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

Specialties Ob/Gyn

Published

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?

Sounds like the nurse was wrong and wasn't going to admit it.

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! :)

I may be wrong here, but....

In the third trimester with ROM, the baby's head or buttocks may act as a plug over the cervix. This is why some women may have a gush while lying down and them have no fluid while standing.

This is really interesting.

The theory of the head plugging it makes sense to me. The first gush was when I was lying down taking a nap. After that, the biggest amounts were when I would move suddenly to a different position. The gush that soaked the maxi pad, a couple hours after it started, was when I was sitting in a chair and suddenly moved to sit differently. Later, once contractions started, I would have a little leak with a contraction.

I did notice that afterwards, when she moved, it felt different than before. I don't think I was imagining it. Is it possible to feel a difference like that?

Well, luckily it worked out ok. It was a little scary when I started running a fever, though - I think that is when they started to worry that I was right about my water breaking. Once I started running a fever, my midwife started me on pitocin, but that was Thursday morning and my water broke around Tuesday noon (says me). I wonder if they would have been quicker to start augmenting with pitocin if they had realized my water really had broken in the first place. Or, maybe it's best that my labor got a chance to start on its own, especially since I was VBAC. Oh well, I'm just Monday morning quarterbacking. :chuckle

And thanks for all the congratulations, and for the information. :)

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

Yea I know about denial: My water broke w/my son when I was only 33 weeks.

Hope this all helped you, Tuppence.

Yes, it has, it is very interesting.

Here's the thing that's amazing to me: A lot of women don't seem to understand/know that there are TWO HOLES (well, three actually)....and that they have absolutely nothing to do with each others eliminatory functions. e.g. that Urine and Foley catheters relate to the urethra...NOT the lady parts.

I can't tell you how many times I've been asked, "How is the baby going to come out if you put that thing [foley catheter] in there WITH the baby??"

I've even heard that urine comes from the privy parts or orifice.

Honestly, there are MANY women who are ignorant of their own anatomy.

Specializes in Emergency & Trauma/Adult ICU.
I may be wrong here, but....

In the third trimester with ROM, the baby's head or buttocks may act as a plug over the cervix. This is why some women may have a gush while lying down and them have no fluid while standing.

Thanks, Dawngloves :)

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

You are absolutely correct in your observation, Dawngloves. That is why we have moms lay down and let fluid "pool" before doing SSE to diagnose ferning. It removes the presenting part off the certix just a bit and allows the fluid to exit more readily.

If the fluid is obvious, we do a nitrazine swipe ( because we are not allowed to do the actual speculum exam here) either of the peri area or the pad the woman brought in....That has to be done before any exam as the nitrazine is protein sensitive...As for that which is not so obvious, we also set up for a fern and use the technique and positioning described by Smiling Blue eyes...

I have a question about ROM. we have certain clinic that sends in people{frequently 35 weekers} with positive nitrazene /positive ferning in the office. We start pit on them,and we see no fluid at all, no leaking on the chux ,nitrozene neg,and we are not supposed to do ferning{only physicians can}Generally after several hours of this the physician will come in and break a second bag. Has anyone else had a lot of incidences of this "second bag syndrome" as we call it.This "syndrome" only seems to happen with one specific physician,and we were just wondering if anyone else has ever heard of this.

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

No, its not a second bag you are noticing, but it sure seems that way! Let me try to explain:

What you see is probable "telescoping" of the remainder of the bag. Clear as mud? Ok, Picture a water balloon, a long one. You can twist it and make two, three or more separate "bubbles" right? And each "bubble" can break yet the others remain largely intact until you change the shape of the balloon or untwist it a bit.

Well, the amnion is much the same. A "forebag" can break, or a "high leak" can occur, and as the baby moves or descends, another piece of the bag push out beside or before the presenting part, thus giving the "feel" of a "second bag". It's all ONE bag, but it's very, very tough, stretchy and able to leak, let remain largely intact until labor advances and it "breaks again". Hope this helps you.

+ Add a Comment