INTRODUCTION

This case study is about a 30-year old pregnant woman who was referred by the
Lying-in clinic to be admitted to Batangas Medical Center. The main objective of this
study is to provide quality nursing care by means of improving nurse-patient interaction
in all areas of the OB complex.
Specifically, this study aims to:

 Define and discuss PROM

 Understand the past medical history of the patient through social and
psychological data, lifestyle, family history, and patterns of health care
 Know the developmental, obstetric and gynecologic history of the patient
 Conduct a comprehensive physical assessment of the patient
 Document the medical and surgical management rendered to the patient
 To evaluate the laboratory and diagnostic procedures performed upon the patient
 Present SMART nursing care plans appropriate for the patient
 Provide additional knowledge regarding the Philippine scenario of Premature
Rupture of Membranes

Premature rupture of membranes (PROM) is a condition which occurs when the

membraned sac holding the baby and the amniotic fluid breaks open before experiencing
labor. Thus, refers to rupture of the fetal membranes prior to the onset of labor irrespective
of gestational age. Once the membranes rupture, delivery is recommended when the risk
of ascending infection outweighs the risk of prematurity. Which makes PROM a major
cause for prematurity which leads to increased perinatal morbidity and mortality. However,
when PROM occurs at term, labor typically ensues spontaneously or is induced within 12
to 24 hours.

On a recent study conducted, the incidence rate of premature rupture of

membranes is approximately 8% to 10% in pregnant women, globally. More than
500,000 babies are born preterm in the US each year, accounting for 12.5% of all births,
and this incidence is increasing. In the UK in 2005, 7.6%of live births were preterm. In
the last decade, there has been more than a 50% increase in preterm births to low-risk
European women aged between 20 and 40 years. A higher proportion of preterm
deliveries occur in women of black ethnicity, and this may in part be related to social
disadvantage. Only 1% of all births occur below 32 weeks' gestation. Review of the
maternal conditions giving rise to a 25% or more rate of neonatal morbidity in the
Philippines shows that premature rupture of membranes accounts for an incidence rate
of 38%.
According to The Internet Journal of Gynecology and Obstetrics. 2012 Volume
16 Number 2, the incidence of PROM was 5.2%. 237 (61.7%) patients came from rural

Page | 1
area and 147 (38.3%) were from urban area. The PROM was frequent among patients
belonging to low socioeconomic class. Residential area definitely makes difference in
incidence of PROM. In rural area because of unhygienic conditions, there are more
chances of infection, which is an independent risk factor for PROM. Lower socio-
economic condition also predisposed to malnutrition. The maximum incidence of PROM
(77.6%) was between age group off 21-30 years, being highest in 21-25 years a group.
It was evident that no age was immune for PROM. The apparent higher incidence of
PROM in age group 21-25 years was due to fact that our patients complete their child
bearing in 3rd decade. The incidence of PROM was 60.7% in primigravida while it was
39.3% in multigravida patients.340 (88.5%) cases were associated with term PROM
while incidence of preterm PROM was 11.5%. In the present study 18.17% cases were
associated with some other disorders of pregnancy like anemia, PET and Rh negative
pregnancy. Rupture of membranes before labor occurs in about 5%-10% of
pregnancies. When this occurs during term, that means the baby is mature enough to
be delivered, and there is not much cause to worry because the decision will be for
delivery. There is, however, a worrisome situation when the waters break when the
baby is still premature (before the 37th week) in about 3% of pregnancies. This is called
PPROM (Preterm Premature Rupture of Membranes). Also, although rarely, PROM can
happen during the second trimester (midpregnancy).

On the other hand, studies show that it is highly associated with women who smoke,
who are very thin and poorly nourished, or who have urinary tract infection. Women who
have a history too, of a previous preterm labor, vaginal bleeding anytime in pregnancy,
and some procedures done on them like cerclage and amniocentesis have higher
incidence of PROM. Cerclage is a procedure where sutures are placed around the
cervix to keep the pregnancy in the uterus longer; amniocentesis is a procedure where
amniotic fluid is obtained from a pregnant uterus using an ultrasound-guided long
needle to aspirate the fluid, mainly for diagnostic reasons.

References:
 https://www.scribd.com/doc/60857243/Premature-Rupture-of-Membranes
 http://ispub.com/IJGO/16/2/14215

Page | 2
 DEMOGRAPHIC DATA

Name Patient S.A.

Address Alangilan, Batangas city

Age 30 y/o

Status Single

Religion Roman Catholic

Occupation

Educational Attainment High school graduate

Chief complaint After urinating, bag of amniotic fluid ruptured

and was dashed to the lying-in clinic where
there she was referred to Batangas Medical
Center

Admitting Diagnosis G1P0 Pregnancy uterine 33 weeks age of

gestation cephalic in preterm labor
Pre term prelabor rupture of membrane x2hours

Page | 3
 Last Menstrual Period & August 30, 2016
Expected Date of Delivery June 6, 2017
Final Diagnosis G1P0 Pregnancy uterine 33 weeks age of
gestation cephalic in preterm labor
Pre term prelabor rupture of membrane x2hours
Date and Time of Admission April 18, 2017– 4:19 AM

Attending Physician Dra. Perez

Page | 4
 A. History of Present Illness

As of October 18, 2017, Patient A is a gravida one, parity zero patient. Patient A
has had one pregnancy and delivered none. It was her 33th week. Her LMP was on
August 30, 2016. Her EDD is on June 6, 2017. She was admitted to Batangas Medical
Center at around 4:19 am with Vital signs 110/70 as her Blood Pressure, 81 as her
Pulse Rate, 20 as her Respiratory Rate and 35.1 as her Temperature.
.

Page | 5