Disturbances in Intranatal Nursing (Premature Rupture of Membranes)

Disturbances in Intranatal Nursing (Premature Rupture of Membranes) a. Definition Premature rupture of membranespremature rupture of the membrane (PROM)is the rupture of the membranes before there are signs of labor starting and waiting one hour before birth occurs. Premature rupture of membranes is the rupture of the fetal membranes before the labor process begins or before the first stage. 1) Preterm KPD (KPDP) is KPD at <37 weeks of age 2) Prolonged PROM is PROM lasting >24 hours which is associated with an increased risk of intra-amniotic infection The membranes are considered premature rupture if they occur before the birth process takes place. Premature rupture of membranes is caused by reduced membrane strength or increased intrauterine pressure or by both factors. Reduced mambran strength is caused by infection which can originate from the vagina and cervix.Premature rupture of membranes orspontaneous/early/premature rupture of the membrane(PROM) is rupture of membranes before parturition, namely when the opening in primigravidas is less than 3 cm and in multiparas it is less than 5 cm. b. Etiology Premature rupture of membranes is caused by reduced membrane strength or increased intrauterine pressure or by both factors. Reduced membrane strength is caused by infection which can originate from the vagina and cervix. Apart from that, premature rupture of membranes is a matter of obstetric controversy. Other causes are as follows: 1) Incompetent cervix. 2) Excessive uterine tension: multiple pregnancy, hydramyon. 3) Abnormalities in the position of the fetus and uterus: breech position, transverse position. 4) Possible pelvic narrowness: the lowest part has not entered the PAP (cephalopelvic disproportion). 5) Infection that causes biomechanics in the amniotic membranes in the form of preteolytic cells, making it easier for the membranes to rupture. (amnionitis/chorioamnionitis). 6) Hereditary factors (low serum Cu ions, low vitamin C, genetic disorders) 7) The interval period from when the membranes rupture until contractions occur is called the latent phase a) The longer the latent phase, the higher the chance of infection b) The younger the pregnancy, the more difficult it is to resolve it without causing fetal morbidity c. Pathophysiology There are many theories, ranging from chromosomal defects to collagen disorders, to infection. In the majority of cases it turns out to be related to infection (up to 65%) 1) High virulence: bacteroides 2) Low virulence: lactobacillus d. Management Considerations need to be made about the management that achieves the highest resultswell born baby And good health mother. A serious problem in dealing with premature rupture of membranes is if the pregnancy is less than 26 weeks because maintaining it takes a long time. If the fetus weighs 2000 grams, induction can be considered. Failed induction is accompanied by infection followed by hysterectomy. In addition, corticosteroids can be administered with consideration. This action will increase receptors for lung maturation, increasing fetal lung maturity. Administration of betamethasone for 12 weeks is carried out at 24 hour intervals and for 12 additional weeks, maximum dose is 24 weeks, the working period is around 2-3 days. If the fetus has not been born after one week, the administration of acortisone can be repeated again. Indications for premature rupture of membranes are as follows: a. Consider the time and weight of the fetus in the womb. Consider whether the time is 6, 12, or 24 hours. The fetus should weigh more than 2000 grams. b. There are signs of intrauterine infection. The temperature rises to more than 38°c, with rectal measurement. There are signs of infectionthrough the results of laboratory examinations and amniotic fluid culture examination.