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寶媽胎膜早破應該如何處理呢？具體有哪些護理措施？

出處：網(wǎng)絡收集 日期：2024-06-29 09:55:56 編輯：秩名

胎膜早破的處理

胎膜早破會引起一些常見并發(fā)癥，比如早產(chǎn)、感染及臍帶脫垂，危害甚大，醫(yī)生一旦確診為胎膜早破，就會通過一系列措施，預防并發(fā)癥的發(fā)生，并保證孕婦及胎兒的安全。那么胎膜早破的處理是怎樣的，我們來看看。
 
一般破膜后常于24小時內(nèi)臨產(chǎn)，不論孕齡大小，均不宜阻止產(chǎn)程進展，因此醫(yī)生會通過如下手段來處理胎膜早破的征兆，防止惡化。
 
1、先露高浮的孕婦，破膜后應臥床休息，抬高床腳，使頭低臀高，以防臍帶脫垂，尤其是臀位和雙胎產(chǎn)婦。
 
2、保持外陰清潔，破膜超過12小時者，應給予抗生素以預防感染。
 
3、孕齡36周，超過24小時未臨產(chǎn)者，胎膜、胎盤感染或圍產(chǎn)兒病率及死亡率均相應增加，為減少感染機會，防止母兒并發(fā)癥，應積極引產(chǎn)。若36周，未臨產(chǎn)，胎兒未成熟，而孕婦要求保胎者，可在積極監(jiān)護和預防感染的前提下，絕對臥床休息，給予宮縮抑制劑，繼續(xù)妊娠，爭取得到促胎肺成熟和促宮頸成熟的時機，有利于圍產(chǎn)兒的預后。如出現(xiàn)羊膜炎的體征（母、胎心率加速，胎心可達160bpm，子宮壓痛、有宮縮、羊水臭、陰道有膿性分泌物排出，白細胞計數(shù)可達15×10/L以上，C反應蛋白2mg/dl）應立即引產(chǎn)，必要時剖宮產(chǎn)。對胎位不正、頭盆不稱、骨盆狹窄以及其他產(chǎn)科并發(fā)癥者，醫(yī)生會根據(jù)情況作相應處理。
 
足月前胎膜早破可根據(jù)情況行期待治療或終止妊娠。足月胎膜早破根據(jù)情況選擇終止妊娠的方法，引產(chǎn)或剖宮產(chǎn)。不論何種情況破膜超過12h要預防性應用抗生素。
 

胎膜早破的癥狀

胎膜早破有一定的癥狀，孕媽提前了解胎膜早破的癥狀，在早期如發(fā)現(xiàn)有類似癥狀，應及早就醫(yī)檢查。下面我們就來看看胎膜早破的癥狀有哪些。
 
1、胎膜早破的癥狀
 
胎膜早破的癥狀主要是看有或沒有各種原因突然陰道排液，排液的量可多可少。胎膜早破的陰道排液通常為持續(xù)性，持續(xù)時間不等，開始量多然后逐漸減少，少數(shù)為間歇性排液。陰道排液通常與孕婦體位變動、活動與否有關，孕媽們?nèi)绻谠衅趧×疫\動后發(fā)送突然排液，就要考慮胎膜早破的可能。
 
2、胎膜早破的體征
 
孕婦仰臥位可能見到陰道口有液體流出，也可能無任何液體流出；如無液體流出，肛查時上托陰道后穹隆上推胎頭按壓宮底或孕婦變動體位可有液體由陰道口流出，這些輔助操作后可能仍不見液體流出。所流出的液體通常稀薄，可能混有胎糞或胎脂。急癥住院的孕婦可能帶內(nèi)衣衛(wèi)生巾或衛(wèi)生紙來醫(yī)院，醫(yī)生也會對這些進行仔細檢查。
 

胎膜早破的原因

胎膜早破可導致早產(chǎn)率升高，圍生兒病死率增加，宮內(nèi)感染率及產(chǎn)褥感染率均升高，一旦發(fā)生胎膜早破，是個危險的現(xiàn)象。那么胎膜早破的原因是什么呢？我們一起來看一下。
 
1、胎膜發(fā)育不良
 
原因很多除胎膜本身因素外，孕早期孕婦維生素C缺乏、銅缺乏和孕婦吸煙等因素與胎膜發(fā)育不良有關。
 
2、感染
 
胎膜早破導致宮腔感染，是傳統(tǒng)的胎膜早破和感染的因果關系，近些年已經(jīng)普遍認識到感染和胎膜早破互為因果關系，而且感染是胎膜早破的最重要原因。
 
3、子宮頸功能不全
 
在非妊娠的狀態(tài)下，子宮頸內(nèi)口可以無阻力地擴大到8.0號即可以診斷子宮頸功能不全子宮頸功能不全主要表現(xiàn)在內(nèi)口松弛和峽部缺欠。
 
