When the fluid is lost the cord and fetus can be compressed causing decelerations in which the baby must be removed from the womb. For example, last week in clinical there was a 33 gestational week mother with PPROM who was a smoker and tested positive for opioids. The fetal monitor the night before had indicated decelerations throughout the night, one even lasting nearly 8 minutes. The nurse I was assigned to said that “she did not realize how close to delivery she was. If a deceleration cannot be brought up in 10 minutes, they are on their way to the OR to deliver! . As discussed in the article, infection is also a major problem with PPROM. The amniotic fluid creates a seal of sorts that is to protect the mother and infant from infection and other harmful things that could enter into the environment of the growing fetus. Once this is lost, infection is easily contracted. Usually infections associated with PPROM are bacterial. According to the article, these types of infections cause a string of effects that virtually throw the mother into premature labor. Because of the infection, prostaglandins are released.
These then cause uterine contractions. However, the metalloproteases that are also released cause the cervix to soften and relax. This is the cause of the membrane rupture according to the article. Race is also thought to play a role in the risk of PPROM. It says that “black and Hispanic women are at a higher risk in comparison to white women [for PPROM]”. Diagnostic procedures can also cause PPROM. These include carclage and amniocenteses. Because these procedures compromise the integrity of the amniotic sac; the risk for PPROM is increased greatly along with the risk for infection.
Management of the PPROM patient depends on gestational age and severity of luid loss. It could be treatment such as medications or it could go as far as full bed rest until delivery. According to the article, 34 weeks ot gestation witn no other complications will often lead to antibiotics and corticosteroids to prolong the pregnancy and decrease the risk for infections. However, in some of the extreme cases that were seen, bed rest or delivery of fetus was seen. In clinical, one of the patients seen was on bed rest until delivery and constant fetal monitoring. In conclusion, infection tends to be the most common effect of PPROM.
Smoking nd drug use are viewed as the most common causing risk factors, and fetal complications can range from poor formation of lungs and other physical features, low birth weight, to even fetal death. It is important to educate newly pregnant mothers on risk factors of PPROM, the effects that could occur with PPROM, and educate them on what they can do to prevent this from happening during their pregnancy.