Nursing care for congenital uterine anomalies woman with preterm premature rupture of membrane included Chorioamnionitis which receiving Caesarean section: A Case study

Abstract

Introduction: Congenital uterine anomalies are classified as high-risk conditions in pregnancy, which increase the risk of preterm pregnancy and fetal growth restriction. Preterm premature rupture of membrane, especially in those with a pregnancy of < 37 weeks, is a complex condition and serious problem that can probably result in chorioamnionitis and sepsis into the uterine cavity. Therefore, the aim of the treatment is to extend gestational age by providing supportive treatment to keep maintaining a healthy pregnancy to ensure fetal maturation. However, chorioamnionitis can negatively affect the pregnancy and preterm labor. A doctor may consider termination of the pregnancy by caesarean section in order to reduce complications in the mother and the fetus.

Methods:  A case study of a pregnant woman with a congenital uterine anomaly with preterm premature rupture of membrane in conjunction with chorioamnionitis who underwent Caesarean section and was admitted to Saraburi Hospital. Data were collected through interviews, observations, and medical records. Then, data were analyzed using nursing process which included nursing diagnoses, nursing implementation, and evaluation.

Results: The results revealed the pregnant woman had a congenital uterine anomaly (Bicornuate type).   While the fetus was continuously growing, the mother suffered from preterm premature rupture of membrane and chorioamnionitis, leading to the termination of pregnancy or preterm labor.  The problems after post caesarean section included postpartum hemorrhage, infection in the uterine cavity, surgical pain, urinary tract infection and anxiety on child's condition. After receiving effective treatment and nursing care, the mother became healthier. She was hospitalized for 14 days and later allowed to go home. Meanwhile, the infant was taken off the ventilator since it could breathe and breastfeed on its own. The infant was hospitalized for 20 days before permitted to go home.

Conclusions: To provide nursing care for pregnant women with congenital uterine anomalies with preterm premature rupture of membrane in conjunction with chorioamnionitis who undergo Caesarean section, nurses play an important role in finding problems and risks at the antenatal phase, the attending phase, the labor phase, and the postpartum phase. Nurses must have knowledge and skills of using instruments and refined technology to assess maternal and fetal health status which could predict risks, and help to plan treatment quickly, timely, and effectively. Mothers and babies would be safe and the family would have confidence in the nursing care process leading to the sustainable development of nursing care.