What is the primary reason why the fetal heart rate is checked following rupture of the bag of waters?

If you suspect that your water has broken and there is fluid leaking from the vagina, your health care provider will need to confirm that the membranes have actually ruptured.

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Nitrazine Test
Other Tests

Your health care provider will examine you and observe the fluid coming from the vagina. They will then order tests to help confirm PROM or PPROM. Tests for PROM involve analyzing vaginal secretions to determine if amniotic fluid is present. Since the fluids might be contaminated with blood or other secretions, these tests look for substances or certain characteristics that are normally only found in amniotic fluid. Your health care provider will collect some fluid from the vagina using a medical tool called a speculum in order to do most of these tests. They will insert the speculum into the vagina and gently spread apart the vaginal walls. This allows them to examine the inside of the vagina and to collect fluid directly from the vagina.

pH Test

This test involves testing the pH of a sample of vaginal fluid. Normal vaginal pH is between 4.5 and 6.0. Amniotic fluid has a higher pH of 7.1 to 7.3. Therefore, if the membranes have ruptured, the pH of the sample of vaginal fluid will be higher than normal.

Nitrazine Test

This test involves putting a drop of fluid obtained from the vagina onto paper strips containing Nitrazine dye. The strips change color depending on the pH of the fluid. The strips will turn blue if the pH is greater than 6.0. A blue strip means it’s more likely the membranes have ruptured.

This test, however, can produce false positives. If blood gets in the sample or if there is an infection present, the pH of the vaginal fluid may be higher than normal. Semen also has a higher pH, so recent vaginal intercourse can produce a false reading.

Ferning

If your water is broken, the fluid mixed together with estrogen will create a “fern-like” pattern under a microscope due to salt crystallization. A few drops of fluid will be placed on a microscope slide and observed under a microscope.

Other Tests

Other tests for diagnosing PROM include:

Dye test: Injecting dye into the amniotic sac through the abdomen. If the membranes have ruptured, the colored fluid will be found in the vagina within 30 minutes.
Tests that measure the levels of chemicals known to exist in the amniotic fluid but not in vaginal fluid. These include prolactin, alpha-fetoprotein, glucose, and diamine oxidase. High levels of these substances mean that the membranes have broken.
Newer noninvasive tests such as the AmniSure ROM test from QIAGEN Sciences. This test does not require a speculum examination. It works by detecting the placental alpha microglobulin-1 biomarker in the amniotic fluid.

Once PROM is confirmed, additional tests to assess the following will likely be performed to assess the following:

the presence of infection by testing the amniotic fluid
the degree of fetal lung development, to determine if the baby’s lungs are mature enough to operate outside the womb
the status and health of the fetus, including listening to the baby’s heart rate

If you are at term (more than 37 weeks pregnant), you may go into labor naturally or your health care provider may induce labor to help reduce the risk of infection.

If your health care provider decides to delay delivery, they should continue to monitor you and your baby to make sure that this decision remains the best course of action. If the baby’s heart rate drops, immediate delivery is essential.

If the pregnancy is 34 weeks or more, usually artificial starting (induction) of labor
If the pregnancy is less than 34 weeks, usually rest, close monitoring usually in the hospital, antibiotics, and sometimes corticosteroids
If the pregnancy is less than 32 weeks, usually magnesium sulfate to prevent bleeding in the brain and problems with development of the newborn's brain

Doctors must balance the risk of infection in the uterus and in the fetus when delivery is delayed against the problems that may occur when a newborn is premature. Generally, a doctor or certified nurse midwife does the following:

If the fetus is in severe distress or the uterus is infected, labor is usually induced and the baby is delivered regardless of the length of the pregnancy.

If the pregnancy is less than 34 weeks, labor is delayed. The woman is advised to rest and to limit her activities as much as possible. She may be hospitalized so that she can be monitored closely. Her blood pressure, temperature, and pulse rate are usually recorded at least 3 times daily. An increase in temperature or pulse rate may be an early sign of infection. If an infection develops, labor is promptly induced and the baby is delivered.

Antibiotics are begun when rupture has been confirmed. Usually, antibiotics (such as erythromycin, ampicillin, and amoxicillin) are given intravenously, then by mouth for several days. Antibiotics delay the start of labor by treating infections that can trigger labor, and they reduce the risk of infection in the newborn.

If the membranes rupture between the 24th and 34th week of pregnancy, corticosteroids are given to help the fetus’s lungs mature.

Doctors may also give women corticosteroids if the membranes rupture

Between 34 and 37 weeks of pregnancy if women are at risk of preterm delivery and have not been given any corticosteroids earlier in the pregnancy
Starting at 23 weeks of pregnancy if women are at risk of preterm delivery within 7 days

If the pregnancy is less than 32 weeks, women may be given magnesium sulfate intravenously. This drug appears to substantially reduce the risk of bleeding in the newborn's brain and the resulting problems with development of the newborn's brain, such as cerebral palsy.

9. Thefetal heart rateis checked following rupture of the bag of waters in order to:A. Check if the fetus is suffering from head compressionB. Determine if cord compression followed the ruptureC. Determine if there is uteroplacental insufficiencyD. Check if fetal presenting part has adequately descended following the ruptureAfter the rupture of the bag of waters, the cord may also go with the water because of the pressure ofthe rupture and flow. If the cord goes out of the cervical opening, before the head is delivered (cephalicpresentation), the head can compress on the cord causing fetal distress. Fetal distress can be detected

through the fetal heart tone. Thus, it is essential do check the FHB right after rupture of bag to ensurethat the cord is not being compressed by the fetal head.10. Upon assessment, the nurse got the following findings: 2 perineal pads highly saturated withbloodwithin 2 hourspostpartum, PR= 80 bpm, fundus soft and boundaries not well defineD. The appropriatenursing diagnosis is:

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11. The following are signs and symptoms of fetal distress EXCEPT:

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12. If the labor period lasts only for 3 hours, the nurse should suspect that the following conditions mayoccur:1.Laceration of cervix2.Laceration of perineum3.Cranial hematoma in the fetus4.Fetal anoxia

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