Identification Data

 Name of The Mother: Debadipta Panda

 Name of The Spouse: Santosh kr. Panda
 Date of Admission: 15/08/2023
 Age: 37 Yr
 Gestational Age: 33 Week 3 Day
 Obstetrical Score: G3P0L0 A2
 LMP: 24/01/2023
 EDD: 08/10/2023
 Ward: Post-Natal Ward
 Bed No.: 20
 Ip No.: Kimsip102307260107
 Address: Atata, Odisha
 Religion: Hindu
 Occupation: Homemaker
 Marital Status: Married
 Diagnosis: PROM with severe oligohydramnios, breech presentation, cord
around neck
 Chief Complaint: Leaking per vagina, For Safe Confinement
History Taking
 Present Medical History:
Soakage in pad with blood, and blood clots.

 Past Medical History:

No significant history

 Past Surgical History:

No significant history
Family History
 Type Of Family: Nuclear Family
 No. Of Members:
INDEX:
Family Tree
= MALE

= FEMALE

= MOTHER

= BABY
 Family Composition & Relationship

Sl Name Age/Sex Relationship Education Occupation Health

No Status
.

Socio Economic History

 Occupation: Business
 Earning Members: 1
 Family Income: 50,000/Per Month
 Type of House: Pucca
 Nearby Health Facilities: Present
Mentrual History
 Age of Menarch: 15 Years
 Duration Of Cycle: 3-4 Days
 Rate of Flow: Normal
 Regularity: Regular
 Any Abnormalities:
Marital History
 Year/ Duration Of Marriage: 2019, 3 Years
 Coital Relationship: Regular
 Abnormality During Coitus: Not Specific
 Contraceptive Use: No
Obstetrical Score
 Gravida: 3
 Para: 0
 Living: 0
 Abortion: 2
Sl Year Pregnancy Event Labor Event Outcome Puerperium
No
.
1. 2020 Spontaneous
abortion at 2.5
months of GA
2. 2021
MTP @ 2.5 months
of GA, fetal
anomaly

Personal History
 Bowel: No Hemorrhoid, No Constipation
 Bladder: No Complications
 Food Habit: Non-Vegetarian
 Fluid Intake: Adequate
 Sleep & Rest: Adequate
 Habits: No History of Any Abuse
 Personal Hygiene: Maintained
Physical Examination
Systemic Examination
 General Appearance: Active
 Height/ Weight: 162 Cm, 76 Kg
 Body Built: Well Built
 Nourishment: Well Nourished
 Gesture: Normal
 Posture: Normal
Vital Signs

Date Blood Temperature Pulse Respiration

Pressure
19/08/23 120/80 99oc 98 Beats/Min 24 Breaths/Min

20/08/23 110/80 97oc 88 Beats/Min 22 Breaths/Min

22/08/23 112/78 97oc 84 Beats/Min 22 Breaths/Min

Head & Neck

 Shape: Normal
 Size: Normal
 Hair: Well Distributed
 Lymph Node: Not Enlarged
  Range of Motion: Present

Integumentary System
 Color: Normal
 Texture: Normal
 Turgor: Normal
 Lesion & Other Signs: Not Present
Eyes
 Symmetry: Well Symmetry
 Conjunctiva: No Inflammation
 Cornea: Normal
 Pupils: Reacts to Light
 Vision: Normal Acuity
Ears
 Position: Normal
 External Ear: No Lesion
 Hearing: Normal Acuity
Nose
 Symmetry: Normal
 Discharge: No Discharge
 Septum: Not Deviated
 Mucous Membrane: No Inflammation
Mouth
 Symmetry: Well Symmetrical
 Lips: Well Nourished
 Teeth: No Dental Carries
 Tongue: Not Coated
 Gum: No Inflammation
Extremities
 Symmetry: Well Symmetrical
 Range of Motion: Present
 Edema: No edema
 Pain: Not Present
 Other Symptoms: Not Present
 Obstetrical Assessment
Abdomen
 Inspection: Linea nigra, stea gravidarum present
 Scar marks: absent
 Contour of uterus: spherical
 Uterine ovoid: longitudinal

Palpation:
 Fundal height: 30 cm
 Abdominal girth: 85 cm
 Week of gestation according to fundal height: 30 weeks

Auscultation:
 FHS: 130b/m
 FMC: present

Obstetric grips
 Fundal grip: longitudinal lie
 Lateral grip: smooth curvature present
 Pelvic grip: not engaged
 Pawlik grip: mobile

