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Preterm premature rupture of membranes thesis
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Preterm Premature Rupture of Membranes
A complication of pregnancy that is often seen in obstetrical triage is premature rupture of membranes, according to Friedman (2013). Premature rupture of membranes (PROM) is a condition in which the membranes spontaneously rupture before the onset of active labor. Preterm premature rupture of membranes (PPROM) is PROM before 37 weeks gestation (Friedman, 2013). According to the American College of Obstetrics and Gynecology (2009), 3% of all pregnancies present with PPROM, including approximately 1/3 of all preterm births. African Americans are shown to be 2 times more likely to experience PPROM than other ethnicities, however, over the last 10 years there has been a downward trend of PPROM in singleton gestations with both African Americans and Caucasians (Mercer, 2010). Although rare, and found in less than 5% of cases, fluid loss can cease and be restored due to spontaneous sealing of the membranes (Mercer, 2010).
Etiology of PPROM is not definitive, but according to Ward and Hisley, it is thought to be a result of weakening due to one or more of the following: stress of contractions, intrauterine infection, inflammation or other conditions that would result in an increase in intrauterine pressure. A 2014 study proposed a correlation between bacteria and the thinning and premature rupture of membranes (Fortner, et al., pp. 1-10). The 2014 study states:
Fetal chorion was uniformly thinner at rupture sites compared to distant sites. In PPROM fetal chorion, we demonstrated pronounced global thinning. Although cause or consequence is uncertain, bacterial presence is greatest and inversely correlated with chorion thinning among PPROM subjects. (Fortner, et al., 2014, p. 9)
A number of ris...
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...and Gynecology. (2009, December 31). Clinical Management Guidelines for Obstetrician-Gynecologists. ACOG Compendium of Selected Publications , pp. 281-293.
Fortner, K. B., Grotegut, C. A., Ransom, C. E., Bentley, R. C., Feng, L., Lan, L., et al. (2014). Bacteria Localization and Chorion Thinning among Preterm Premature Rupture of Membranes. PLOS ONE , 9 (1), 1-10.
Friedman, A. (2013). Chapter 14: Preterm Premature Rupture of Membranes. In D. J. Angelini, D. (. LaFontaine, D. J. Angelini, & D. LaFontaine (Eds.), Obstetric Triage and Emergency Care Protocols (pp. 129-135). New York, New York: Springer Publishing.
Mercer, B. M. (2010). Preterm Premature Rupture of Membranes. In V. Berghella, Preterm Birth: Prevention and Management (pp. 217-231). Philidelphia: Wiley-Blackwell.
Ward, S. L., & Hisley, S. M. (2009). Maternal Child Nursing Care. Washington: FA Davis.
Eden, Elizabeth. "HowStuffWorks "Pregnancy Complications in Older Mothers" HowStuffWorks. N.p., 16 Nov. 2006. Web. 11 Apr. 2014.
Thrombocytopenia affects 6% to 10% of all pregnant women and, other than anemia, is the most common hematologic disorder in pregnancy (McCrae, 2010). The blood consists of three main ingredients: red blood cells, white blood cells, and platelets. Each plays an essential function to provide the human body with elements and protects the body against any exterior viral and infection. Platelets are responsible to help blood to clot. The deficiency or disorder of platelets lead to disease called Thrombocytopenia. This issue is diagnosed when platelets are less than 150,000 platelets per microliter of blood (Erkurt, et. al, 2012).
Neonatal nursing is a field of nursing designed especially for both newborns and infants up to 28 days old. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin”. Neonatal nurses are a vital part of the neonatal care team. These are trained professionals who concentrate on ensuring that the newborn infants under their care are able to survive whatever potential life threatening event they encounter. They treat infants that are born with a variety of life threatening issues that include instances of prematurity, congenital birth defects, surgery related problems, cardiac malformations, severe burns, or acute infection. Neonatal care in hospitals was always done by the nursing staff but it did not officially become a specialized medical field until well into 1960s. This was due to the numerous advancements in both medical care training and related technology that allowed for the improved treatment and survival rate of premature babies. According to the March of Dimes, one of every thirteen babies born in the United States annually suffers from low birth weight. This is a leading cause in 65% of infant deaths. Therefore, nurses play a very important role in providing round the clock care for these infants, those born with birth defects or other life threatening illness. In addition, these nurses also tend to healthy babies while their mothers recover from the birthing process. Prior to the advent of this specialized nursing field at risk newborn infants were mostly cared for by obstetricians and midwives who had limited resources to help them survive (Meeks 3).
