when the baby is born.
 Amniotic fluid is continually being
swallowed and "inhaled" and replaced through
being "exhaled", as well as being urinated by the
baby. It is essential that the amniotic fluid be
breathed into the lungs by the fetus in order for
thelungs to develop normally. Swallowed
aminotic fluid contributes to the formation of
meconium.
 Analysis of amniotic fluid, drawn out of the mother's
abdomen in an amniocentesis procedure, can reveal
many aspects of the baby's genetic health. This is
because the fluid also contains fetal cells which can be
examined for genetic defects. Recent research by
researchers led by Anthony Atala of Wake Forest
University and a team from Harvard University has
found that amniotic fluid is also a plentiful source of
non-embryonic stem cells. These cells have demonstrated
the ability to differentiate into a number of different cell-
types, including brain, liver and bone. Amniotic fluid
also protects the developing baby by cushioning against
blows to the mother's abdomen, allows for easier fetal
movement, promotes muscular/skeletal development,
and helps protect the fetus from heat loss.
 The forewaters are released when the amnion ruptures,
commonly known as when a woman's "water breaks". When this
occurs during labor at term, it is known as "spontaneous rupture
of membranes"

 (SROM). If the rupture precedes labor at term, however, it is

referred to as "premature rupture of membranes"

 (PROM). The majority of the hindwaters remain inside the womb

until the baby is born.
Pathophysiology
DIAGNOSTIC PROCEDURE
DRUGS STUDY
 Name Classification Action Adverse Nursing
Reaction Responsibilitie
s

Dexamethasone Corticosteroid Dexamethason Growth For systemic

e is a synthetic retardation, administration
glucocorticoid osteoporosis, , do not give
which pepticulcer, drug to
decreases glaucoma and nursing
BRAND NAME: inflammation subcapsular mothers; drug
by inhibiting cataracts, is secreted in
Aeroseb- the migration vertebral breastmilk.
Dex,Decadron,Hexa of leukocytes compression •
drol,MaxidexOphth and reversal fractures. Do not stop
almic,ratio-
of increased Cushing-like taking the oral
capillary features, drug without
Dexanamethasone
permeability. pancreatic consulting your
(CAN) It suppresses dysfunction health care
normal and provider.
immune pancreatitis, •
Dosage: response GI upsets, Avoid exposure
increased to infection.
6mg appetite, •
increased Report unusual
 Name Classification Action Adverse Nursing
Reaction Responsibiliti
es

Ampicillin Anti-infective, Inhibit cell- Nausea and •Prior to

bactericidal wall synthesis vomiting, administratio
during diarrhea, n, skin test is
Brand name: bacterial abdominal to be done to
Ampicillin multiplication pain, fatigue, determine
Trihydrate headache, signs and
dysuria, symptoms
Dosage: urinary of hypersensit
2g retention ivity;
•Monitor
Route: seizures when
IV giving high
doses.
Frequency:
Q6 •Do not miss a
dose unless
ordered by
physician.
 Name Classificatio Action Adverse Nursing
n Reaction Responsibilities

Nifedipine Enzymatic Ferrous Sulfate Large doses Store all forms at

mineral and is an essential may room temperature.
Iron component in aggravate •
Brand name: preparation. the formation peptic ulcer, Give between meal
Adalat, of hemoglobin, regional with water but may
Procardia, myoglobin and enteritis, give with meals if
Afeditab, enzymes. It is and gastrointestinal
Nifediac necessary for ulcerative discomfort occurs.
effective colitis.* •
Dosage: erythropoiesis Severe Iron Transient staining
1tab and transport Poisoning: mucous membrane
or utilization Vomiting and teeth will occur
Route: of oxygen Severe with liquid
Oral abdominal p iron preparation. T
ain avoid, place liquid o
Frequency: Diarrhea the back of the
OD Dehydration tongue with droppe
Hyperventil or use straw.
ation •
Nursing Care Plans
HEALTH TEACHINGS
 Medical Management
 Instructed client as well as the significant others
about the indications and mechanisms of actions
of each drug that the doctor ordered so that
without hesitation they will really comply all the
medications given with them.
 Adherence to the medication promotes
improvement of condition.
 Outpatient (CHECK-UP)
 ONCE DISCHARGED

 Instructed the client’s family to come back one

week after discharged for further follow-up and
evaluation of the client’s health condition. This is
very important so that the health condition of the
client will be evaluated if there is better
improvement. The physician should see and
examine the physical appearance of the client.
 Diet
 Taught the importance of eating green leafy
vegetables
 Increased intake of fruits and vegetables because
this can provide vitamins and minerals for
nutrition.
 Just as important as what you eat is the manner
in which you eat. Eat moderate proportions, eat
at regular times and relax while you eat advised a
low residue diet.
 XII. PROGNOSIS
 The case of Ms. R.R. came up with good
prognosis, theres a chance of giving birth to her
5th child through normal spontaneous delivery
 The diagnosis for this criterion is good because
he showed understanding in the importance of
compliance/adhering to treatment regimen, as of
now the patient doesn’t complain anything and
has a stable vital signs.