Per vaginal examination

 Inspection: edematous, leaking
 No of pads: 3 pads/ day

Investigations

Date Name Of Patient Value Normal Remark

Investigation Value
15/08/2 Serum Urea 15 Mg/Dl 12-42 Mg/Dl Normal
3 Serum Creatinine 0.58 Mg/Dl 0.5-1.1 Mg/Dl Normal
Serum Sodium 148 Mmol/L 136-146 Normal
Serum Potassium 4 Mmol/L Mmol/L Normal
3.5-5.5
Urine Re/Me Normal Mmol/L
15/08/2
3 Cbc
Haemoglobin 11.6 Gm/Dl Normal
15/08/2 12-15 Gm/Dl
3 USG Cord around
neck
Moderate left
15/08/2 hydrouretoneph
 3 osis
Breech

DISEASE DESCRIPTION: PRE-RUPTURE OF MEMBRANE WITH

OLIGOHYDRAMNIOS

INTRODUCTION:

PRELABOR RUPTURE OF MEMBRANES is leakage of amniotic fluid before onset

of labor. Diagnosis is clinical. Delivery is recommended when gestational age is ≥
34 weeks and is generally indicated for infection or fetal compromise regardless of
gestational age.

Prelabor rupture of membranes (PROM) may occur at term (≥ 37 weeks) or earlier

(called preterm PROM if < 37 weeks).

Preterm PROM predisposes to preterm delivery.

RISKS OF PROM:

PROM at any time increases risk of the following:

 Infection in the woman (intra-amniotic infection), neonate (sepsis), or both

 Abnormal fetal presentation
 Abruptio placentae
 Group B streptococci and Escherichia coli are common causes of infection.
Other organisms in the vagina may also cause infection.
 PROM can increase risk of intraventricular hemorrhage in neonates;
intraventricular hemorrhage may result in neurodevelopmental disability (eg,
cerebral palsy).
 Prolonged preterm PROM before viability (at < 24 weeks) increases risk of
limb deformities (eg, abnormal joint positioning) and pulmonary hypoplasia
due to leakage of amniotic fluid (called Potter sequence or syndrome).

The interval between PROM and onset of spontaneous labor (latent period) and
delivery varies inversely with gestational age. At term, > 90% of women with PROM
begin labor within 24 hours; at 32 to 34 weeks, mean latency period is about 4
days.

SIGNS OF PROM:
BOOK PICTURE PATIENT PICTURE
 leakage or a sudden gush of fluid Leakage of fluid from vagina
from the vagina.
 Fever
  Heavy or foul-smelling vaginal
discharge, abdominal pain,
 fetal tachycardia, particularly if
out of proportion to maternal
temperature, strongly suggest
intra-amniotic infection.

DIAGNOSIS OF PROM:
BOOK PICTURE PATIENT PICTURE
 Amniotic fluid appears to be  Amniotic fluid appears to be
escaping from the cervix. escaping from the cervix.
 Vernix or meconium is visible.  Amniotic fluid index: 2cm
 USG  Oligohydramnios

TREATMENT MANAGEMENT OF PROM:

BOOK PICTURE PATIENT PICTURE

 Delivery if there is fetal  pelvic rest, close monitoring,
compromise, infection, or antibiotics
gestational age ≥ 34 weeks  Corticosteroids to help develop
 Otherwise, pelvic rest, close the fetus’s lungs.
monitoring, antibiotics  Antibiotics to prevent infection
 Corticosteroids to help develop and prolong the pregnancy.
the fetus’s lungs.
 Antibiotics to prevent infection
and prolong the pregnancy.
 Tocolytics (medication to stop
labor).
 Magnesium sulfate to help the
fetus’s brain.

