A CASE STUDY ON PROM

STDENT NAME—Miss Itismita Biswal

HOSPITAL—IMS & SUM HOSPITAL , BBSR.

YEAR OF STUDY—2018

IDENTIFICATION DATA

NAME OF THE PATIENT—Mrs. Bhagyabati Das

NAME OF THE HUSBAND—Mr . Manoj Das

AGE— 23years

SEX— Female

MARITAL STATUS— married

HOPITAL REGISTRATION NO— 181205055

WARD/BED NO— 2(maternity Ward) / Bed No- 3

ADRESS— At- Kantagotha, P.O – Satyapur, PS – Balianta, Dist - Khurdha

RELIGION— Hindu

EDUCATION— Graduation

ADMISSION DATE— 05/12/18

DISCHARGE DATE— 08/12/18

DIAGNOSIS – Pre – Labour rupture of membrane (PROM)

NAME OF THE DOCTOR— Dr. P. Sujata

OCCUPATION— Housewife

MONTHLY FAMILY INCOME— Rs- 35,000

WEIGHT— 50 kg

HIGHT—5 feet, 1 inch

CHIEF COMPLAINS—

 Pain in lower abdomen since 6 days

 Leaking per vagina since 1 day
 Unable to perceive fetal movement since 1 day
HISTORY OF PAST ILLNESS —

There is no past medical history of TB, HTN, DM

she has not undergone any surgical procedure.

FAMILY HISTORY—

She belongs to a joint family having 6 numbers . Her husband & Brother-in-law are the
supporting person in her family. The monthly income of her family is nearly about Rs 35,000.
There is no history of any disease like TB,HTN, DM & hereditary disease , twin pregnancy in
her family.

HEALTHY FACILITY NEAR HOME—

There is a CHC in her village at a distance of about 5 km. Transportation facility available like
bicycle & motorcycle.

HOUSING —

She lives in a pucca house having 8 numbers of rooms with adequate ventilation. They use
sanitary latrine for toileting. Electricity supply is available. They use municipality water supply
taps for drinking.

PERSONAL HISTORY—

 PERSONAL HYGIENE—She is maintaining her oral hygiene by brushing daily

and taking bath once daily with soap & normal water.

 DIET—She takes both vegetarian & non-vegetarian diet & She takes meals 4 times a
day. she don’t have any addiction of alcohol & tobacco. She drinks about 2-3 lts of
water per day. She takes rest of about 2 hrs at day time & 8 hrs during night time. She
takes no drugs for sleep.
 ELIMINATION—She has a regular bowel & bladder habits
 MOBILITY & EXERCISE—No regular walking habits. Only moderate activity with
normal house hold work

MENSTRUAL HISTORY—

She got menarche at 13 year of age with regular cycles of 28-30 days interval & 3-4 days
duration with average amount of bleeding. Her LMP is 11/3/18 and EDD- 18/12/18.

SEXUAL & MARITAL HISTORY—

She is married since 2and 1/2 years & She has satisfactory relationship with her spouse.
General health of her spouse is good.

OBSTETRICAL HITORY—
  PAST OBSTETRIC HISTORY—
Nothing significant as she is Primigravida.
 PRESENT OBSTETRIC HISTORY-
She is a registered case . She had attended antenatal clinic 4 times,
Her LMP was 11/3/18 & EDD - 18/12/18 .Thus the Gestational age
(GA) is 38 weeks.
 FIRST VISIT—
She missed her menstrual period & went to nearby clinic & tested her urine
for pregnancy & become confirm of her pregnancy. On her examination her weight was
40kg, BP=120/70mmhg , pulse =78bpm.At that time she suffered from minor
alignments like nausea & vomiting.
 SECOND VISIT-

INVESTIGATIONS—

 Hb=11gm%
 FBS=83mg/dl
 Urine for HCG=positive
 Blood group— ‘B’ positive
 Sickling -- Negative
 Urine test=Albumin- Not Present
=Sugar---Not Present
 VDRL=Negative
 HIV=Non reactive
 HbsAg =Non reactive
 HCV =Non reactive

 USG= done on 1/11/18 showing single live intra-uterine fetus in cephalic presentation.

OBSERVATION & ASSESSMENT—

 Her general appearance is good

 Pt is conscious & anxious
 She has no foul body odour & foul breath

PHYSICAL XAMINATION—

VITAL SIGN—

 Temp –98.2 F
  BP—120/70mmhg
 Pulse –78beat/min.
 Resp –20 braeth/min.

HEAD TO TOE EXAMINATION—

 Her skin colour is normal

 Hair & scalp are clean & healthy. No dandruff & pediculosis is present
 In eye ,no Jaundice & Pallor is seen
 Mouth is clean
 Tongue is hydrated
 Gum is healthy
 Total no of teeth is 32
 Nose, ear, throat is clear
 In neck no abnormal enlargement of lymph node & glands.
 In breast secondary areola has formed & nipple are normal,.
 Engorged breast is present.
 Liver & spleen are not palpable
 Leg ,spine & back are normal
 pedal oedema is not present

OBSTETRICAL EXAMINATION—

INSPECTION—

 No undue enlargement of the Uterus .

