Nitrazine vs. Amnisure

**LibraSunCNM, BSN, MSN, CNM** · Oct 31, 2018

What is your rule of thumb for determining true ROM?
Hypothetical situation: Patient comes in at 38weeks c/o possible rupture 8 hours earlier with no other discharge. Nitrizine positive/questionable. Amnisure negative. No contractions. 1/50/-2. No pooling of fluid in lady parts or smell of amniotic fluid. Any evidence backed articles would be appreciated or what policies you have regarding this.

Well, in the scenario described above, I would consider the patient to have intact membranes, although I also always, always do a fern test and full wet mount. I've used Amnisure at previous jobs but currently don't have access to it, we determine SROM with ferning, pooling, and nitrazine. If it's equivocal, we have the patient put on a pad, walk around for a couple hours, and reassess the whole thing. What issues are you specifically running into?

brynnelizabeth · Oct 31, 2018

I felt as if the amnisure is being considered the final say and golden standard. We don't do the fern test and I'd be interested to learn more about it. I'll start some research and see if we can't make some sort of procedure. I am just someone that wants a final iron clad answer/way to truly determine ROM. I do like the idea of the wearing the pad and just sitting on her for obs to make sure.

**LibraSunCNM, BSN, MSN, CNM** · Oct 31, 2018

I felt as if the amnisure is being considered the final say and golden standard. We don't do the fern test and I'd be interested to learn more about it. I'll start some research and see if we can't make some sort of procedure. I am just someone that wants a final iron clad answer/way to truly determine ROM. I do like the idea of the wearing the pad and just sitting on her for obs to make sure.

Well, to my understanding Amnisure is incredibly accurate, although I did hear of a recent study claiming that it is actually not---possibly because of "micro" leaks in amniotic fluid that cause the test to be positive but essentially the membranes are still intact. In my experience in OB, the standard trifecta for determining ROM is ferning, pooling, nitrazine, and that's what I rely on. Ferning is easy as long as you have a microscope.

klone, MSN, RN · Nov 1, 2018

Nitrizine alone should never determine presence or absence of ROM. If it's positive, but there's no ferning or pooling, and Amnisure is negative, the patient should be considered intact. If nitrazine and ferning were positive, but Amnisure is negative, we would consider the patient positive for ROM.

Amnisure's literature states that after 24 hours of ROM, there is a greater risk of false negative. So our providers are leery of relying on Amnisure alone to rule out rupture (they will rely on it alone to diagnose it, however).

We have one provider who calls it "Amnimaybe"

klone, MSN, RN · Nov 1, 2018

I felt as if the amnisure is being considered the final say and golden standard. We don't do the fern test and I'd be interested to learn more about it. I'll start some research and see if we can't make some sort of procedure. I am just someone that wants a final iron clad answer/way to truly determine ROM. I do like the idea of the wearing the pad and just sitting on her for obs to make sure.

The only "gold standard" iron-clad definitive method of diagnosis is injecting indigo carmine (or whatever dye they're using nowadays) into the uterus and monitoring color of lady partsl discharge.