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?
where i work the DOCS do the fern and spec exam. Nurses can look for obvious fluid and do nitrazine but then the doc comes in a looks for ferning.
We do an NST when a mom comes in for SROM check. We assess her "Story"--basically what she felt, how much came out, wcolor, 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.
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
Did they put you on antibiotics at any point in your labor? From my point of view (I do babies, not mommies) you had prolonged rupture of membranes, and were febrile. What was your GBS status?
where i work the DOCS do the fern and spec exam. Nurses can look for obvious fluid and do nitrazine but then the doc comes in a looks for ferning.
We don't do a spec exam but we do allow pooling and the nurses check with nitrazine paper or check ferning. I take the slide down to lab - check it out myself and call the doc.
We do a sterile nitrazine test...if positive, we call her ruptured. (Providing she has the symptoms of SROM, of course) If neg, the doc will come in and do a sterile spec exam and ferning test if necessary.
I ALWAYS believe a woman if she said she felt something gush. Esp. if they said they were soaking a pad and I actually saw the fluid. I can't believe that any doc or midwife would send someone home with obvious "discharge" that copious. And to the credit of pregnant women, sometimes you just can't tell if its urine or fluid. With my daughter, I "wet" myself, and I didn't know if it was urine or fluid. Having been young, never experienced a pregnancy or urinary incontinence before, I just wasn't sure. Turns out it was just urine, but hey, better safe than sorry! I always tell women if they think they might be leaking fluid to come in.
I have also had the experience of a "second bag". Just recently, we had done AROM on this gal...a few hours later I checked her and felt a bulging bag. I had to have another nurse come in and check after me just to make sure I was feeling the right thing!
Anyway, congrats on your baby, and I hope our posts have helped!
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.
Why on earth is this doc pitting 35 weekers with questionable ruptured membranes? Does s/he own stock in the local NICU?
Why on earth is this doc pitting 35 weekers with questionable ruptured membranes? Does s/he own stock in the local NICU?
Wish I knew. Most of us hate taking those pt.s cause we just feel we are not doing what is in their best interest. We have tried to dicuss it with administration ,but get little or no support.
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.
We also are experiencing a lot of this syndrome lately! LOL Particularly with PIA patients and no other good reason to induce!
Did they put you on antibiotics at any point in your labor? From my point of view (I do babies, not mommies) you had prolonged rupture of membranes, and were febrile. What was your GBS status?
Glad all went well and you got to VBAC.
I had forgotten about this old thread until I started getting e-mail alerts of replies!
The baby in question is a healthy, beautiful 9-month-old now. :)
They may have given me antibiotics towards the end, although I don't remember anyone saying they were. I haven't looked at the records. But, I didn't have an I.V. until we decided on the epidural and pit, so if I did get any antibiotics it wouldn't have been until then, over 40 hours after my water broke.
Anyway, congrats on your baby, and I hope our posts have helped!
Thanks. :) All of this is really interesting to me. I just registered today for my first semester of nursing classes, for this fall. I find labor and delivery, women's health, etc., especially interesting, and can't wait to learn more.
Or hospital will induce anything >34 with ROM. 34-35 weeks will get beta.
The risk of infection is much greater than the risk of prematurity at this point.
Dawn,
I understand that, if it is clear that membranes are ruptured. But it was my understanding that these patients are not clearly ruptured. Just seems like a very short-sighted approach taken for convenience, rather than sound medical reasons. Not that that should surprise me!
lauriesalRNC
34 Posts
where i work the DOCS do the fern and spec exam. Nurses can look for obvious fluid and do nitrazine but then the doc comes in a looks for ferning.