 Skin condition—healthy & no discolouration.
 Linea nigra is prominent
 Striae gravidarum visible at lower abdomen
 Episiotomy wound present.

PALPATION—

 Uterus is hard, mobile & globular.

 Fundal height is 15 c.m i.e. at the level of umbilicus.

P/V EXAMINATION—

Vulva – Normal, No oedema

Perineal area & Anus – Clean

Lochia rubra present in normal amount

Episiotomy wound - Healthy

DEPENDENCY LEVEL OF PATIENT –

Patient is partially dependent.

CLINICAL EXAMINTION & NOTES

DIAGNOSIS—Prelabour Rupture Of The Membranes ( PROM )

INTRODUCTION—

Rupture of membranes before onset of labor is considered premature. Diagnosis is clinical.

Delivery is recommended when gestational age is >/ 34 wk and is generally indicated for
infection or fetal compromise regardless of gestational age.

DEFINITION—

Spontaneous rupture of the membranes any time beyond 28th week of pregnancy but before the
onset of labour is called Prelabour rupture of the membranes( PROM ).

It is of 2 types :-

 Term PROM –
When rupture of the membranes occur beyond 37th week but before the onset of
labour is called term PROM.
 Preterm PROM –
When rupture of the membranes occur before 37 completed week is called
Preterm PROM.
 Prolonged rupture of membranes-
When rupture of membranes occur for more than 24 hours before delivery is
called Prolonged rupture of membranes.

INCIDENCE –

PROM occur in approximately 10% of all pregnancies.

ETIOLOGY —

IN BOOK IN CLIENT
 In majority causes are not known. Idiopathic
Possible causes are - ( Causes are not known)
 Increased friability of the membranes
 Decreased tensile strength of the membranes
 Polyhydramnios
 Cervical incompetence
 Multiple Pregnancy
 Infection – Chorio – amnionitis, Urinary tract infections
and lower genital tract infection
 Cervical length < 2.5 c.m
 Prior preterm labour
 Low BMI ( < 19 kg/m2)

SIGNS & SYMPTOMS--

IN BOOK IN CLIENT
Only subjective symptom- Watery discharge in a gush leak
Watery discharge per vagina either in the
form of gush or slow leak

DIAGNOSIS –

IN BOOK IN PATIENT

1.Speculum examination Cervix Posteriorly placed, OS 1 finger

dilated, Vagina high up, No frank leaking
PV, Pelvis adequate for vaginal delivery

2)USG Amniotic fluid index -23 c.m., Cervical

length – 3.8 c.m., single live fetus present,
Estimated fetal weight – 2428 gm

3)HIV/HbsAg/HCV Nonreactive

4)CBC TWBC-10.65/mm3 ,HB-12.4gm/dl, TPC-3,61000/m

5)C-REACTIVE PROTEIN Not done

6)URINE (R/M) albumin /sugar- nil

 7)VAGINAL SWAB CULTURE Not done

8)CTG FHR -140beat/min.

COMPLICATION:

IN BOOK IN PATIENT

Cord prolapsed, , In my client, nothing present

Dry labor
Placental abruption,
Fetal pulmonary hypoplasia ,
Neonatal sepsis

MANAGEMENT-

PRELIMINARIES-

1) Aspectic examination with a sterile speculum is done confirm the diagnosis ,to note the state
of the cervix,and to detect the cord prolapsed

2)patient is put to rest and sterile vulval pad is applied to observe any further leakage.

Once diagnosis is confirmed , management depends on (a)gestational age of the

fetus, (b)whether the patient is in labour or not, (c) any evidenced of sepsis,(d)prospective fetal
survival in that institution if delivery occurs. Maternal vital sign ,FHR monitored 4 hourly.

OBSTETRIC MANAGEMENT-

TERM PROM-

 Observed patient carefully If the she is not in labor and there is no evidenced of
infection or fetal distress ,
 if labor does not ocurr spontaneously within 24 hour then induction of labor with
oxytocin start.
  Caesarean section is performed with obstetric condition.

PRE-TERM PROM-

If gestational age is 34 weeks or more, then wait for spontaneous labor for 24 -48 hour.
 If fails then induction with oxytocin or caesarean for non cephalic presentation
If gestational age is less than 34 weeks and absence of maternal and fetal condition,
 then provide bed rest ,antibiotic
 pelvic rest and antibiotic help to seal leak sponateously and reduce infection ,and
pregnancy continues
USE OF ANTIBIOTICS-
Prophylactic antibiotics are given to minimise maternal and fetal risk of infection

USE OF CORTICOSTEROID-To stimulate surfactant synthesis against RDS in preterm

IN PATIENT-At the time of admission Obstetrical examination

ABDOMINALEXAMINATIO VAGINALEXAMINATI ADVICE

N ON

 Uterine contraction -  Cx –fully effeced  Cap Erythromycin 500mg

2/20min at duration 10  Os -3 cm dilated 6 hrly
sec  Membrane absent  Inlection Betensol 3 amp
 Relaxation-good  Station vertex -2 im start
 FHR-150  Injection tramadol 1amp
im start
 Sterile vulval pad

