In a client admitted for premature rupture of membranes at 37 weeks, which prescription should be questioned?

In a client admitted for premature rupture of membranes at 37 weeks, which prescription should be questioned?

• A. Monitor fetal heart rate continuously
• B. Monitor maternal vital signs frequently
• C. Perform a vaginal examination every shift
• D. Administer antibiotics per protocol

Answer: (C)

The main concept is infection prevention after the membranes have ruptured. Once the protective barrier is gone, the risk of ascending infection increases, so invasive procedures that can introduce bacteria should be minimized and performed only when clearly needed and with sterile technique. Performing a vaginal examination every shift should be questioned because repeated vaginal exams after rupture of membranes raise the risk of infection and can further compromise the sterile environment. Exams are only indicated if there is a specific need to assess labor progression or fetal status, and should always use sterile technique if they are performed. The other prescriptions fit with standard PROM management: continuous fetal heart rate monitoring helps detect distress, frequent maternal vital sign checks aid in early signs of infection, and administering antibiotics per protocol helps prevent maternal and neonatal infection.

The main concept is infection prevention after the membranes have ruptured. Once the protective barrier is gone, the risk of ascending infection increases, so invasive procedures that can introduce bacteria should be minimized and performed only when clearly needed and with sterile technique.

Performing a vaginal examination every shift should be questioned because repeated vaginal exams after rupture of membranes raise the risk of infection and can further compromise the sterile environment. Exams are only indicated if there is a specific need to assess labor progression or fetal status, and should always use sterile technique if they are performed.

The other prescriptions fit with standard PROM management: continuous fetal heart rate monitoring helps detect distress, frequent maternal vital sign checks aid in early signs of infection, and administering antibiotics per protocol helps prevent maternal and neonatal infection.