Management of PROM, PPROM, and SROM

Abruptio Placenta

• Occurs when the placenta separates from the uterine wall prematurely, usually after the 20th week of gestation, producing hemorrhage
• Degrees of severity:
  • Mild: marginal separation, develops gradually, mild to moderate bleeding, produces vague lower abdominal discomfort, abdominal tenderness, and uterine irritability
  • Moderate: about 50% placental separation, may develop gradually or abruptly, produces continuous abdominal pain, moderate dark red bleeding, a tender uterus that remains firm between contractions, barely audible or irregular and bradycardic fetal heart tones, and possibly signs of shock
  • Severe: 70% placental separation, develops abruptly, causes agonizing, unremitting uterine pain, a board-like, tender uterus, moderate vaginal bleeding, and rapidly progressive shock
• Diagnostic findings: pelvic examination, ultrasonography, decreased hemoglobin levels, and platelet counts
• Medical management: IV infusion of lactated Ringer's solution, central venous pressure (CVP) line, urinary catheter, blood for hemoglobin level, hematocrit, coagulation studies, typing and cross-matching, external electronic fetal monitoring, and maternal vital signs and vaginal bleeding monitoring

Premature Rupture of Membranes (PROM)

• Also known as preterm premature rupture of membranes (PPROM) before 37 weeks, spontaneous premature rupture of membranes (SROM), and rupture of membranes (ROM)
• Associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and possibly incompetent cervix
• Basic and effective defense against the fetus contracting an infection is lost, increasing the risk of ascending intrauterine infection (chorioamnionitis)
• Nursing management: prevent infection, make an early and accurate evaluation of membrane status, minimize vaginal examinations, and provide client and family education

Pregnancy-Induced Hypertension (PIH)

• Also called hypertension of pregnancy or gestational hypertensive disorder
• A potentially life-threatening disorder that usually develops after the 20th week of pregnancy
• Cardinal signs: hypertension, proteinuria, and edema
• Preeclampsia: the non-convulsive form of the disorder, marked by the onset of hypertension after 20 weeks' gestation
• Eclampsia: the convulsive form, occurs between 24 weeks' gestation and the end of the first postpartum week
• Changes associated with PIH:
  • Vascular: vasoconstriction, impaired organ perfusion
  • Renal: reduced glomerular filtration rate, increased glomerular membrane permeability, oliguria, increased BUN and creatinine, proteinuria
  • Interstitial tissues: fluid diffusion from vascular space to interstitial space, edema

HELLP Syndrome

• Hemolysis, elevated liver enzyme levels, and a low platelet count
• Managed through:
  • Platelet transfusion via aphoresis
  • Magnesium sulfate administration
  • Corticosteroid (betamethasone) administration for lung maturity
  • Bed rest
• Blood pressure management:
  • Keep emergency resuscitative equipment and an anticonvulsant readily available
  • Maintain patent airway and prepare oxygen
  • Prepare for emergency CS delivery if indicated
  • Maintain seizure precautions to protect from injury
  • Monitor the extent and location of edema