Cuidados de enfermería basados en Dorotea Orem en ruptura prematura de membrana y oligoamnios / Nursing care in premature membrane rupture and oligohydramnios

La morbilidad materna y perinatal asociada a la ruptura prematura de membranas constituye un problema social y de salud importante, por lo que es primordial estimar su frecuencia y magnitud. Este artículo condensa las intervenciones de enfermería en paciente con ruptura prematura de membranas aplicando el proceso de atención de enfermería (PAE) orientado en la teoría de Dorothea Orem, la cual basa el autocuidado de acuerdo al nivel de dependencia para aplicar una intervención de enfermería obstétrica. La metodología utilizada es el estudio de caso que describe una patología y manejo de un problema el cual se intervino logrando la salud de la madre y su hijo. Participó una gestante de 19 años, con 29 semanas y 5 días de gestación, al valorarla ofreció información sobre su estado actual y antecedentes. Se realizó diagnóstico mediante prueba de helecho y reflejó ruptura prematura de membrana (RPM) que la llevó al oligoamnios, manifestando altura de fondo uterino (AFU) de 19 cm y amenaza de parto pretérmino (APP). El oligoamnios pone en riesgo el crecimiento adecuado del feto, por no ser un embarazo viable para recurrir a un parto. Se realizarón cuidados de enfermería dependientes, procurando un reposo absoluto; e interdependientes manteniendo un equilibrio hídrico, alimentación adecuada, tratando el estreñimiento, prevención de infección y manejo de la ansiedad que puede repercutir en el sueño y comodidad. La asiduidad de los cuidados de enfermería logra una respuesta positiva, al prologar la etapa de gestación hasta una maduración fetal viable para la vida...(AU)

[Ambulant Management in Case of Premature Rupture of Membranes (PROM) at Term: Maternal and Perinatal Outcome]. / Ambulantes Management bei vorzeitigem Blasensprung (VBS) am Termin. Eine Outcome-Analysestudie bei ambulantem vs. stationärem Management.

Introduction: It is estimated that after premature rupture of membranes (PROM) at term, 60% of all women go into labour within 48 h, 95% within 72 h. Often labour is induced after 24 h because the risk of maternal and neonatal infection rises. The majority of clinicians advise hospital care to allow monitoring and detection of problems. But for low-risk patients who meet strict inclusion criteria, sometimes home management is possible. This study examines the safety and costs of home management. Material and Methods: We included 239 patients with PROM at term, 202 of them with hospital and 37 with home management. Patients who met the inclusion criteria were checked 12 h after PROM and were induced by the end of 24 h if labour had not begun spontaneously. Results: There were no differences in maternal or neonatal outcome. Women with home management were likely to spend less time in hospital and this was associated with reduced costs. Conclusion: Women with outpatient management of PROM had a shorter hospitalization stay without negative impact on maternal or fetal outcome. In times of increasing financial pressure on the medical system, outpatient management for PROM seems to be a viable option.

Lying Down after Premature Rupture of the Membranes in Term Singleton Pregnancies: An Evidence-Based Recommendation?

Objectives: In many countries pregnant women in term singleton pregnancies are advised by obstetricians and midwives to lie down immediately after rupture of membranes until engagement of the foetal head is confirmed. The horizontal positioning aims to prevent the prolapse of the umbilical cord. The objective of this systematic review is to assess the effects of the maternal lying down measure in term singleton pregnancies. Search methods: We searched the databases of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL (Issue 10, 2015) from their inception until September 30th, 2015. Additionally, we searched selected trial registers, the reference lists of potentially relevant studies and national and international obstetrical clinical guidelines. All types of studies without language restriction were selected. Main results: One retrospective study was found. Only one woman with a term singleton pregnancy had the event of an umbilical cord prolapse following premature rupture of membranes (0.008%). The study did not report on the presence of an engaged foetal head in this woman. Conclusions and implications: Recommendations cannot be made in favour or against the lying down positioning based solely on the single identified study. For that reason, the widespread recommendation given by obstetricians and midwives should be critically reassessed. Also, induction of maternal anxiety and increased costs to the healthcare system following transportation to the delivery unit have to be considered in the light of the given minimal risk of umbilical cord prolapse in conjuncture with lacking evidence for the utility of the common recommendation.

[Prelabour Rupture of Membranes at Term: In- or Outpatient Management? A Survey in Birth Institutions in the German-Speaking Part of Switzerland]. / Vorzeitiger spontaner Blasensprung am Termin: Hospitalisation oder ambulantes Management? Eine Erhebung in Deutschschweizer Geburtsinstitutionen.

