Discharge And Home Healthcare Guidelines

HOME CARE IF UNDELIVERED. If the patient is discharged undelivered, emphasize that follow-up appointments are important for timely diagnosis of progressive preeclampsia. Educate the patient on the importance of the left lateral position for bedrest. Tell the patient to notify the physician immediately for any of the following symptoms: headache; visual disturbance; right upper quadrant pain; change in level of consciousness or "feeling funny"; decreased urine output; increase in edema, especially facial; or any decrease in fetal movement. Tell the patient to weigh herself daily and notify the physician of a sudden weight gain. Be sure the patient understands the seriousness of the disorder and the potential complications to her and her infant.

HOME CARE IF DELIVERED. If the patient is discharged delivered, she needs to receive similar teaching because preeclampsia does not resolve immediately after delivery.

Premature rupture of membranes (PROM) refers to the spontaneous rupturing of the amniotic membranes ("bag of water") before the onset of true labor. While it can occur at any gestational age, PROM ususally refers to rupture of the membranes (ROM) that occurs after 37 weeks' gestation. Preterm premature rupture of membranes (PPROM) occurs between the end of the 20th week and the end of the 36th week. PPROM occurs in 33% of all preterm births and is a major contributor to perinatal morbidity and mortality owing to the lung immaturity and respiratory distress. PROM can result in two major complications. First, if the presenting part is ballotable when PROM occurs, there is risk of a prolapsed umbilical cord. Second, the mother and fetus can develop an infection. The amniotic sac serves as a barrier to prevent bacteria from entering the uterus from the vagina; once the sac is broken, bacteria can move freely upward and cause infection in the mother and the fetus. Furthermore, if the labor must be augmented because of PROM, and the cervix is not ripe, the patient is at a higher risk for a cesarean delivery.

Although the specific cause of PROM is unknown, there are many predisposing factors. An incompetent cervix leads to PROM in the second trimester. Infections such as cervicitis and amnionitis—and also placenta previa, abruptio placentae, and a history of induced abortions— may be involved with PROM. In addition, any condition that places undue stress on the uterus, such as multiple gestation, polyhydramnios, or trauma, can contribute to PROM. Fetal factors involved are genetic abnormalities and fetal malpresentation. A defect in the membrane itself is also a suspected cause.

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