DELIVERY NOTE-

Under all aspectic condition with full term male child delivered by vaginal delivery with right
mediolateral episiotomy at 11.43 a.m /6.12.18. Baby weight is 3.02 kg .Episiotomy stitched
with catgut

Baby-baby born by NVD, Spontaneous cry, no congenital malformation detected

Advice for mother Advice for baby

Tab MAHACEF CV BD for 5 days Exclusive Breast feeding
Tab ZERODOL SP BD for 5 days Warmth
Tab pan 40 mg od for 5 days Immunization
T-Bact ointment L/A Injection vit –k 1mg im
Post Delivery DAY -1( 6.12.18 )

GENERAL CONDITION OF ADVICE NURSING

MOTHER INTERVENTION

Patient conscious Tab. Mahacef CV 1 Bed making done

Afebrile tab BD Mouth care given
Pallor (- ve) Tab. Zerodol p 1 tab Vital sign checked
Pulse= 78bpm BD I/O chart maintain
BP= 122/76mmhg Tab. Pan 40 mg 1 Bleeding P/V checked
Chest/CVS = NAD tab OD Medication given in
P/A= contraction T-Bact ointment time
present L/A Perineal Care given
Lochia- Lochia rubra
present and of normal
amount

GENERAL CONDITION OF ADVICE NURSING

BABY-- INTERVENTION

Active & Alert Exclusive breast feeding Baby is kept warm by

Reflex – well developed Immunization warm clothes
Pulse – 134 bpm, Resp- Eye care given
30breath/min Mouth care given
Temp – 98.60f Cord care given
Urine passed Napkin changed
Stool passed Rooming-in of mother &
baby maintained

Post Delivery DAY -2( 7.12.18 )

GENERAL CONDITION OF ADVICE NURSING

MOTHER INTERVENTION
 Patient conscious Tab. Mahacef CV 1 Bed making done
Afebrile tab BD Mouth care given
Pallor (- ve) Tab. Zerodol p 1 tab Vital sign checked
Pulse= 84bpm BD I/O chart maintain
BP= 120/78mmhg Tab. Pan 40 mg 1 Bleeding P/V checked
Chest/CVS = NAD tab OD Medication given in
P/A= contraction T-Bact ointment time
present L/A Perineal Care given
Lochia- Lochia rubra
present and of normal
amount

GENERAL CONDITION OF ADVICE NURSING

BABY-- INTERVENTION

Active & Alert Exclusive breast feeding Baby is kept warm by

Reflex – well developed Immunization warm clothes
Pulse – 130 bpm, Eye care given
Resp- 30breath/min Mouth care given
Temp – 990f Cord care given
Urine passed Napkin changed
Stool passed Rooming-in of mother &
baby maintained

Post Delivery DAY -3( 8.12.18 )

GENERAL CONDITION OF ADVICE NURSING

MOTHER INTERVENTION

Patient conscious Tab. Mahacef CV 1 Bed making done

Afebrile tab BD Mouth care given
Pallor (- ve) Tab. Zerodol p 1 tab Vital sign checked
Pulse= 82bpm BD I/O chart maintain
BP= 120/80mmhg Tab. Pan 40 mg 1 Bleeding P/V checked
Chest/CVS = NAD tab OD Medication given in
P/A= contraction T-Bact ointment time
present L/A Perineal Care given
Lochia- Lochia Rubra
present and of normal
amount

GENERAL CONDITION OF ADVICE NURSING

BABY-- INTERVENTION

Active & Alert Exclusive breast feeding Baby is kept warm by

 Reflex – well developed Immunization warm clothes
Pulse – 132 bpm, Eye care given
Resp- 30breath/min Mouth care given
Temp – 990f Cord care given
Urine passed Napkin changed
Stool passed Rooming-in of mother &
baby maintained

ADVICE ON DISCHARGE :

High fibre, high protein, low carbohydrate diet should take.

Adequate fluid to drink
To seek immediately the medical attention in case any complication arises.
To maintain personal hygiene
To take high calorie diet .
Iron & calcium to be continued.
Provide Exclusive breast feeding to baby.
To provide warm by proper covering the baby.
To follow the immunization schedule.

SUMMARY-

Bhagyabati Das, a primipara having GA 38 week 2 days & with PROM, is taken to improve
nursing care. The care giver established a good IPR with the client & her trust & confidence
was gained. The client revealed all her problems, thus the care giver was able provide care to
meet the need up to an optimum. During this period she gains knowledge on different aspects
like care of herself, how to give care to her baby, how to give proper breast feeding, regular
follow up, which makes her more confident & due to this she is now able to cope to any
stressful situation . She was also given health education on nutrition, personal hygiene, antenatal
exercise & regular follow up.