Premature Rupture of Membranes (PROM & PPROM)

Premature rupture of membranes, or PROM, is rupture of the amniotic sac before labor begins, and preterm PROM, or PPROM, is rupture before thirty-seven weeks. Once the sac opens, the cord can slip down and bacteria can climb into the uterus. So the first nursing move after any rupture is to check the fetal heart rate, because a sudden deceleration or bradycardia can mean cord prolapse. Then document the fluid's color, odor, amount, and time. Clear is normal, green or yellow means meconium, and bloody fluid needs a report. Rupture is confirmed with a sterile speculum exam, nitrazine paper turning blue, ferning, or an immunoassay such as AmniSure. In PPROM, avoid digital cervical exams unless birth is imminent, since they raise infection risk. Before thirty-four weeks, expect latency antibiotics and, from twenty-four weeks, betamethasone, and expect magnesium sulfate for fetal neuroprotection when birth is likely before thirty-two weeks. Watch closely for chorioamnionitis: maternal fever and tachycardia, a fetal heart rate over one hundred sixty, uterine tenderness, and foul-smelling fluid. Infection means delivery at any gestational age.