Subject:         Premature Rupture of Membranes and/or Prolonged Rupture of Membranes

POLICY:         Prolonged rupture of membranes may predispose the mother and baby to risks including preterm labor, prolapsed cord, chorioamnionitis and fetal malpresentation.  The birth attendant minimizes the likelihood of risks by careful assessment, restricting pelvic exams and limiting length of time in non productive labor patterns.  A Physician will be consulted if the PROM lies outside of the guideline parameters.

GUIDELINES: 1. Vaginal exams will be limited to one exam prior to active labor and try to limit vaginal exams during labor after rupture of membranes.  (Goal: three or less)

2. Primagravida clients will come to center for assessment and stimulation of labor if no labor within six hours of ROM.  Multigravida clients will come to center for assessment and stimulation of labor if no labor within twelve hour of ROM.

3. A Physician will be consulted if no labor pattern within eighteen hours of ROM.

4. A Physician will be consulted and transport will be planned if delivery is not imminent (or expected within 4 hours) at twenty four hours after ROM.

5. A Physician will be consulted and transport will be planned if additional risk factors present:

·         Maternal temperature of 100.4 or above

·         Uterine tenderness if accompanied with other risk factors

·         Moderate to thick meconium staining in the fluid

·         Persistant maternal and/or fetal tachycardia

·         Infant with Apgar below 7 at five minutes of birth

PROCEDURE: 1.  Assess Fetal heart tones.  If within normal limits (WNL) proceed to next step.  If not WNL, assess for cord prolapse.

2. Elicit history from client:

·         Time of ROM

·         Amount of fluid

·         Smell of fluid

·         Movement of fetus

·         Amount of current flow

3. Examine sanitary napkin or underwear to assess SROM:

·         Fluid amount

·         Fluid color

·         Fluid odor

·         Fluid Ph assessed with nitrazine paper

4. Sterile speculum exam may be performed if necessary to further assess SROM

·         Assess for pooling of vaginal fluid in speculum

·         Fern test may be done by placing a drip of fluid on slide and allowed to dry without a cover then observed by microscope for a ferning pattern

5.   Vaginal exams will be limited to one exam prior to active labor and try to limit vaginal exams during labor after ROM. (Goal: three or less)

6. When active labor is established, monitor according to normal labor monitoring protocols with the addition of:

·         Maternal temperature and heart rate take every 2 hours.

 7. A Physician will be consulted if additional risk factors present:

·         Delivery is not imminent (or expected within four hours) at twenty four hours after ROM.

·         Maternal temperature of 100.4 or above.

·         Uterine tenderness if accompanied with other risk factors

·         Moderate to thick meconium staining in the fluid

·         Persistant maternal and/or fetal tachycardia.

·         Infant with Apgar below 7 at five minutes post birth