West Coast University, Orange County Study Guide NURSING 306
Chapter 7 DURHAM: High Risk Antepartum Nursing Care
Week 5 Pre WORK
• Due @ 2359 on Sunday, Week 5
• Upload your copy under Journal Week 5 for Week 5 Pre work
• Complete ATI N306F5 Practice Assessment and attach the report with a minimum
score of 76%, with your prework
Chapter 7 DURHAM: High Risk Antepartum Nursing Care
Handwrite or type
Define and
explain:
❖ Medical management
❖ Nursing Actions/Interventions
❖ Patient education
• PROM p 140
o Prolong rupture of membrane
o Greater than 24 hours
o Risk Factors for preterm PROM
▪ Previous preterm PROM or preterm delivery
▪ Bleeding during pregnancy
▪ Hydramnios
▪ Multiple gestation (up to 15% in twins, up to 20% in triples)
▪ Sexually transmitted infections (STIs)
▪ Cigarette smoking
o Risk for the Woman
▪ Maternal infections (ex: chorioamnionitis)
▪ Preterm labor and birth
▪ Increase rates of cesarean birth
o Risk for the Fetus and Newborn
▪ Fetal or neonatal sepsis
• The earlier the fetal gestation at ROM, the greater the risk for infection
• The membranes serve as a protective barrier that separates the
sterile fetus and fluid from the bacteria-laden vaginal canal
▪ Preterm delivery and complications of prematurity
▪ Hypoxia or asphyxia because of umbilical cord compression due to
decreased fluid
▪ Fetal deformities if preterm PROM before 26 weeks’ gestation
o Assessment Findings
▪ Confirmed premature gestational age by prenatal history and ultrasound
W e s t C o a s t U n i Wv eer ssti t CW
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Revision Date: 1-8-16M e e ti n 1-
, ▪ Confirmed rupture of membranes with speculum exam and positive ferning test
▪ Oligohydramnios on ultrasound may be seen but is not diagnostic
o Medical Management
W e s t C o a s t U n i Wv eer ssti t CW
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Revision Date: 1-8-16M e e ti n 1-
, Week 5 Pre
WORK ▪ Pt with PROM between 34-36 wks should be managed as if they were term
with induction of labor and treatment for group B streptococcal prophylaxis
recommended
▪ Pt with PROM before 32 weeks of gestation should be cared for expectantly
until 33 completed weeks of gestational if no maternal or fetal
contraindications exist.
▪ All women with preterm PROM and viable fetus, GBS-should receive
intrapartum chemoprophylaxis to prevent vertical transmission of group
B streptococci
▪ Corticosteriods should be administered to women with preterm PROM
before 32 weeks of gestation tor reduce risk of RDS, perinatal mortality, and
other morbidities
▪ Delivery is recommended when preterm PROM occurs at or beyond 34 weeks
of gestation
▪ With preterm PROM at 32-33 completed weeks of gestation labor
induction may be considered if fetal pulmonary maturity has been
documented
▪ Digital cervical exam should be avoided in pt with PROM unless they are
in active labor or imminent delivery
▪ Monitor for infection, labor, and fetal compromise
▪ Assess for fetal lung maturity with LS ratio/ phosphatidyl glycerol (PG)
▪ Administer prophylactic antibiotic therapy to reduce maternal and
fetal infection
▪ Antibiotic prophylactic therapy
o Nursing Actions
▪ Assess FHR and uterine contractions
▪ Assess for signs of infection
• Tachycardia
• Fever > 100.4 F or 38C
• Uterine tenderness
• Malodorous fluid or vaginal discharge
▪ Monitor for labor and for fetal compromise
▪ Provide antenatal testing including non stress test (NST) and (BPP)
• PPROM p140
o Preterm premature rupture of membranes
o Rupture of membrane with a premature gestation <37 weeks
• Pregestational Diabetes p147
o Women with preexisting pregestational diabetes have a fivefold increase in the
incidence of major fetal anomalies of the heart and central nervous system
(CNS)
o Risk for the woman
▪ Hypoglycemia or hyperglycemia
W e s t C o a s t U n i Wv eer ssti t CW
y oeCsatosCtuo raUss tneUi vnS ievy erl rlssaii t y Page 1
tb yu s Page 1 06-2019
Revision Date: 1-8-16M e e ti n 1-
