Preterm Premature Rupture of Membranes
A complication of pregnancy that is often seen in obstetrical triage is premature rupture of membranes, according to Friedman (2013). Premature rupture of membranes (PROM) is a condition in which the membranes spontaneously rupture before the onset of active labor. Preterm premature rupture of membranes (PPROM) is PROM before 37 weeks gestation (Friedman, 2013). According to the American College of Obstetrics and Gynecology (2009), 3% of all pregnancies present with PPROM, including approximately 1/3 of all preterm births. African Americans are shown to be 2 times more likely to experience PPROM than other ethnicities, however, over the last 10 years there has been a downward trend of PPROM in singleton gestations with both African Americans and Caucasians (Mercer, 2010). Although rare, and found in less than 5% of cases, fluid loss can cease and be restored due to spontaneous sealing of the membranes (Mercer, 2010).
Etiology of PPROM is not definitive, but according to Ward and Hisley, it is thought to be a result of weakening due to one or more of the following: stress of contractions, intrauterine infection, inflammation or other conditions that would result in an increase in intrauterine pressure. A 2014 study proposed a correlation between bacteria and the thinning and premature rupture of membranes (Fortner, et al., pp. 1-10). The 2014 study states:
Fetal chorion was uniformly thinner at rupture sites compared to distant sites. In PPROM fetal chorion, we demonstrated pronounced global thinning. Although cause or consequence is uncertain, bacterial presence is greatest and inversely correlated with chorion thinning among PPROM subjects. (Fortner, et al., 2014, p. 9)
A number of ris...
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...and Gynecology. (2009, December 31). Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Compendium of Selected Publications , pp. 281-293.
Fortner, K. B., Grotegut, C. A., Ransom, C. E., Bentley, R. C., Feng, L., Lan, L., et al. (2014). Bacteria Localization and Chorion Thinning among Preterm Premature Rupture of Membranes. PLOS ONE , 9 (1), 1-10.
Friedman, A. (2013). Chapter 14: Preterm Premature Rupture of Membranes. In D. J. Angelini, D. (. LaFontaine, D. J. Angelini, & D. LaFontaine (Eds.), Obstetric Triage and Emergency Care Protocols (pp. 129-135). New York, New York: Springer Publishing.
Mercer, B. M. (2010). Preterm Premature Rupture of Membranes. In V. Berghella, Preterm Birth: Prevention and Management (pp. 217-231). Philidelphia: Wiley-Blackwell.
Ward, S. L., & Hisley, S. M. (2009). Maternal Child Nursing Care. Washington: FA Davis.
Gale Group. (2013, May). Maternal Complications from Placenta Previa. Retrieved May 06, 2013, from Galenet: http://140.234.20.9:8080/EPSessionID=838ee1ba12d4ed675b34eeada9e17bc/EPHost=galenet.galegroup.com/EPPath/servlet/HWRC/hits?docNum=A246374229&index3=KE&index2=KE&index1=FT&tcit=0_1_0_0_0_1&locID=lac73470&rlt=6&text3=&text2=&origSearch=false&text1=maternal+
Mphahlele, R. R. (2007). Caring for premature babies - a clinical guide for nurses. Professional Nursing Today, 11(1), 40-46.
Getahun, Darios, Yinka Oyelese, Hamisu M. Salihu, and Cande V. Ananth. "Previous Cesarean Delivery and Risks of Placenta Previa and Placental Abruption." Obstetrics & Gynecology 107.4 (2006): 771-78. Print.
In my previous role as a Licensed vocational nurse, I worked in the outpatient setting, Perinatology, where there are high-risk pregnant patients. The patient I helped take care of, was early in her pregnancy, approximately 29 weeks, and was a patient who had been seen in this clinical office
...s. Most women are fortunate and have an outcome of a full term, healthy baby, however, there are some women that are not so fortunate and have preterm births. With this said, all women, when contemplating pregnancy, should be aware of all the risks and possible complications that can arise and also the preventions that can be taken.
