Question about checking for rupture of membranes (and LONG, about my birth, sorry)

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What exactly do you do when a woman comes in with possible rupture of membranes? I assume you leave them to let any amniotic fluid pool for a while, then check with a speculum and then do either a ferning or nitrazine test, right? But, what position do you leave the patient to let the amniotic fluid pool? Lying down, or sort of sitting up, or what?

I hope I didn't get any terminology wrong. :)

I'm a pre-nursing student, and I'm really interested in L&D, plus I had my second baby last month. So that makes me curious to learn about things surrounding my birth. First let me say that my baby and I are fine, no big complications, and I was able to have the VBAC I wanted, so overall, I'm happy about the outcome.

I'm kind of curious whether my experience was typical. I called my midwife to say I was having some fluid leaking, and she had me go in to the hospital that evening. I had experienced several small gushes of fluid, the largest one being enough to soak a maxi pad all at once. I relayed this information to my nurse. She put me in a sort of half-sitting position with my knees up, and said it was a "pooling position" (??) well, as I waited, I could feel fluid coming out and going onto the pad underneath me.

She ended up doing a slide and looking for ferning, and came back and said it wasn't amniotic fluid, just cervical mucus. I questioned her about the amount, and about the fluid on the pad on the bed, but she stated that you can get a lot of cervical mucus at the end of pregnancy, but that I would know when my water had broken because it would be watery like urine. I stated that the fluid I had observed *was* watery like urine, and she told me that as mucus leaves the body, my body heat warms it up so that it *seems* watery, but in fact it is *not* watery. OK, I use FAM, so I'm pretty familiar with my mucus, LOL, but whatever. I was sent home.

Long story short, I continued to leak watery fluid in small intermittent gushes, I started having contractions that night, and about 48 hours after I believed my water broke, my daughter was born. Meanwhile, my nurses kept asking me if I had had a BIG gush of fluid, because they were wondering if my water had broken yet. Eventually it became apparent that my water had broken at some point. There never was a BIG gush, even when it was time to put on the internal monitor, or later when the baby was born.

Oh well. But I wonder if the reason the ferning test was wrong was because the amniotic fluid leaked out onto the pad and so all she got on the slide was mucus. Is that the usual position to put a patient in? I guess I would have thought lying down would be the way to do it, but what do I know. :) Any other comments on the situation? I'm mostly looking to learn, and why not use my own birth experience to learn, right?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

The way we do it where I work:

We put the mother in the bed in a left or right lateral position (on her side) with the head of the bed relatively low. This allows for leaking fluid to "pool" in the lady partsl vault and cervical areas. Meantime, we place the monitors on to see how mother and baby are doing. I allow 20-30 minutes to pass before I collect a sample.

Once the time has passed, I get a lamp and set the woman up as if for a Pap Smear, e.g. breaking down the bed, putting up footrests and doing a sterile speculum exam of her cervix . I have the woman cough a few times (to push out any fluid pooling in her cervix and just above it). Usually, if membranes are ruptured, the water quickly pools on the lower blade of the speculum, leaving me little doubt as to the probable result. I then collect a sample from this fluid, or in the cervix itself, if it's pretty dry, using TWO slides ( in case I mess one up).

I then allow about 10 minutes or so for the slides to dry (and crystals to form, if there are any) and examine them under the microscope for ferning. Where I work, two RN's must examine and sign off on results of fern testing.

I can't speak for the exact method used where you are, but where I work, nothing less then a sterile speculum exam will do if there is any question about membrane status (gross rupture, where water is literally gushing all over, is not a case where spec exam is needed).

hope this helps!!!!! Welcome to the forums and congratulations on your new baby!!

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Thanks! That was really informative!

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We do an NST when a mom comes in for SROM check. We assess her "Story"--basically what she felt, how much came out, color, odor etc and other symptoms. She gets a SSE to look for pooling (have her cough a few times), nitrazine test and ferning test. If all are negative then we keep her for an hour or two left or right lateral then repeat all of the above tests.

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Specializes in private duty/home health, med/surg.

Hi Tuppence! Congratulations on the new baby and I'm happy that you had the VBAC you wanted!

I had a similar thing happen to me when I had my 2nd child. I knew my membranes had ruptured even though contractions hadn't started (happened with my 1st child too) so I called my CNM who told me to go to the hospital. Anyhow, the nitrazine was + but the darn fluid wouldn't fern. I'm pretty sure the nurses who had been in the room with me agreed it was amniotic fluid--they could see that I was soaking the chux--but the charge nurse wouldn't even come in the room to see me and she was saying to send me home. I was rather peeved & asked the nurse what did they think this fluid was that kept running out of my lady parts?

So the other nurses called my CNM, who told them to do the fern test again & give it more time to dry. They finally saw some ferning to show the charge nurse, & I was admitted.

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Sorry to highjack here Tuppence...

How many women come in thinking their water broke and it was actually urine? Really.

Also had bad expereinces with PROM and was constantly asked if I peed myself before anyone would check.Like rnmi2004 said, "What else would be gushing out of my lady parts???"

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Sorry to highjack here Tuppence...

How many women come in thinking their water broke and it was actually urine? Really.

QUOTE]

actually quite a few in my experience.

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I guess having expereinced one, but not the other, I can't fathom. :uhoh21:

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Specializes in Emergency & Trauma/Adult ICU.

Another student here ... just starting my L&D rotation ...

I have a question about Tuppence's experience: could it have been that the particular position & presentation of the baby prevented one large gush of fluid? We were just discussing this in class ... just trying to also learn from people's experiences. Thanks for your insight! :)

And Tuppence - congratulations! :)

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I've seen it too Dawngloves, more often than you'd think:) A lot of women can't tell if fluid is coming from the lady parts or the urethra.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Ok, all one need do is think of the female anatomy and the close proximity of the urethra to the lady parts (heck, I had to cath someone where her urethral meatus was IN the introitus). Think, then, how SWOLLEN things can get. And you can then see how sometimes they can't tell if it's pee or amniotic fluid coming out. I couldn't when my water broke w/my son. He kicked my bladder so I was half incontinent and losing control of my bladder all the time. Then when my membranes ruptured, slow leak, I thought it was a serious episode of incontinence. So you can see how this CAN and does happen all the time.

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Ok, all one need do is think of the female anatomy and the close proximity of the urethra to the lady parts (heck, I had to cath someone where her urethral meatus was IN the introitus). Think, then, how SWOLLEN things can get. And you can then see how sometimes they can't tell if it's pee or amniotic fluid coming out. I couldn't when my water broke w/my son. He kicked my bladder so I was half incontinent and losing control of my bladder all the time. Then when my membranes ruptured, slow leak, I thought it was a serious episode of incontinence. So you can see how this CAN and does happen all the time.

Yes, I had exactly the same experience...slow leak, which I, and my nurse that day, both attributed to a "serious episode of incontinence". Of course I was also in denial because I was only 32 weeks and really wanted to believe it was urine and not amniotic fluid. But I can see how this could cause confusion on a regular basis.

Shannon

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