الفهرس 
Functions of Amniotic FluidOnly 14 pages are availabe for public view
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Abstract
Premature rupture of membranes (PROM) constitute one of the
most important dilemmas in current obstetric practice .the term is applied
to leakage of amniotic fluid in the absence of labor irrespective of
gestational age .( PROM) before (37) weeks gestation is referred to as
preterm premature rupture of membranes (PPROM ). overall ,about
(10%) of all gestations are complicated by (PROM). At term, the
incidence of PROM varies from 6 to 10%. Nearly all women
with(PPROM) will eventually deliver before term, and the majority of
these women will deliver within one week of rupture regardless of their
gestational age at the time of membrane ruprture.
Premature Rupture of Membrane (PROM) is one of the most
common complications of pregnancy that has a major impact on neonatal
mortality and morbidity. Premature rupture of membranes(PROM) is
associated with a series of adverse maternal and neonatal out comes so, It
turns a pregnancy into a high-risk situation and increases the need for
neonatal resuscitation in the delivery room. The occurrence of PROM is
either directly or indirectly responsible for a large number of premature
births and the concomitant mortality and morbidity associated with
preterm delivery. The incidence of neonatal sepsis increases with PROM,
but the overall out come of the neonate is still primarily dependent on the
gestational age at the time of delivery.
Premature Rupture of the fetal membranes is one of the most
common and controversial problems facing the obstetric clinician. It may
lead to various complications including maternal and fetal neonatal
infection, premature labour and delivery, hypoxia, and asphyxia
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Summary
125
secondary to umbilical cord compression, increased caesarean section
rates, and fetal deformation.
The purpose of this study was to assess the role of the nurse in
management of premature rupture of membrane (Routine care) and to
assess the effect of Nursing management for women with premature
rupture of the membrane on the maternal and neonatal out comes. The
study was conducted at two Hospitals in Menoufiya governorate. These
hospitals were Quisna general hospital and Menoufiya Univerisity
Hospital.
The total sample was 60 women with premature rupture of
membranes. To be able to achieve the aims of the study, the inclusion
criteria of these women included in the study sample were :
§ Full term delivery 37 weeks gestation,
§ both primipara and multipara were included,
§ not diagnosis with fetal disease,
§ premature rupture of membrane,
§ cephalic presentation and singleton gestation.
The sample of the study was randomly assigned into two groups, a
study group and a control group.
The methods of data collection included an interviewing
questionnaire sheet, Assessment sheet for the mother, Partograph sheet, A
pgar score to asses the condition of the neonate, Post partum assessment
sheet for both mother and baby, and nurses observational chick list for
assessment of nurses intervention for women with (P.R.O.M).
The study revealed that the mean age of the women ranged from
26.2 to 28.7 years. About half of the sample (46.7%) has secondary
education, while near one quarter of the women (23.3%) were illiterate,
and about one quarter of the women (30%) has University education. The
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study has indicated that the majority of the women (64%) were house
wives, while (36%) of women were employee and working. And near to
three quarter (71.5%) of women were multi Para, and only (28.5%) were
primigravida & Para.
The study has indicated also that, there are no cause to the PROM
in the majority of women (70%) of the study sample, while (30%) had
causes of PROM as, the coitus during the last week of the pregnancy,
polyhydramnious, Abnormal fetal presentation or malposition, cervical
cerculage and leucorrhea.
The study revealed that, the nurses scores in their intervention with
women with PROM ranged from (62.9) in the study group to (68.6) in the
control group. The Majority of nurses (60%) had fair scores while more
than one fourth (30%) of the nurses had good scores in their intervention.
According to the study findings, the Mean duration of the first
stage of labor ranged from (5.23+4.23) to (5.46+5.73) hours, while the
mean duration of the second stage of labor ranged from (20.86+18.6) to
(23.33+21.2) minutes. And the mean duration of the third stage ranged
from (12.66+10.14) to (13.33+13.5) minutes.
According to the study findings, the Majority of the women (70%) in
the study group and (50%) in the control group had normal vaginal
deliveries.While the lower percentage of cesarean section deliveries
(30%) was in the study group, than (43.3%) in the control group and very
law percentage (6.6%) had instrumental deliveries.
The study has revealed that, the Maternal complications during
labor were (10%) in the study group, while it was (30%) in the control
group. However, the infant’s complications during labor was (63.3%) in
the study group and very high in the control group (93.3%). These
differences were statistically significant regarding cyanosis and
Respiratory Distress syndrome.
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According to the study findings. The lower Apgar scoring during
the first minute (5.8) score was in the control group, while it was (6.6)
score in the study group. But at the fifth minute, there is an improvement
in the Apgar scores, it was (7.8) score in the control group and (8.7)
score in the study group. Also, the study explained that the NICU
Admission was high (20%) in the control group and very low (6.6%) in
the study group.
Based on the study findings, the following is recommended:
§ Preventive measures about PROM should be instructed for the
pregnant women who are at risk for PROM during antenatal care
visits.
§ Women who have predisposing factors or risk factors for PROM
should be hospitalized two weeks before delivery as they are
considered high risk.
§ In service training for nurses working in labor units (areas that
nurses had shortage in) in the following topics: use of pantograph,
immediate care of the newborn, and Apgar score.
§ Labor wards should be provided with electronic maternal and fetal
monitoring in order to detect any abnormalities of uterine
contractions at first and second stages of labor, and fetal heart rate
(F H R) pattern.
§ Similar research should be carried on a large number of cases to be
able to generalize the findings of the study.
§ The pediatrician should be present during labor of (PROM) cases
to carry out immediate baby care and receive the newborns
correctly and safely.