MANAGEMENT OF PREMATURE RUPTURE OF MEMBRANES

REQUIREMENTS

1. Vital signs tray
2. Speculum examination tray
3. Foetal monitor
4. IV fluids
5. IV Cannula
6. Cotton wool swabs
7. Sterile gloves
8. Perineal pad
9. Delivery Set
10. Prescribed Antibiotics
11. Prescribed Tocolytics
12. Prescribed Corticosteroids
13. Resuscitaire
14. Foetal kick count chart
15. 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)