Chapter 7 DURHAM: High Risk Antepartum Nursing Care
Week 5 Pre WORK
• Due @ 2359 on Sunday, Week 5
• Upload your copy under Journal Week 5 for Week 5 Pre work
• Complete ATI N306F5 Practice Assessment and attach the report with a minimum
score of 76%, with your prework
Chapter 7 DURHAM: High Risk Antepartum Nursing Care
Handwrite or type
Define and
explain:
❖ Medical management
❖ Nursing Actions/Interventions
❖ Patient education
• PROM p 140
o Prolong rupture of membrane
o Greater than 24 hours
o Risk Factors for preterm PROM
▪ Previous preterm PROM or preterm delivery
▪ Bleeding during pregnancy
▪ Hydramnios
▪ Multiple gestation (up to 15% in twins, up to 20% in triples)
▪ Sexually transmitted infections (STIs)
▪ Cigarette smoking
o Risk for the Woman
▪ Maternal infections (ex: chorioamnionitis)
▪ Preterm labor and birth
▪ Increase rates of cesarean birth
o Risk for the Fetus and Newborn
▪ Fetal or neonatal sepsis
• The earlier the fetal gestation at ROM, the greater the risk for infection
• The membranes serve as a protective barrier that separates the
sterile fetus and fluid from the bacteria-laden vaginal canal
▪ Preterm delivery and complications of prematurity
▪ Hypoxia or asphyxia because of umbilical cord compression due to
decreased fluid
▪ Fetal deformities if preterm PROM before 26 weeks’ gestation
o Assessment Findings
▪ Confirmed premature gestational age by prenatal history and ultrasound
W e s t C o a s t U n i Wv eer ssti t CW
y oeCsatosCtuo raUss tneUi vnS ievy erl rlssaii t y Page 1
tb yu s Page 1 06-2019
Revision Date: 1-8-16M e e ti n 1-
, ▪ Confirmed rupture of membranes with speculum exam and positive ferning test
▪ Oligohydramnios on ultrasound may be seen but is not diagnostic
o Medical Management
W e s t C o a s t U n i Wv eer ssti t CW
y oeCsatosCtuo raUss tneUi vnS ievy erl rlssaii t y Page 1
tb yu s Page 1 06-2019
Revision Date: 1-8-16M e e ti n 1-
, Week 5 Pre
WORK ▪ Pt with PROM between 34-36 wks should be managed as if they were term
with induction of labor and treatment for group B streptococcal prophylaxis
recommended
▪ Pt with PROM before 32 weeks of gestation should be cared for expectantly
until 33 completed weeks of gestational if no maternal or fetal
contraindications exist.
▪ All women with preterm PROM and viable fetus, GBS-should receive
intrapartum chemoprophylaxis to prevent vertical transmission of group
B streptococci
▪ Corticosteriods should be administered to women with preterm PROM
before 32 weeks of gestation tor reduce risk of RDS, perinatal mortality, and
other morbidities
▪ Delivery is recommended when preterm PROM occurs at or beyond 34 weeks
of gestation
▪ With preterm PROM at 32-33 completed weeks of gestation labor
induction may be considered if fetal pulmonary maturity has been
documented
▪ Digital cervical exam should be avoided in pt with PROM unless they are
in active labor or imminent delivery
▪ Monitor for infection, labor, and fetal compromise
▪ Assess for fetal lung maturity with LS ratio/ phosphatidyl glycerol (PG)
▪ Administer prophylactic antibiotic therapy to reduce maternal and
fetal infection
▪ Antibiotic prophylactic therapy
o Nursing Actions
▪ Assess FHR and uterine contractions
▪ Assess for signs of infection
• Tachycardia
• Fever > 100.4 F or 38C
• Uterine tenderness
• Malodorous fluid or vaginal discharge
▪ Monitor for labor and for fetal compromise
▪ Provide antenatal testing including non stress test (NST) and (BPP)
• PPROM p140
o Preterm premature rupture of membranes
o Rupture of membrane with a premature gestation <37 weeks
• Pregestational Diabetes p147
o Women with preexisting pregestational diabetes have a fivefold increase in the
incidence of major fetal anomalies of the heart and central nervous system
(CNS)
o Risk for the woman
▪ Hypoglycemia or hyperglycemia
W e s t C o a s t U n i Wv eer ssti t CW
y oeCsatosCtuo raUss tneUi vnS ievy erl rlssaii t y Page 1
tb yu s Page 1 06-2019
Revision Date: 1-8-16M e e ti n 1-