PHARMACOTHERAPHY:

PATIENT PICTURE
 TAB. IRON & CALCIUM TABS
 TAB. ECOSPORIN 75 MG, OD
 TAB. DUVADILON 10 MG, BD
 TAB. GESTOFIT SR 300 MG, OD
 INJ. EVAPARIN, every 2nd day
NURSING MANAGEMENT

Problem Nursing Diagnosis Need

Leaking per vagina Risk for preterm labor  Give Proper
Positioning.
 Monitor maternal
vital signs and fetal
heart rate (FHR)
every 4 hours.
 Assess for signs of
preterm labor, such
as contractions,
vaginal bleeding,
and leaking
amniotic fluid.
 Administer
tocolytic
medications as
ordered.
 Educate the
mother about the
signs and
symptoms of
preterm labor and
what to do if she
experiences them.
 Restrict Ambulation
If Needed
Infection Risk For Infection Related  Monitor for signs of
To leaking per vagina infection, such as
fever, chills, and
foul-smelling
vaginal discharge.
 Administer
antibiotics as
ordered.
 Encourage the
 mother to drink
plenty of fluids.
 Teach the mother
about good
hygiene practices.
Risk for impaired fetal  Monitor the fetus's
growth and development growth and
development using
ultrasound.
 Administer
corticosteroids to
the mother to help
mature the fetal
lungs.
 Provide the mother
with emotional
support.
Deficient knowledge  Deficient
about PROM and knowledge about
oligohydramnios PROM and
oligohydramnios
 Interventions:
 Educate the
mother about
PROM and
oligohydramnios.
 Explain the risks
and complications
of these conditions.
 Teach the mother
how to monitor for
signs of preterm
labor.
 Provide the mother
with written
information about
PROM and
oligohydramnios.
 NURSING CARE PLAN

Assessm Nursing Goal Intervention Evaluation

ent Diagnosis
Mother Risk for To reduce  Give Proper Positioning.
complain preterm labor the risk of  Monitor maternal vital signs
s of preterm and fetal heart rate (FHR)
leaking labor every 4 hours.
per  Assess for signs of preterm
vagina labor, such as contractions,
vaginal bleeding, and leaking
amniotic fluid.
 Administer tocolytic
medications as ordered.
 Educate the mother about the
signs and symptoms of
preterm labor and what to do if
she experiences them.
 Restrict Ambulation If Needed
Risk For To reduce  Monitor for signs of infection, Reduced risk
Infection the risk of such as fever, chills, and foul- of infection
Related To infection smelling vaginal discharge.
leaking per  Administer antibiotics as
 vagina ordered.
 Encourage the mother to drink
plenty of fluids.
 Teach the mother about good
hygiene practices.
Risk for To reduce  Monitor the fetus's growth and Monitoring of
impaired fetal the risk of development using ultrasound. fetus through
growth and impaired  Administer corticosteroids to usg and
development fetal the mother to help mature the doppler
developme fetal lungs.
nt  Provide the mother with
emotional support
Deficient To provide  Deficient knowledge about Mother is well
knowledge health PROM and oligohydramnios knowledgeabl
about PROM education  Interventions: e on her
and on the  Educate the mother about disease
oligohydramnio disease PROM and oligohydramnios. condition
s condition  Explain the risks and
complications of these
conditions.
 Teach the mother how to
monitor for signs of preterm
labor.
 Provide the mother with
written information about
PROM and oligohydramnios.

PROGNOSIS:

My mother, Mrs debadipta panda, 37 yr, with obstetrical score of G3A2, with
gestational age of 33 weeks 3 days, presented on 15/08/23, with leaking per vagina.
Usg reports suggest severe oligohydramnios, cord around neck, and breech
presentation. Mother is on treatment and confined to bed for safety.

HEALTH TALK ON WARNING SIGNS DURING ANTENATAL PERIOD

it is important to be aware of the warning signs of preterm labor. These signs

include:
 Contractions that are regular, painful, and get closer together over time
 Leaking or gushing of fluid from your vagina
 Pain in your lower back or abdomen
 A change in your baby's movements
  Fever or chills
 Foul-smelling vaginal discharge
If you experience any of these warning signs, it is important to call your healthcare
provider right away. Early diagnosis and treatment can help to reduce the risk of
complications for you and your baby. Some additional tips for antenatal mothers
with PROM or oligohydramnios:
 Get plenty of rest.
 Drink plenty of fluids.
 Avoid strenuous activity.
 Monitor your baby's movements closely.
 Report any concerns to your healthcare provider immediately
Bibliography:
1. Salhan Sudha“ Text Book Of Gynecology” 2011, 1 st Edition, Jaypee Brothers
Medical Publisher ,New Delhi ,Pg No-43
2. Jacob Annamma, “A Text Book Of Midwifery And Gynecological Nursing”, 3 rd
Edition , 2012, Jaypee Brothers Medical Publishers, New Delhi ,Pg No-315