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Did my water break? Tests used to tell if you have ruptured membranes.

Posted Dec 19 2009 5:24pm
Sometimes, medicine and nursing is not an exact science.

Many times, we have women come in to evaluate if their membranes are ruptured. There are several observations/tests used to determine if the membranes are possibly ruptured.

Test #1 – visual inspection of the labia: if things are saturated, you can pretty much guarantee that it’s ruptured membranes.

Test #2 – nitrazine paper: this tells the pH of the fluid. Acidic fluid doesn’t change the color of the yellow test paper. Alkaline fluids change the paper to a blue color. The darker the shade of blue, the more alkaline the fluid is. Several things can cause the nitrazine to test positive (change color): amniotic fluid, semen, vaginal mucous and secretions (vaginal fluids can have a very high pH), feces, and blood. So, you can see it’s not an exact test.

Test #3 – speculum exam: this is where we visualize the cervix and look for “pooling” of fluid from the cervix. This is usually a good indicator that it’s amniotic fluid. The provider will usually have the woman cough to help express any fluid from the uterus into the vagina.

Test #4 – looking at a specimen of the fluid on a slide under the microscope. This is where we look for a pattern called “ferning”. When amniotic fluid is placed on a slide and allowed to air dry, it will take on a distinctive ferning pattern under the microscope. However, amniotic fluid doesn’t fern before 20ish weeks, which makes this test difficult to use for diagnosis.

Test #5 – injection of indigo carmine into the uterus via an amnioscentesis. Indigo carmine is a bright blue dye. When it’s injected into the uterus via an amnio, we watch for fluid leakage out of the vagina. If the woman leaks blue fluid, then it’s positive. This is a very definitive test, but also very invasive and has some risks associated with it.

Test #6 – ultrasound: the provider looks for pockets of fluid around the baby. If the fluid pockets and measurements are adequate, then either there was a lot of fluid (polyhydramnios) in the first place, or the membranes haven’t leaked a significant enough to affect the level of fluid left around the baby. Sometimes, a high leak that seals itself will show normal fluid levels on an ultrasound.

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