Whereas signs and symptoms to the mother can include: rapid uterine contractions, back and abdominal pain, vaginal bleeding, and uterine tenderness. Direct causes sometimes can correlate with direct injury to abdominal wall, rapid loss or excess of amniotic fluid, the mother’s lifestyle choices, hypertension, advanced maternal age, diabetes mellitus, and prior placental abruption. Although, preventive measures for placenta abruption is uncommon, attention to ongoing medical evaluation of fetal and maternal welfare connected with consideration of risk factors, outcomes can be
In America, 1 out of 8 children are born premature. The earlier a child is born from their suggested due date, the poor severe the condition the child can receive. With health conditions of the mother, that may be a main reason why a child may become premature. Women with uterine, cervical abnormalities, or having twins, triplets, etc. may cause a risk of preterm labor. A women’s health is a main factor of how their child may come out. Smoking, drinking, use of illegal drugs may cause women to have preterm labor as well. To...
Worldwide, the rate of cesarean section is increasing. According to the CDC, in 2012 the rate of cesarean sections comprised 32.8% of all births in the United States (CDC, 2013). Between 1996-2009 the cesarean section rate has risen 60% in the U.S (CDC, 2013). According to the World Health Organization (WHO), more than 50% of the 137 countries studies had cesarean section rates higher than 15% (WHO, 2010). The current goal of U.S. 2020 Healthy People is to reduce the rate of cesarean section to a target of 23.9%, which is almost 10% lower than the current rate (Healthy People 2020, 2013). According to a study conducted by Gonzales, Tapia, Fort, and Betran (2013), the appropriate percentage of performed cesarean sections is unclear, and is dependent on the circumstances of each individual birth (p. 643). Though often a life-saving procedure when necessary, the risks and complications associated with cesarean delivery are a cause for alarm due to the documented rate increase of this procedure across the globe. Many studies have revealed that cesarean deliveries increase the incidence of maternal hemorrhage and mortality and neonatal respiratory distress when compared to vaginal deliveries. As a result, current research suggests that efforts to reduce the rate of non-medically indicated cesarean sections should be made, and that comprehensive patient education should be provided when considering an elective cesarean delivery over a planned vaginal delivery.
According to the Centers for Disease Control and Prevention, one out of every eight babies each year in the United States is born premature. This affects approximately 500,000 babies yearly. Premature babies are defined as babies born more than three weeks before the baby’s due date. Full term babies are born at approximately forty weeks, and premature babies are born at less than thirty-seven weeks. In the final months and weeks of pregnancy, important growth and development occur in the fetus. This is why premature babies are considered to be at-risk for a number of issues. The earlier that a baby is born, the baby’s risks drastically increase for developmental issues.
Spontaneous preterm birth. This is a birth resulting from preterm labor that is not medically induced or preterm premature rupture of membranes (PPROM).
Sepsis is a “cunning, insidious and non-specific illness” (Raynor, 2012) but progression can be rapturous with a sudden catastrophic circulatory collapse and mortality up to 50%. (Angus et al., 2001) Over five million cases arise per year of maternal sepsis, resulting in an estimated 62,000 maternal deaths globally (WHO, 2008) During the 18th and 19th century, puerperal sepsis resulted in 50% of maternal deaths over Europe (Loudon, 2000). The World Health Organisation (WHO) defined puerperal sepsis as ‘infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum, of which two or more of the following are present: pelvic pain, fever 38.5C or more, abnormal vaginal discharge, abnormal smell of discharge, and delay in the rate of reduction of size of uterus (less than 2 cm a day during the first 8 days)’ (WHO, 1992).
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally deliver after a cesarean delivery, as well as the risks and benefits if it. Delivering a child by a c-section also has a few advantages and disadvantages for both the mother and child; this will also be discussed in more depth a bit later.
Preterm birth is defined as ‘any neonate whose birth occurs before the thirty seventh week of gestation’1 and represents approximately eight percent of all pregnancies1-4. It is eminent that these preterm infants are at risk of physical and neurological delay, with prolonged hospitalisation and an increased risk of long-term morbidity evident in prior literature3, 5-13. Innovative healthcare over the past thirty years has reduced mortality significantly14, with the survival rate of preterm infants having increased from twenty five percent in 1980 to seventy three percent in 200715. Despite, this drop in mortality long-term morbidity continues to remain within these surviving infants sparking a cause for concern15, 16.
Although childbirth appears to be a calm and unforgettable moment for mothers and family members, there can be severe complications that can affect not only the mother, but also the delivery and the child; on the contrary, the process may also run smoothly without any