4、宮腔內(nèi)壓力異常
 
宮腔內(nèi)壓力不均常見于頭盆不稱和胎位異常；宮腔內(nèi)壓力過大常見于雙胎妊娠，羊水過多，劇烈咳嗽和排便困難等。
 
5、創(chuàng)傷和機械性刺激
 
主要分為醫(yī)源性和非醫(yī)源性兩類。非醫(yī)源性常見的為妊娠晚期的性交活動；醫(yī)源性的包括多次羊膜腔穿刺，多次陰道檢查和剝膜引產(chǎn)等。
 

胎膜早破的危害

胎膜早破是指妊娠中晚期或臨產(chǎn)前胎膜破裂，羊水自陰道突然流出，在孕產(chǎn)婦中，胎膜早破的發(fā)生率約2.7-17%，是一種妊娠晚期嚴重并發(fā)癥，對母嬰生命威脅極大，因此決不能掉以輕心。
 
對母體來說，胎膜早破最嚴重的后果在于感染，表現(xiàn)為發(fā)熱，白細胞升高，子宮壓痛，胎心加速及羊水有臭味等，致病菌來自陰道或外陰部位，常伴菌血癥現(xiàn)象。
 
對未成熟的胎兒來說，胎膜早破最大的威脅在于早產(chǎn)。對成熟的胎兒來說，胎膜早破的威脅在于引起羊水過少而導致胎兒宮內(nèi)窘迫，且在出生后易發(fā)生敗血癥、肺炎和呼吸窘迫綜合征，因此，圍產(chǎn)兒的病死率明顯增加。
 
另外，胎膜早破還是難產(chǎn)的信號，這是由于有難產(chǎn)因素如頭盆不稱，胎頭高浮等易發(fā)生胎膜早破;而胎膜早破由于羊水量減少，感染及胎兒宮內(nèi)窘迫又使得難產(chǎn)率及剖宮產(chǎn)率增加，由此可見，胎膜早破與難產(chǎn)互為因果。
 
胎膜早破的危害極大，如果準媽媽們發(fā)現(xiàn)胎膜早破的征兆，一定要及時就醫(yī)，采取措施。
 

胎膜早破怎樣護理

胎膜早破可導致早產(chǎn)率升高，圍生兒病死率增加，宮內(nèi)感染率及產(chǎn)褥感染率均升高，一旦發(fā)生胎膜早破，是個危險的現(xiàn)象。如果確診為胎膜早破，更需要通過多方面護理，來保證寶寶能安全來到世上。那么胎膜早破的護理措施有幾個要點，我們一起來看一下。
 
1、減輕焦慮、配合治療
 
向孕婦及家屬說明目前的情況，以及醫(yī)護人員采取處理措施的目的意義，指導配合治療與監(jiān)護，協(xié)助孕婦做好各種生活護理，減輕焦慮。
 
2、防止臍帶脫垂促進圍生兒健康
 
胎膜已破臍帶隨羊水從胎先露部與骨盆入口的空隙處脫出于子宮頸外口，降至陰道甚至外陰者，稱臍帶脫垂。
 
（1）破膜后立即肛查或陰道檢查，了解先露高低，宮口情況，及有無臍帶脫垂。
 
（2）宮口未開全，先露未入盆，應立即臥床并抬高臀部側(cè)臥位，禁灌腸。
 
（3）及時聽取胎心音，并進行嚴密監(jiān)護。
 
（4）一旦發(fā)現(xiàn)臍帶脫垂者，宮口未開全應立即氧氣吸入，在胸膝臥位下帶無菌手套將臍帶送回宮腔，做好即行剖宮產(chǎn)準備，宮口開全，應協(xié)助立即助產(chǎn)。
 
3、防感染
 
（1）保持外陰清潔，每日2次外陰擦洗，并勤換消毒衛(wèi)生墊。
 
（2）觀察羊水量、性質(zhì)、顏色、氣味，注意是否混有胎糞，尤其是頭先露者。
 
（3）觀察體溫變化，每日測體溫4次，若體溫上升，白細胞計數(shù)升高，血清C-反應蛋白升高，均提示宮內(nèi)感染，應及早處理。
 
（4）絕對臥床休息，盡量少做肛查或陰道檢查，必要時必須在無菌下進行。
 
（5）破膜超過12小時，可考慮應用抗生素預防感染，超過24小時尚未臨產(chǎn)，應按醫(yī)囑給予引產(chǎn)。
 
4、防早產(chǎn)
 
（1）若破膜發(fā)生于妊娠37周以前，在預防感染和預防臍帶脫垂的護理下，保守治療。
 
（2）在保守治療中盡量避免干擾，少作肛查和陰道檢查。
 
（3）定期監(jiān)測胎兒，以了解胎兒在宮內(nèi)的情況，一旦發(fā)生異?，F(xiàn)象，應及時報告醫(yī)生終止妊娠。

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