Mphahlele, R. R. (2007). Caring for premature babies - a clinical guide for nurses. Professional Nursing Today, 11(1), 40-46.
Getahun, Darios, Yinka Oyelese, Hamisu M. Salihu, and Cande V. Ananth. "Previous Cesarean Delivery and Risks of Placenta Previa and Placental Abruption." Obstetrics & Gynecology 107.4 (2006): 771-78. Print.
A review of the records reveals the member to be an adult female with a birth date of 08/26/1985. The member had a diagnosis of pregnancy with leaking of amniotic fluid and suspicion of rupture of fetal membranes (ROM). The member’s treating provider, Deepti Pruthi, MD ordered a ROM Plus testing, which was performed on 03/04/2015.
In my previous role as a Licensed vocational nurse, I worked in the outpatient setting, Perinatology, where there are high-risk pregnant patients. The patient I helped take care of, was early in her pregnancy, approximately 29 weeks, and was a patient who had been seen in this clinical office
Thus the reason fetal monitoring is important in the case of
Reddy, U. M., Zhang, J., Sun, L., Chen, Z., Raju, T. N., & Laughon, K. (2012). Neonatal mortality by attempted route of delivery in early preterm birth. American Journal of Obstetrics & Gynecology, 207(2). doi:10.1016/j.ajog.2012.06.023
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
...as than others. The oldest source was the textbook Infants and Children. The other three sources were from the Internet written in 1996. Doctors wrote two of the articles and the other one was from the health information for Lenox Hill Hospital. I believe that overtime birthing methods have changed and have alternative ways to proceed, however, the cesarean delivery is pretty much the same procedure and cannot really be changed in any way, which means that the information given will be basically the same.
Every woman when pregnant has a 3-5% chance of having a baby born with a birth defect, and these chances increase when the developing fetus/ embryos are exposed to teratogens, whether it’s intentional or unintentional (Bethesda (MD), 2006). Teratogens can cause severe birth defects, malformations, or terminate the pregnancy altogether (Jancárková, & Gregor, 2000). The placenta is known as an effective barrier from any detrimental pathogen that can potentially hurt the fetus. The timing of exposure of any teratogen is critical to the impact of prenatal development (Bethesda (MD), 2006). The most vulnerable time of the fetus for severe damage is during early pregnancy when all the major organ and central nervous system (CNS) are developing. Miscarriages have an important role in keeping a pregnancy from evolving when there is something serious going on with the developing fetus/embryo. Miscarriages are more common than we think and are the most familiar type of pregnancy loss (Bethesda (MD), 2006).
Sepsis is a “cunning, insidious and non-specific illness” (Raynor, 2012) but progression can be rapturous with a sudden catastrophic circulatory collapse and mortality up to 50%. (Angus et al., 2001) Over five million cases arise per year of maternal sepsis, resulting in an estimated 62,000 maternal deaths globally (WHO, 2008) During the 18th and 19th century, puerperal sepsis resulted in 50% of maternal deaths over Europe (Loudon, 2000). The World Health Organisation (WHO) defined puerperal sepsis as ‘infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum, of which two or more of the following are present: pelvic pain, fever 38.5C or more, abnormal vaginal discharge, abnormal smell of discharge, and delay in the rate of reduction of size of uterus (less than 2 cm a day during the first 8 days)’ (WHO, 1992).
After obtaining approval from our Institutional Review Board and written informed consent, 80 parturients with mild preeclampsia between 18-40 years old were included in this randomized, double-blind study. The study was done at Saad Specialist Hospital, Alkhobar, Saudi Arabia between March 2012 and December 2013. Any parturient diagnosed as mild preeclamp...
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.