HLTH 1030 PROM presentation

Hello, My name is Marco down,

and this is my presentation on what to keep

in mind if your water breaks before labour starts.

The medical term for this phenomenon is called pre labour.

Rupture of membranes or prom.

And basically the amniotic sac that surrounds the foetus

ruptures before contraction sinker enough into labour patterns

that can actually bring forth the baby.

And this occurs in about 8% of births in the U. S.

The two major concerns are managing infection

in managing the time from rupture to delivery

that you are related.

The risk of infection increases by degrees after 24 hours,

meaning that your risk of infection usually goes up

by percentage points and not doubling or tripling.

There are generally two options available at any point

expectant management at home or induction at the hospital.

And the important thing to remember here is that you

can usually go from home to the hospital if necessary,

like an emergency,

but usually not from the hospital back home. Once you've been admitted,

factors that can make expectant management at home more favourable include the

possibility of the membranes actually resealing and closing up the leak.

We don't have a whole lot of numbers on how frequently this happens,

but it is a possibility.

Um,

additionally, you will be producing

new amniotic fluid continuously.

So you don't have to worry about that being a factor in, um,

the time that it takes for you to deliver.

Additionally, most parents

will spontaneously go into labour.

Um,

at least 60% of parents will go into labour within 24 hours.

Studies kind of vary on that one, but at least 60%

90% of parents will go into labour within 48 hours,

and 95% will go into labour within 72 hours.

So sometimes it's, uh, nice to wait and let you give your body a chance,

um,

to kind of catch up with what needs to happen next.

So one of the things that can sometimes cause a

pre labour rupture of membranes is when the hard parts of

the foetal skull are against the hard parts of the parental

pelvis and this can create a little bit of friction,

so this often leads to painful back labour.

But if we know what we're working with, it's more easily managed

with some position changes and

again the freedom to move around.

So the last thing that can make expectant management, um,

more favourable is

the potential for,

um,

colonisation with healthy microbes that can help fight off any

pathogens that may be present within the birth canal.

If you manage your hygiene will

and you keep anything out of your vagina, then

that's generally the best way to reduce your risk.

Factors that can make the hospital more favourable include

a positive Group B strep test

and the need for antibiotics during labour in order

to prevent the passage of infection to the foetus.

Additionally,

if the foetus passes meconium their first bowel movement,

uh, after the waters have already broken, that can be a sign of distress.

Sometimes if when your waters break initially,

there's some meconium present that doesn't

necessarily mean that anything is wrong.

But,

um,

if the foetus passes a bowel movement, uh, due to stress, then um,

we definitely want to be able to check that out and

make sure that we can respond in a timely fashion,

um, to any sort of foetal distress.

Another thing that may make the hospital more favourable is,

uh if the pregnant person is already beyond, um, 40 plus weeks.

So I say 40 plus because it kind of depends on the state.

Um, in California, the cut off for the midwifery scope of practise is 42 weeks,

and that is usually when you see a greater risk of infection

related to premature

rupture of membranes.

Another thing that, um may make the hospital more favourable.

And when I say hospital, sometimes that can be, um, synonymous with basically,

like easy access to I v antibiotics.

Um, are things like an active genital tract infection like a U T. I.

The proximity of the urinary tract to the birth canal

can lead to an easily

easy transfer of pathogens, um,

up the birth canal and into the uterus.

So the last thing that is definitely a genuine emergency and requires

the fastest birth possible is if there is an umbilical cord prolapse.

So usually we diagnose that through distressed heart

tones because we don't want to put anything

up the vagina in order to assess what's

happening unless we are really seriously needing to,

um, make sure that it's not rule out the umbilical cord prolapse,

but the danger of that obviously is going to be, um,

that the foetal head might be putting pressure on the umbilical cord and

cutting off their own blood supply with the pressure of the contractions.

So

in that case,

you do want to have a surgical suite available for the health of the parent and child.

Something that is really important to keep in mind with

hospitals and medical management are the frequency of internal exams.

Now

labour progress in the hospital is mainly measured

by assessing cervical dilation.

So even though it's your right to say no

and

decline any exams that are offered,

some providers do feel entitled to that information

in order to make a medical decision.

Um,

about your care.

So

what's concerning is that the rates of Corio and Munitis,

which is a specific type of infection,

are observed to be related to the number of internal exams received.

So we see here 2% of patients who got three

or less internal exams throughout their labour got infections,

and 20% of patients who got eight or more internal exams

over the course of their labour ended up with infections.

Um,

it's best to go to the hospital.

If baby needs to be born like now,

um,

the more time elapses between admission and delivery,

the greater the chances for infection.

Not just because of the internal exams,

although that's usually the biggest factor,

but also because they're sick people in the hospital.

Um

and so sometimes that can expose you to things that you

would not otherwise be exposed to in the home environment.

Studies have shown that labouring at home has been, uh,

demonstrated to decrease the time between admission and delivery,

even if it becomes necessary to use medical induction.

So this is my flow chart on what to keep in mind At the moment,

I was hoping I would be able to zoom in on some of the options here.

But basically what you want to do is you want to assess where you are, uh,

usually by the state of the fluid, and then see

if you are going to need more information from the midwife like a quick assessment,

Um,

or if you're safe to stay at home.

So, um, anything that is suggested here, like, uh,

this call midwife prep for the hospital is

still within your control. You can still say no,

but be prepared for a medical emergency.

Um,

things to keep in mind

when it comes to premature rupture of membranes

is,

um, mainly related to these points.

Do you want the ability to immediately have access

two i V antibiotics if you need them?

That's usually the Group B strep positive people as well as anyone,

um,

who just feels like that's what they need to in order to manage their risk.

Um,

do you feel more confident with a hands off approach?

Are you going to feel better about your labour and birth if, um, you

reduce your exposure to the hospital

or do you want the monitoring and the potential for a swift delivery?

Uh, is maintaining a hygienic environment within your control?

Are you in a place where you can labour at home

and, uh,

still keep everything *** and span in order to manage your risk of infection?

And do you feel like you have good communication with your baby?

Because sometimes that is the first clue that we get that something is wrong.

So thank you very much for listening to my presentation.

These are all my references, and I hope you have a great day

HLTH 1030 PROM presentation

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