Tests for Premature Rupture of Membranes

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.

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.

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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

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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

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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.

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