The nurse working in the labor room understands that preterm prelabor rupture of membranes (PPROM) can lead t… - HPSSC - 2015

HPSSC - 2015

Obstetrics & Gynaecology

Medium

Appeared in: HPSSC - 2015

Explanation

Preterm prelabor rupture of membranes (PPROM) is the rupture of fetal membranes before 37 weeks of gestation and before labor begins.
It breaks the sterile barrier of the amniotic sac, allowing bacteria to ascend from the vagina, which can cause chorioamnionitis and increase the risk of maternal postpartum infections like endometritis and wound infection.
The loss of amniotic fluid (oligohydramnios) removes the cushion around the umbilical cord, leading to cord compression, which can cause fetal distress.
If the fetal presenting part is not engaged when the membranes rupture, the gush of fluid can carry the umbilical cord down, resulting in a cord prolapse, which is an obstetric emergency.
Since all listed options are potential and serious complications, 'All of the above' is the correct and most comprehensive answer.

Option A: This is a correct complication but is not the only one. Choosing this option alone is incomplete.
Option B: This is a correct complication but is not the only one. Choosing this option alone is incomplete.
Option C: This is a correct complication but is not the only one. Choosing this option alone is incomplete.

Clinical Relevance

Nursing practice connection: Knowing Complications of Preterm Prelabor Rupture of Membranes (PPROM) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's priority after any suspected rupture of membranes is to immediately assess the fetal heart rate to detect cord compression (variable decelerations) or prolapse (bradycardia), which are emergencies.
Strict aseptic technique is crucial in managing PPROM. Digital vaginal exams should be minimized or avoided to reduce the risk of introducing infection (chorioamnionitis).
Nurses play a key role in monitoring for signs of infection, such as maternal fever, tachycardia, uterine tenderness, and foul-smelling amniotic fluid, and reporting them promptly.

How to Approach the Question

First, understand the question's core concept, which is the potential complications of preterm prelabor rupture of membranes (PPROM).
Recall the two main pathophysiological consequences of PPROM: 1) loss of the sterile barrier between the uterus and the vagina, and 2) loss of amniotic fluid volume (oligohydramnios).
Evaluate each option against these consequences.
Option A (Maternal wound infection): Loss of the sterile barrier allows bacteria to ascend, causing chorioamnionitis, which is a major risk factor for postpartum infections, including wound infections. This is a plausible complication.
Option B (Cord prolapse): Loss of amniotic fluid, especially with a sudden gush when the fetal head is not engaged, can cause the cord to wash out. This is a plausible complication.
Option C (Cord compression): Loss of amniotic fluid reduces the cushion around the cord, making it vulnerable to compression. This is a plausible complication.

Concept Tested & Keywords

Concept Tested: Complications of Preterm Prelabor Rupture of Membranes (PPROM)
Stem keywords: preterm prelabor rupture of membranes, PPROM, labor room, complications
Lead-in keywords: can lead to
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Negative lead-in flag: false

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 463-465

E6 Obstetrics Williams pp. 7, 1-8