Approximately 8-10% of pregnant women experience prelabour rupture of membranes at term (tPROM). The ideal timing to induce labour as a means to shorten the time interval to birth and thus to reduce maternal and neonatal risk of infection is a controversial topic. A distinction is made between an active and an expectant approach. There is little evidence comparing in- and outpatient management in the expectant approach. The goal of this investigation was to determine the current management approach in birth institutions in the German-speaking part of Switzerland. In this cross-sectional study, a self-designed online questionnaire was distributed to obstetricians and midwives in leading positions at all obstetric institutions in Switzerland. Outcome measures were: the currently offered approach at tPROM, experience with outpatient expectant management and the willingness to introduce outpatient management as an option for pregnant women. From a total of n=85 Swiss German birth institutions, n=47 (55%) responded to the questionnaire. 53% (n=25) provide outpatient expectant management. The women's satisfaction was seen as a decisive advantage. The respondents furthermore ascribed advantages for maternal outcome but no advantage for fetal outcome. 73% (n=16) of respondents working in institutions that hospitalize exclusively stated their willingness to introduce outpatient management provided that there was evidence of maternal and fetal outcome and that expectant mothers were satisfied. The number of birth institutions offering outpatient management is surprisingly high. In future studies examining general management at tPROM, the question of outpatient management should be included. Even though this survey seems to justify outpatient management under strict quality control conditions, prospective studies to assess safety issues are urgently needed.

Análise da produção científica brasileira sobre amniorrexe prematura / Analyze of the brazilian scientific production about early amniorrhexis

Objetivo: identificar e analisar estudos sobre amniorrexe prematura. Metodologia: trata-se de um estudo descritivo e exploratório, de natureza bibliográfica. A pesquisa foi realizada pela busca on line de artigos completos e resumos nacionais disponíveis na Biblioteca Virtual de Saúde (BVS) no período de março a abril de 2008, utilizando como descritor: "ruptura prematura de membranas fetais". O período delimitado foi 2003 a 2008. Resultados: foram encontrados oito artigos na íntegra e cinco em forma de resumo. Os estudos foram categorizados por similaridade de conteúdo: "aspectos que envolvem a amniorrexe prematura", "condutas adotadas ou a serem adotadas", "complicações" e "etiologia". Conclusão: sugere-se que cada vez mais os profissionais publiquem suas ações em mulheres com diagnóstico de ruptura prematura de membranas, porque através da socialização de suas práticas assistenciais, poderão ajudar outros profissionais no cuidado a essa mulher, ao feto e neonato.(AU)

Personal conscience and the problem of moral certitude.

The moral practice of nursing requires the difficult work of discerning the best response to an ethical quandary. Determining the right course of action can rarely be discovered by assuming that one value, one theory, one point of view will always and reliably identify the morality of an action. Thus, the role of a nurse is an inherently moral activity that is at the heart and soul of health care. Practitioners who move too quickly to a state of moral certainty about a decision may be missing essential components of the enactment of moral agency. Personal integrity and professional integrity, patient interests, society's expectation of a profession, the balance between rights and obligations within the nurse-patient relationship, acting according to one's conscience, power, control, and moral certainty are a few of the topics that enrich thinking about the moral richness of nursing practice, and will encourage readers to know, to reason, and to act in ways that demonstrate reflective moral judgment.

Maternal role transition experiences of women hospitalized with PROM: a phenomenological study.

This study investigated the subjective experiences of the maternal role transition during the first two weeks of hospitalization for premature rupture of the amniotic membranes (PROM). Thirteen pregnant couples participated in the study by completing interviews. Average gestation of the expectant mothers was 27 weeks and the women were already experiencing fetal movement during the first two weeks of hospitalization for PROM. Lincoln and Cuba's trustworthiness criteria were employed to evaluate methodological rigor. Colaizzi's phenomenological approach was used to analyze the structure of the experience. Four themes emerged: pending loss, concern about the safety of the fetus, identification of maternal roles, and the process of maternal role-making. The results provide a scientific basis for empowering nurses to assist with maternal role transition in high-risk pregnancies in a more sensitive and effective manner.

Nursing care of the patient with preterm premature rupture of membranes.

Preterm premature rupture of the membranes (PPROM) is diagnosed when rupture of the amniotic membranes occurs prior to the completion of the 36th week of gestation. PPROM accounts for 25% of all cases of premature rupture of the membranes and is responsible for 30%-40% of all preterm deliveries. In mothers diagnosed with PPROM without evidence of infection, active labor, or fetal compromise, the current standard of care is expectant management. The goal of expectant management is the prolongation of the pregnancy to increase fetal gestational age thus potentially decreasing the effects of prematurity. Expectant management consists of ongoing observation for signs and symptoms of infection, active labor, and/or nonreassuring fetal status. This article provides clinical nursing guidelines for the mother diagnosed with PPROM who is managed expectantly. Eight targeted areas for nursing assessment and intervention are described: preterm labor, side effects of tocolytic therapy, maternal/fetal infection, fetal compromise, side effects of extended bed rest, maternal stress, educational needs, and routine prenatal care.

Premature rupture of the fetal membranes. An update for advanced practice nurses.

Advanced practice nurses in obstetric settings are frequently required to diagnose premature rupture of fetal membranes; co-management of care with physicians is becoming more common in many health care facilities. Therefore, Advanced practice nurses must have an in-depth understanding of this potentially severe obstetric complication. This article presents a review of the current literature focusing on the epidemiology, physiology, pathophysiology, prevention measures, subjective and objective assessment, diagnostic tests, and management of premature rupture of membranes. Psychosocial aspects of this event, often upsetting for the family, are also discussed.